reglab/housing_qa huggingface dataset:
SD Codified L § 58-12-23 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 12 - Insurance Claims And Benefits|Section 58-12-23 - Application for or acceptance of medical assistance paid by department operates as release of information to facilitate coordination of benefits--Request.

58-12-23. Application for or acceptance of medical assistance paid by department operates as release of information to facilitate coordination of benefits--Request.Notwithstanding any provision of a policy, plan, contract, or certificate, an insurer shall recognize that an application for medical assistance or acceptance of medical assistance, paid by the Department of Social Services operates as a release of any information kept by the insurer that would facilitate efficient coordination of benefits between the department and the insurer, which may include:(1)The name, address, date of birth, social security number if available, and unique health care identification number of the covered individual;(2)The name, address, date of birth, social security number if available, policy number, group identification number of the policyholder, sponsor, or subscriber;(3)The name and address of the employer if it is an employer-employee benefit plan; types of services covered under the plan or policy; and the name and address of the claims administrator for the policy or plan;(4)Previously paid benefits including the name and address of the payee; and(5)The name and address of claims processing or administration centers, or both.Upon written request by the department, the insurer shall provide the requested information in writing within thirty calendar days of receipt of the request. Source: SL 2005, ch 263, §2; SL 2007, ch 286, §1.
SD Codified L § 58-12-24 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 12 - Insurance Claims And Benefits|Section 58-12-24 - Refusal of reimbursement due to manner, form, or date of claim prohibited--Time for submission of claim.

58-12-24. Refusal of reimbursement due to manner, form, or date of claim prohibited--Time for submission of claim.Notwithstanding any provision of a policy, plan, contract, or certificate, no insurer may refuse to reimburse the Department of Social Services for medical assistance paid by the department on the basis of the date of submission of the claim, the type or format of the claim form, or a failure to present proper documentation at the point-of-sale for which reimbursement is sought, if the claim is submitted within three years from the date the item or service was furnished and any action by the department to enforce its rights with respect to such claim is commenced within six years of the department's submission of such claim. Source: SL 2005, ch 263, §3; SL 2007, ch 286, §2.
SD Codified L § 58-12-25 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 12 - Insurance Claims And Benefits|Section 58-12-25 - Reimbursement to department for cost of services.

58-12-25. Reimbursement to department for cost of services.If the Department of Social Services notifies an insurer that the department has paid for services on behalf of an individual who is covered under an individual, group, or blanket health insurance policy or contract that the insurer issued, delivered, entered into, or renewed in the state, to the extent that the insurer is legally liable, it shall reimburse the department for the cost of the services, regardless of any provision in the health insurance policy or contract that requires payment to the policy holder, subscriber, or another payee. If the insurer, after notice from the department, issues payment to any payee other than the department, the insurer remains liable to the department for the amount of benefits paid to the other party. Source: SL 2005, ch 263, §4.
SD Codified L § 58-12-26 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 12 - Insurance Claims And Benefits|Section 58-12-26 - Insurer defined.

58-12-26. Insurer defined. For the purposes of §§58-12-22 to 58-12-28, inclusive, the term, insurer, means:(1)Any commercial insurance company, employer-employee benefit plan, health maintenance organization, professional association, service benefit plan, public self-funded employer or pool, union, or fraternal group selling or otherwise offering individual or group health insurance coverage including self-insured and self-funded plans;(2)Any profit or nonprofit prepaid plan offering either medical services of full or partial payment for services included in the department's medicaid plan;(3)Any other entity offering health benefits for which a medicaid recipient may be eligible in addition to public medical assistance;(4)Any managed care organization, third-party administrator, pharmacy benefits manager, or other entity which processes claims, administers services, or otherwise manages health benefits on behalf of any of the aforementioned insurers; or(5)Any other party that is by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service including workers' compensation, automobile insurance, and liability insurance plans. Source: SL 2005, ch 263, §5; SL 2007, ch 286, §3; SL 2021, ch 210, § 6.
SD Codified L § 58-12-27 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 12 - Insurance Claims And Benefits|Section 58-12-27 - Department defined.

58-12-27. Department defined. For the purposes of §§58-12-22 to 58-12-28, inclusive, the term, department, means the Department of Social Services, or an entity under contract with the Department of Social Services to carry out the functions of §§58-12-22 to 58-12-28, inclusive. Source: SL 2005, ch 263, §6; SL 2021, ch 210, § 7.
SD Codified L § 58-12-28 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 12 - Insurance Claims And Benefits|Section 58-12-28 - Provisions of chapter 1-27 not applicable to insurer records.

58-12-28. Provisions of chapter 1-27 not applicable to insurer records.The provisions of chapter 1-27 do not apply to any records the insurer is required to provide to the department. Source: SL 2005, ch 263, §7.
SD Codified L § 58-12-30 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 12 - Insurance Claims And Benefits|Section 58-12-30 - Annual reports of commercial property casualty insurance claims--Exception--Promulgation of rules.

58-12-30. Annual reports of commercial property casualty insurance claims--Exception--Promulgation of rules.Any carrier who is or has provided commercial property casualty coverage in this state shall provide, at the written request of the insured, annual reports of the claims experience of that insured for the immediate past policy period and for any time frames which are not in excess of three years prior to the policy period for which the request was made. A carrier is not required to provide any claim information that pertains to a prior carrier's experience with that insured. The claims report shall be in sufficient detail so as to provide the insured with data sufficient to assess the insured's future commercial property casualty insurance needs. The director may promulgate rules pursuant to chapter 1-26 regarding the content and time frames for the annual reports. Source: SL 2007, ch 287, §1.
SD Codified L § 58-12-31 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 12 - Insurance Claims And Benefits|Section 58-12-31 - Definitions regarding standards for claims processing.

58-12-31. Definitions regarding standards for claims processing.Terms used in §§58-12-31 to 58-12-37, inclusive, mean:(1)"Director," the director of the South Dakota Division of Insurance;(2)"Insured," the party named on a policy or certificate as the individual with legal rights to the benefits provided by the policy;(3)"Insurer," a person, reciprocal exchange, interinsurer, Lloyd's insurer, fraternal benefit society, and any other legal entity engaged in the business of insurance, including claim agents, brokers, adjusters, and third party administrators. The term also includes medical service plans, hospital service plans, health maintenance organizations, prepaid limited health care service plans, dental plans, and optometric plans. This term does not include any insurance producer licensed pursuant to chapter 58-30, unless an insurance producer is directly involved in the adjudication of claims;(4)"Person," a natural or artificial entity, including individuals, partnerships, associations, trusts, or corporations;(5)"Policy," or "certificate," a contract of insurance, indemnity, medical, health, or hospital service, or annuity issued. The term does not include contracts of workers' compensation, fidelity, suretyship, or boiler and machinery insurance. Source: SL 2014, ch 235, §1.
SD Codified L § 58-12-32 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 12 - Insurance Claims And Benefits|Section 58-12-32 - Application of standards for claims investigation and disposition.

58-12-32. Application of standards for claims investigation and disposition.The provisions of §§58-12-31 to 58-12-37, inclusive, set forth standards for claim investigation and disposition of claims arising under policies or certificates of insurance issued to residents of South Dakota. It does not apply to claims involving workers' compensation, fidelity, suretyship, or boiler and machinery insurance. Nothing in §§58-12-31 to 58-12-37, inclusive, may be construed to create or imply a private cause of action for violation of §§58-12-31 to 58-12-37, inclusive. No disposition under the provisions of §§58-12-31 to 58-12-37, inclusive, or any rule promulgated thereto may be used as evidence in any civil litigation. Nothing herein alters the rules of evidence as contained in title 19. Source: SL 2014, ch 235, §2.
SD Codified L § 58-12-33 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 12 - Insurance Claims And Benefits|Section 58-12-33 - Flagrant or frequent violations--Notice and opportunity to correct inadvertent violations.

58-12-33. Flagrant or frequent violations--Notice and opportunity to correct inadvertent violations.Any act by an insurer, if committed in violation of this section, is an unfair claims practice if:(1)It is committed flagrantly and in conscious disregard of the provisions of §§58-12-31 to 58-12-37, inclusive, or any rule promulgated pursuant to §§58-12-31 to 58-12-37, inclusive; or(2)It is committed with such frequency to indicate a general business practice to engage in that type of conduct.For any act defined in §58-12-34, the director shall provide notice and an opportunity to correct the violation pursuant to §58-33-68 if the act was inadvertent. Any act that is committed flagrantly or in conscious disregard of the provisions of §§58-12-31 to 58-12-37, inclusive, are not subject to the procedures required under §58-33-68. Source: SL 2014, ch 235, §3.
SD Codified L § 58-12-34 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 12 - Insurance Claims And Benefits|Section 58-12-34 - Acts constituting unfair claims practices.

58-12-34. Acts constituting unfair claims practices.Any of the following acts by an insurer, if committed in violation of §58-12-33, is an unfair claims practice:(1)Knowingly misrepresents to a claimant or an insured a relevant fact or policy provision relating to coverages at issue;(2)Fails to acknowledge with reasonable promptness pertinent communications with respect to claims arising under its policies;(3)Fails to adopt and implement reasonable standards to promptly complete claim investigations and settlement of claims arising under its policies;(4)Fails to make a good faith attempt to effectuate prompt, fair, and equitable settlement of claims submitted in which liability coverage, and causation of claims have become reasonably clear;(5)Compels an insured or beneficiary to institute a suit to recover an amount due under its policies by offering substantially less than the amount ultimately recovered in a suit brought by the insured or beneficiary;(6)Refuses to pay claims without conducting a reasonable claim investigation;(7)Fails to affirm or deny coverage of claims within a reasonable time after having completed a claim investigation related to the claim;(8)Attempts to settle a claim for less than the amount that a reasonable person would believe the insured or beneficiary is entitled by reference to written or printed advertising material accompanying or made part of an application;(9)Attempts to settle a claim on the basis of an application that was materially altered without notice to, or knowledge or consent of, the insured;(10)Makes a claim payment to an insured or beneficiary without indicating the coverage under which each payment is being made;(11)Unreasonably delays a claim investigation or payment of a claim by requiring both a formal proof of loss form and subsequent verification that would result in duplication of information and verification appearing in the formal proof of loss form;(12)Fails, in the case of a claim denial or offer of compromise settlement, to promptly provide a reasonable and accurate explanation of the basis for such action; or(13)Fails to provide forms necessary to present a claim within fifteen days of a request with reasonable explanations regarding their use. Source: SL 2014, ch 235, §4.
SD Codified L § 58-12-35 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 12 - Insurance Claims And Benefits|Section 58-12-35 - Notice of hearing.

58-12-35. Notice of hearing.If the director has reasonable cause to believe that an insurer doing business in this state is engaging in an unfair claims practice and that a proceeding in respect thereto is in the public interest, the director may issue and serve upon the insurer a notice of hearing, which shall set a hearing date not less than thirty days from the date of the notice. The hearing shall be conducted pursuant to chapter 1-26. Prior to conducting a public hearing pursuant to this section against an insurer regulated by chapter 58-35, the director shall attempt to resolve the alleged unfair claims practice with the insurer. Source: SL 2014, ch 235, §5.
SD Codified L § 58-12-36 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 12 - Insurance Claims And Benefits|Section 58-12-36 - Cease and desist order--Monetary penalty--Suspension or revocation of license.

58-12-36. Cease and desist order--Monetary penalty--Suspension or revocation of license.If, after the hearing, the director finds an insurer has engaged in an unfair claims practice, the director shall reduce the findings to writing and shall issue and serve the insurer a copy of the findings and an order requiring the insurer to cease and desist from engaging in the act or practice. The secretary of labor and regulation may order either or both of the following:(1)The insurer to pay a monetary penalty of not more than one thousand dollars for each violation but not to exceed an aggregate penalty of one hundred thousand dollars, unless the violation was committed flagrantly and in conscious disregard of §§58-12-31 to 58-12-37, inclusive, in which case the penalty may not be more than twenty-five thousand dollars for each violation, but not to exceed an aggregate penalty of two hundred fifty thousand dollars; and(2)Suspension or revocation of the insurer's license if the insurer knew or reasonably should have known it was in violation of §§58-12-31 to 58-12-37, inclusive.This section only applies to violations of §§58-12-31 to 58-12-37, inclusive. Any penalty imposed pursuant to this section is the sole and exclusive remedy for any act or violation brought by the director under §§58-12-31 to 58-12-37, inclusive.The director shall consider the size, the amount of surplus, and the premium volume of the insurer when determining a penalty pursuant to this section. Source: SL 2014, ch 235, §6.
SD Codified L § 58-12-37 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 12 - Insurance Claims And Benefits|Section 58-12-37 - Promulgation of rules regarding definitions and records.

58-12-37. Promulgation of rules regarding definitions and records.The director may promulgate rules, pursuant to chapter 1-26, to carry out the purposes of §§58-12-31 to 58-12-37, inclusive. In promulgating rules, the director shall consider the impact of the rule on the cost and availability of insurance in this state and the degree of protection that the rule will have for the insurance buying public in this state. The rules are limited to the following areas:(1)Definition of terms; and(2)Record keeping. Source: SL 2014, ch 235, §7.
SD Codified L § 58-13-1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 13 - Limit Of Risk Insured|Section 58-13-1 - Maximum single risk assumed.

58-13-1. Maximum single risk assumed.No insurer shall retain any risk on any one subject of insurance, whether located or to be performed in this state or elsewhere, in an amount exceeding ten percent of its surplus to policyholders. Source: SL 1966, ch 111, ch 4, §11 (1).
SD Codified L § 58-13-2 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 13 - Limit Of Risk Insured|Section 58-13-2 - Subject of insurance defined.

58-13-2. Subject of insurance defined.A "subject of insurance" for the purposes of this chapter, as to insurance against fire and hazards other than windstorm, earthquake, or other catastrophe hazards, includes all properties insured by the same insurer which are customarily considered by underwriters to be subject to loss or damage from the same fire or the same occurrence of such other hazard insured against. Source: SL 1966, ch 111, ch 4, §11 (2).
SD Codified L § 58-13-3 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 13 - Limit Of Risk Insured|Section 58-13-3 - Surplus to policyholders defined.

58-13-3. Surplus to policyholders defined."Surplus to policyholders" for the purposes of this chapter, in addition to the insurer's capital and surplus, shall be deemed to include any voluntary reserves which are not required pursuant to law, and shall be determined from the last sworn statement of the insurer on file with the director, or by the last report of examination of the insurer, whichever is the more recent at time of assumption of risk. Source: SL 1966, ch 111, ch 4, §11 (5).
SD Codified L § 58-13-4 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 13 - Limit Of Risk Insured|Section 58-13-4 - Deduction for reinsurance or cosuretyship.

58-13-4. Deduction for reinsurance or cosuretyship.Reinsurance ceded for which credit is allowed pursuant to chapter 58-14 shall be deducted in determining risk retained. As to surety risks, deductions shall also be made of the amount assumed by any established incorporated cosurety and the value of any security deposited, pledged, or held subject to the surety's consent and for the surety's protection. Source: SL 1966, ch 111, ch 4, §11 (3).
SD Codified L § 58-13-5 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 13 - Limit Of Risk Insured|Section 58-13-5 - Chapter inapplicable when maximum possible loss not ascertainable.

58-13-5. Chapter inapplicable when maximum possible loss not ascertainable.This chapter shall not apply to life or health insurance, annuities, title insurance, insurance of wet marine and transportation risks, workers' compensation insurance, employer's liability coverages, nor to any policy or type of coverage as to which the maximum possible loss to the insurer is not readily ascertainable on issuance of the policy. Source: SL 1966, ch 111, ch 4, §11 (6).
SD Codified L § 58-13-6 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 13 - Limit Of Risk Insured|Section 58-13-6 - Application of chapter to alien insurers.

58-13-6. Application of chapter to alien insurers.As to alien insurers, this chapter shall relate only to risks and surplus to policyholders of the insurer's United States branch. Source: SL 1966, ch 111, ch 4, §11 (4).
SD Codified L § 58-14-1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 14 - Reinsurance|Section 58-14-1 - "Reinsurance" defined.

58-14-1. Reinsurance defined."Reinsurance" is a contract under which an originating insurer, called the "ceding insurer," procures insurance for itself in another insurer, called the "assuming insurer" or the "reinsurer," with respect to part or all of any insurance risk of the originating insurer. Source: SL 1966, ch 111, ch 4, §9.
SD Codified L § 58-14-3 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 14 - Reinsurance|Section 58-14-3 - Risk limits applicable.

58-14-3. Risk limits applicable.An insurer may only reinsure risks within the limits it is authorized to insure. Source: SL 1966, ch 111, ch 4, §10 (1); SL 1992, ch 344, §14.
SD Codified L § 58-14-4 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 14 - Reinsurance|Section 58-14-4 - Credit not allowable as an asset or deduction from liability to ceding insurer--Exceptions--Payments.

58-14-4. Credit not allowable as an asset or deduction from liability to ceding insurer--Exceptions--Payments.No credit may be allowed, as an asset or as a deduction from liability, to any ceding insurer for reinsurance unless the reinsurance contract provides, in substance, that in the event of the insolvency of the ceding insurer, the reinsurance is payable under a contract reinsured by the reinsurer on the basis of reported claims allowed in the liquidation proceeding or proof of payment of the claim by a guaranty association without diminution because of the insolvency of the ceding insurer. Such payments shall be made directly to the ceding insurer or to its domiciliary liquidator unless:(1)The contract or other written agreement specifically provides another payee of such reinsurance in the event of the insolvency of the ceding insurer; or(2)The reinsurer, with the consent of the direct insured, has assumed such policy obligations of the ceding insurer as direct obligations of the reinsurer to the payees under such policies and in substitution for the obligations of the ceding insurer to such payees. The consent of the liquidator is required for any such assumption of policy obligations effected after an order of liquidation. Source: SL 1966, ch 111, ch 4, §10 (3); SL 1992, ch 344, §15; SL 2005, ch 274, §3.
SD Codified L § 58-14-4.1 (2021)
2021 South Dakota Codified Laws|Title 58 - Insurance|Chapter 14 - Reinsurance|Section 58-14-4.1 - Association election to succeed to rights and obligations of insolvent insurer under reinsurance contract--Reinsurer's liability to pay claims.

58-14-4.1. Association election to succeed to rights and obligations of insolvent insurer under reinsurance contract--Reinsurer's liability to pay claims.Notwithstanding §58-14-4, if a life and health insurance guaranty association has made the election to succeed to the rights and obligations of the insolvent insurer under the contract of reinsurance, the reinsurer's liability to pay covered reinsured claims continues under the contract of reinsurance, subject to the payment to the reinsurer of the reinsurance premiums for such coverage. Payment for such reinsured claims may only be made by the reinsurer pursuant to the direction of the guaranty association or its designated successor. Any payment made at the direction of the guaranty association or its designated successor by the reinsurer discharges the reinsurer of any further liability to any other party for the claim payment. Source: SL 2005, ch 274, §4.