reglab/housing_qa huggingface dataset:
IN Code § 27-8-28-7 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 28. Internal Grievance Procedures|27-8-28-7. "Grievance Procedure"

Sec. 7. As used in this chapter, "grievance procedure" means a written procedure established and maintained by an insurer for filing, investigating, and resolving grievances and appeals.As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.
IN Code § 27-8-28-8 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 28. Internal Grievance Procedures|27-8-28-8. "Insured"

Sec. 8. As used in this chapter, "insured" means:(1) an individual whose employment status or other status except family dependency is the basis for coverage under a group accident and sickness insurance policy; or(2) in the case of an individual accident and sickness insurance policy, the individual in whose name the policy is issued.As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.
IN Code § 27-8-28-9 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 28. Internal Grievance Procedures|27-8-28-9. "Insurer"

Sec. 9. As used in this chapter, "insurer" means any person who delivers or issues for delivery an accident and sickness insurance policy or certificate in Indiana.As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.
IN Code § 27-8-28-10 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 28. Internal Grievance Procedures|27-8-28-10. Grievance Procedure to Comply With Chapter Requirements

Sec. 10. An insurer shall establish and maintain a grievance procedure that complies with the requirements of this chapter for the resolution of grievances initiated by a covered individual.As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.
IN Code § 27-8-28-11 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 28. Internal Grievance Procedures|27-8-28-11. Commissioner May Examine Procedure

Sec. 11. The commissioner may examine the grievance procedure of any insurer.As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.
IN Code § 27-8-28-12 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 28. Internal Grievance Procedures|27-8-28-12. Grievance Records

Sec. 12. An insurer shall maintain all grievance records received by the insurer after the most recent examination of the insurer's grievance procedure by the commissioner.As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.
IN Code § 27-8-28-13 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 28. Internal Grievance Procedures|27-8-28-13. Notice of Grievance Related Information

Sec. 13. (a) An insurer shall provide, at the request of the insured, covered individual, or legal representative of the insured or covered individual, and upon policy issuance, at each policy renewal, and with any notice of denial of a claim, timely, adequate, and appropriate notice to each insured, covered individual, or legal representative, of:(1) the grievance procedure required under this chapter;(2) the external grievance procedure required under IC 27-8-29;(3) information on how to file:(A) a grievance under this chapter; and(B) a request for an external grievance review under IC 27-8-29;(4) a toll free telephone number through which a covered individual may contact the insurer at no cost to the covered individual to obtain information and to file grievances; and(5) the address for the Internet web site established by the department under IC 27-1-3-33.(b) An insurer shall prominently display on all notices to covered individuals the toll free telephone number and the address at which a grievance or request for external grievance review may be filed.As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13. Amended by P.L.18-2016, SEC.2.
IN Code § 27-8-28-14 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 28. Internal Grievance Procedures|27-8-28-14. Filing Grievance; Toll Free Number

Sec. 14. (a) A covered individual may file a grievance orally or in writing.(b) An insurer shall make available to covered individuals a toll free telephone number through which a grievance may be filed. The toll free telephone number must:(1) be staffed by a qualified representative of the insurer;(2) be available for at least forty (40) hours per week during normal business hours; and(3) accept grievances in the languages of the major population groups served by the insurer.(c) A grievance is considered to be filed on the first date it is received, either by telephone or in writing.As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.
IN Code § 27-8-28-15 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 28. Internal Grievance Procedures|27-8-28-15. Assistance in Filing Grievance; Designation of Representative

Sec. 15. (a) An insurer shall establish procedures to assist covered individuals in filing grievances.(b) A covered individual may designate a representative to file a grievance for the covered individual and to represent the covered individual in a grievance under this chapter.As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.
IN Code § 27-8-28-16 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 28. Internal Grievance Procedures|27-8-28-16. Policies and Procedures for Timely Resolution of Grievances

Sec. 16. (a) An insurer shall establish written policies and procedures for the timely resolution of grievances filed under this chapter. The policies and procedures must include the following:(1) An acknowledgment of the grievance, given orally or in writing, to the covered individual within five (5) business days after receipt of the grievance.(2) Documentation of the substance of the grievance and any actions taken.(3) An investigation of the substance of the grievance, including any aspects involving clinical care.(4) Notification to the covered individual of the disposition of the grievance and the right to appeal.(5) Standards for timeliness in:(A) responding to grievances; and(B) providing notice to covered individuals of:(i) the disposition of the grievance; and(ii) the right to appeal;that accommodate the clinical urgency of the situation.(b) An insurer shall appoint at least one (1) individual to resolve a grievance.(c) A grievance must be resolved as expeditiously as possible, but not more than twenty (20) business days after the insurer receives all information reasonably necessary to complete the review. If an insurer is unable to make a decision regarding the grievance within the twenty (20) day period due to circumstances beyond the insurer's control, the insurer shall:(1) before the twentieth business day, notify the covered individual in writing of the reason for the delay; and(2) issue a written decision regarding the grievance within an additional ten (10) business days.(d) An insurer shall notify a covered individual in writing of the resolution of a grievance within five (5) business days after completing an investigation. The grievance resolution notice must include the following:(1) A statement of the decision reached by the insurer.(2) A statement of the reasons, policies, and procedures that are the basis of the decision.(3) Notice of the covered individual's right to appeal the decision.(4) The department, address, and telephone number through which a covered individual may contact a qualified representative to obtain additional information about the decision or the right to appeal.As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13. Amended by P.L.1-2002, SEC.115.
IN Code § 27-8-28-18 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 28. Internal Grievance Procedures|27-8-28-18. Insurer Prohibited From Taking Action

Sec. 18. An insurer may not take action against a provider solely on the basis that the provider represents a covered individual in a grievance filed under this chapter.As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.
IN Code § 27-8-28-19 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 28. Internal Grievance Procedures|27-8-28-19. Grievance Procedure Filing; Complaint Analysis and Reporting

Sec. 19. (a) An insurer shall each year file with the commissioner a description of the grievance procedure of the insurer established under this chapter, including:(1) the total number of grievances handled through the procedure during the preceding calendar year;(2) a compilation of the causes underlying those grievances; and(3) a summary of the final disposition of those grievances.(b) The information required by subsection (a) must be filed with the commissioner on or before March 1 of each year. The commissioner shall:(1) make the information required to be filed under this section available to the public; and(2) prepare an annual compilation of the data required under subsection (a) that allows for comparative analysis.(c) The commissioner may require any additional reports as are necessary and appropriate for the commissioner to carry out the commissioner's duties under this article.(d) The commissioner shall do the following:(1) Compile and analyze complaints received by the department concerning a denial of coverage under an accident and sickness insurance policy for:(A) an investigational or experimental treatment; or(B) a treatment not considered to be medically necessary for a covered individual.(2) If the commissioner determines that a pattern of denials of coverage is evident through the analysis performed under subdivision (1), report the pattern to the legislative council in an electronic format under IC 5-14-6.(3) Remove from a report made under subdivision (2) any information that could be used to identify an individual.As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13. Amended by P.L.18-2016, SEC.3.
IN Code § 27-8-28-20 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 28. Internal Grievance Procedures|27-8-28-20. Adoption of Rules

Sec. 20. The department may adopt rules under IC 4-22-2 to implement this chapter.As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.
IN Code § 27-8-29-1 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 29. External Review of Grievances|27-8-29-1. "Accident and Sickness Insurance Policy" Defined

Sec. 1. As used in this chapter, "accident and sickness insurance policy" has the meaning set forth in IC 27-8-28-1.As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.
IN Code § 27-8-29-2 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 29. External Review of Grievances|27-8-29-2. "Appeal" Defined

Sec. 2. As used in this chapter, "appeal" means the procedure described in IC 27-8-28-17.As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.
IN Code § 27-8-29-3 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 29. External Review of Grievances|27-8-29-3. "Commissioner" Defined

Sec. 3. As used in this chapter, "commissioner" refers to the insurance commissioner appointed under IC 27-1-1-2.As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14. Amended by P.L.1-2002, SEC.117.
IN Code § 27-8-29-4 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 29. External Review of Grievances|27-8-29-4. "Covered Individual" Defined

Sec. 4. As used in this chapter, "covered individual" has the meaning set forth in IC 27-8-28-3.As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.
IN Code § 27-8-29-5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 29. External Review of Grievances|27-8-29-5. "Department" Defined

Sec. 5. As used in this chapter, "department" refers to the department of insurance.As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.
IN Code § 27-8-29-6 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 29. External Review of Grievances|27-8-29-6. "External Grievance" Defined

Sec. 6. As used in this chapter, "external grievance" means the independent review under this chapter of a:(1) grievance filed under IC 27-8-28; or(2) denial of coverage based on a waiver described in IC 27-8-5-2.5(e) (expired July 1, 2007, and removed) or IC 27-8-5-19.2 (expired July 1, 2007, and repealed).As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14. Amended by P.L.211-2003, SEC.6; P.L.3-2008, SEC.215.
IN Code § 27-8-29-7 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 29. External Review of Grievances|27-8-29-7. "Grievance" Defined

Sec. 7. As used in this chapter, "grievance" has the meaning set forth in IC 27-8-28-6.As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.
IN Code § 27-8-29-8 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 29. External Review of Grievances|27-8-29-8. "Grievance Procedure" Defined

Sec. 8. As used in this chapter, "grievance procedure" has the meaning set forth in IC 27-8-28-7.As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.
IN Code § 27-8-29-9 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 29. External Review of Grievances|27-8-29-9. "Health Care Provider" Defined

Sec. 9. As used in this chapter, "health care provider" means a person:(1) that provides physician services (as defined in IC 12-15-11-1(a)); or(2) who is licensed under IC 25-33.As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.
IN Code § 27-8-29-10 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 29. External Review of Grievances|27-8-29-10. "Insured" Defined

Sec. 10. As used in this chapter, "insured" has the meaning set forth in IC 27-8-28-8.As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.
IN Code § 27-8-29-11 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 29. External Review of Grievances|27-8-29-11. "Insurer" Defined

Sec. 11. As used in this chapter, "insurer" has the meaning set forth in IC 27-8-28-9.As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.
IN Code § 27-8-29-12 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 29. External Review of Grievances|27-8-29-12. Insurer to Establish External Grievance Procedures

Sec. 12. An insurer shall establish and maintain an external grievance procedure for the resolution of external grievances regarding the following:(1) The following determinations made by the insurer or an agent of the insurer regarding a service proposed by the treating health care provider:(A) An adverse determination of appropriateness.(B) An adverse determination of medical necessity.(C) A determination that a proposed service is experimental or investigational.(D) A denial of coverage based on a waiver described in IC 27-8-5-2.5(e) (expired July 1, 2007, and removed) or IC 27-8-5-19.2 (expired July 1, 2007, and repealed).(2) The insurer's decision to rescind an accident and sickness insurance policy.As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14. Amended by P.L.211-2003, SEC.7; P.L.3-2008, SEC.216; P.L.160-2011, SEC.23.
IN Code § 27-8-29-14 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 29. External Review of Grievances|27-8-29-14. Rights of Individuals Who File Grievances

Sec. 14. (a) A covered individual who files an external grievance under this chapter:(1) shall not be subject to retaliation for exercising the covered individual's right to an external grievance under this chapter;(2) shall be permitted to utilize the assistance of other individuals, including health care providers, attorneys, friends, and family members throughout the review process;(3) shall be permitted to submit additional information relating to the proposed service throughout the review process; and(4) shall cooperate with the independent review organization by:(A) providing any requested medical information; or(B) authorizing the release of necessary medical information.(b) An insurer shall cooperate with an independent review organization selected under section 13(b) of this chapter by promptly providing any information requested by the independent review organization.As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14. Amended by P.L.1-2002, SEC.119.
IN Code § 27-8-29-15 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 29. External Review of Grievances|27-8-29-15. Independent Review Organizations; Determinations

Sec. 15. (a) An independent review organization shall:(1) for an expedited external grievance filed under section 13(a)(2)(A) of this chapter, within seventy-two (72) hours after the external grievance is filed; or(2) for a standard external grievance filed under section 13(a)(2)(B) of this chapter, within fifteen (15) business days after the external grievance is filed;make a determination to uphold or reverse the insurer's appeal resolution under IC 27-8-28-17 based on information gathered from the covered individual or the covered individual's designee, the insurer, and the treating health care provider, and any additional information that the independent review organization considers necessary and appropriate.(b) When making the determination under this section, the independent review organization shall apply:(1) standards of decision making that are based on objective clinical evidence; and(2) the terms of the covered individual's accident and sickness insurance policy.(c) In an external grievance described in section 12(1)(D) of this chapter, the insurer bears the burden of proving that the insurer properly denied coverage for a condition, complication, service, or treatment because the condition, complication, service, or treatment is directly related to a condition for which coverage has been waived under IC 27-8-5-2.5(e) (expired July 1, 2007, and removed) or IC 27-8-5-19.2 (expired July 1, 2007, and repealed).(d) The independent review organization shall notify the insurer and the covered individual of the determination made under this section:(1) for an expedited external grievance filed under section 13(a)(2)(A) of this chapter, within seventy-two (72) hours after the external grievance is filed; and(2) for a standard external grievance filed under section 13(a)(2)(B) of this chapter, within seventy-two (72) hours after making the determination.As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14. Amended by P.L.211-2003, SEC.9; P.L.3-2008, SEC.218; P.L.81-2012, SEC.37; P.L.72-2016, SEC.21.
IN Code § 27-8-29-15.5 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 29. External Review of Grievances|27-8-29-15.5. Information From Independent Review Organization

Sec. 15.5. Upon the request of a covered individual who is notified under section 15(d) of this chapter that the independent review organization has made a determination, the independent review organization shall provide to the covered individual all information reasonably necessary to enable the covered individual to understand the:(1) effect of the determination on the covered individual; and(2) manner in which the insurer may be expected to respond to the determination.As added by P.L.173-2007, SEC.42.
IN Code § 27-8-29-16 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 29. External Review of Grievances|27-8-29-16. Binding Determinations

Sec. 16. A determination made under section 15 of this chapter is binding on the insurer.As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.
IN Code § 27-8-29-17 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 29. External Review of Grievances|27-8-29-17. Reconsideration of Resolution by Insurer

Sec. 17. (a) If, at any time during an external review performed under this chapter, the covered individual submits information to the insurer that is relevant to the insurer's resolution of the covered individual's appeal of a grievance decision under IC 27-8-28-17 and that was not considered by the insurer under IC 27-8-28:(1) the insurer may reconsider the resolution under IC 27-8-28-17; and(2) if the insurer chooses to reconsider, the independent review organization shall cease the external review process until the reconsideration under subsection (b) is completed.(b) An insurer reconsidering the resolution of an appeal of a grievance decision due to the submission of information under subsection (a) shall reconsider the resolution under IC 27-8-28-17 based on the information and notify the covered individual of the insurer's decision:(1) within seventy-two (72) hours after the information is submitted, for a reconsideration related to an illness, a disease, a condition, an injury, or a disability that would seriously jeopardize the covered individual's:(A) life or health; or(B) ability to reach and maintain maximum function; or(2) within fifteen (15) days after the information is submitted, for a reconsideration not described in subdivision (1).(c) If the decision reached under subsection (b) is adverse to the covered individual, the covered individual may request that the independent review organization resume the external review under this chapter.(d) If an insurer to which information is submitted under subsection (a) chooses not to reconsider the insurer's resolution under IC 27-8-28-17, the insurer shall forward the submitted information to the independent review organization not more than two (2) business days after the insurer's receipt of the information.As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14. Amended by P.L.1-2002, SEC.120.
IN Code § 27-8-29-18 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 29. External Review of Grievances|27-8-29-18. Applicability of Chapter

Sec. 18. This chapter does not add to or otherwise change the terms of coverage included in a policy, certificate, or contract under which a covered individual receives health care benefits under IC 27-8.As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.
IN Code § 27-8-29-20 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 29. External Review of Grievances|27-8-29-20. Documents of Review Organizations

Sec. 20. Except as provided in section 19(g) of this chapter, documents and other information created or received by the independent review organization or the medical review professional in connection with an external grievance review under this chapter:(1) are not public records;(2) may not be disclosed under IC 5-14-3; and(3) must be treated in accordance with confidentiality requirements of state and federal law.As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14.
IN Code § 27-8-29-21 (2021)
2021 Indiana Code|Title 27. Insurance|Article 8. Life, Accident, and Health|Chapter 29. External Review of Grievances|27-8-29-21. Filing Description of Grievance Procedure

Sec. 21. (a) An insurer shall each year file with the commissioner a description of the grievance procedure established by the insurer under this chapter, including:(1) the total number of external grievances handled through the procedure during the preceding calendar year;(2) a compilation of the causes underlying those grievances; and(3) a summary of the final disposition of those grievances;for each independent review organization used by the insurer during the reporting year.(b) The information required by subsection (a) must be filed with the commissioner on or before March 1 of each year. The commissioner shall:(1) make the information required to be filed under this section available to the public; and(2) prepare an annual compilation of the data required under subsection (a) that allows for comparative analysis.(c) The commissioner may require any additional reports that are necessary and appropriate for the commissioner to carry out the commissioner's duties under this article.As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14. Amended by P.L.1-2002, SEC.122.