reglab/housing_qa huggingface dataset:
SC Code § 38-59-30 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 59 - Claims Practices|Section 38-59-30. Notice and hearing by director or designee; penalties.

 If, after due notice and hearing, the director or his designee determines that the insurer has engaged in any of the improper claim practices defined in Section 38-59-20, he shall order the insurer to cease and desist from the practice and may impose a penalty as provided in Section 38-2-10. If the penalty is imposed, the penalty may not be considered a cost of the insurer for purposes of determining whether or not the rates of the insurer warrant adjustment.  HISTORY: Former 1976 Code Section 38-37-1120 [1962 Code Section 37-591.57; 1974 (58) 2718] recodified as Section 38-59-30 by 1987 Act No. 155, Section 1; 1988 Act No. 374, Section 30; 1993 Act No. 181, Section 723.
SC Code § 38-59-40 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 59 - Claims Practices|Section 38-59-40. Liability for attorneys' fees where insurer has refused to pay claim.

 (1) In the event of a claim, loss, or damage which is covered by a policy of insurance or a contract of a nonprofit hospital service plan or a medical service corporation and the refusal of the insurer, plan, or corporation to pay the claim within ninety days after a demand has been made by the holder of the policy or contract and a finding on suit of the contract made by the trial judge that the refusal was without reasonable cause or in bad faith, the insurer, plan, or corporation is liable to pay the holder, in addition to any sum or any amount otherwise recoverable, all reasonable attorneys' fees for the prosecution of the case against the insurer, plan, or corporation. The amount of reasonable attorneys' fees must be determined by the trial judge and the amount added to the judgment. The amount of the attorneys' fees may not exceed one-third of the amount of the judgment.  (2) If attorneys' fees are allowed and, on appeal by the defendant, the judgment is affirmed, the Supreme Court or the court of appeals shall allow to the respondent an additional sum as the court adjudges reasonable as attorneys' fees of the respondent on the appeal.  (3) Nothing in this section may be construed to alter or affect the Tyger River Pine Co. v. Maryland Casualty Co., 161 SE 491, 163 SC 229, doctrine.  (4) This section applies to cases filed or removed to federal court and cases appealed in the federal court system.  HISTORY: Former 1976 Code Section 38-9-320 [1962 Code Section 37-167.1; 1972 (57) 2203] recodified as Section 38-59-40 by 1987 Act No. 155, Section 1; 1989 Act No. 148, Section 50; 1999 Act No. 55, Section 38.
SC Code § 38-59-50 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 59 - Claims Practices|Section 38-59-50. Payment or settlement of benefits in merchandise or services prohibited.

 It is unlawful for an insurer to make payment or settlement of benefits arising under life, endowment, accident, health, or hospitalization policies written by the insurer in merchandise, services rendered or agreed to be rendered, or to issue a policy which provides for settlement in merchandise or services rendered or to be rendered.  An insurer violating this section pays a penalty of ten times the amount of the policy, certificate, or other evidence of insurance to be collected in a suit by the policyholder or his legal representatives or beneficiary. An officer, agent, or servant of an insurer who violates this section is guilty of a misdemeanor and, upon conviction, must be fined in the discretion of the court or imprisoned not more than three years, or both.  HISTORY: Former 1976 Code Section 38-9-330 [1947 (45) 322; 1952 Code Section 37-168; 1958 (50) 1554; 1962 Code Section 37-168] recodified as Section 38-59-50 by 1987 Act No. 155, Section 1; 1988 Act No. 374, Section 31; 1993 Act No. 184, Section 220.
SC Code § 38-59-200 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 59 - Claims Practices|Section 38-59-200. Citation of article.

 This article may be cited as the "South Carolina Health Care Financial Recovery and Protection Act".  HISTORY: 2008 Act No. 356, Section 1, eff one year after approval by the Governor (approved June 11, 2008).
SC Code § 38-59-220 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 59 - Claims Practices|Section 38-59-220. Requesting fee schedule from insurer; confidentiality.

 (A) Within six months of the effective date of this article, each insurer, upon written request from a physician who is also a participating provider will provide, by CD-ROM, or electronically at the insurer's option, the fee schedule that is contracted with that physician for up to 100 CPT(r) Codes customarily and routinely used by the specialty type of such physician. Each physician may request from an insurer an updated fee schedule no more than two times annually.  (B) A physician requesting a fee schedule pursuant to subsection (A) may elect to receive a hard copy of the fee schedule in lieu of the foregoing; however, the insurer may charge the physician a reasonable fee to cover the increased administrative costs of providing the hard copy.  (C) The physician shall keep all fee schedule information provided pursuant to this section confidential. The physician shall disclose fee schedule information only to those employees of the physician who have a reasonable need to access this information in order to perform their duties for the physician and who have been placed under an obligation to keep this information confidential. Any failure of a physician's office to abide by this subsection shall result in the physician's forfeiture of the right to receive fee schedules pursuant to this section and at the option of the insurer may constitute a breach of contract by the physician.  (D) Nothing in this section prohibits an insurer from basing actual compensation to the physician on the insurer's maximum allowable amount or other contract adjustments, including those stated in the patient's plan of benefits, or both.  HISTORY: 2008 Act No. 356, Section 1, eff one year after approval by the Governor (approved June 11, 2008).
SC Code § 38-59-240 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 59 - Claims Practices|Section 38-59-240. Interest on payments later than applicable period; exceptions.

 (A) For each clean claim with respect to which an insurer has directed the issuance of a check or the electronic funds transfer later than the applicable period specified in Section 38-59-230, the insurer shall pay interest in the same manner and at the same rate set forth in Section 34-31-20(A) on the balance due on each claim computed from the twenty-first or the forty-first business day, as appropriate, based on the circumstances described in Section 38-59-230, up to the date on which the insurer directs the issuance of the check or the electronic funds transfer for payment of the clean claim. At the insurer's election, interest paid pursuant to this section must be included in the claim payment check or wire transfer or must be remitted periodically, but at least quarterly, in a separate check or wire transfer along with a report detailing the claims for which interest is being paid.  (B) No insurer has an obligation to make any interest payment pursuant to subsection (A):  (1) with respect to any clean claim if within twenty business days of the submission of an original claim submitted electronically or within forty business days of an original claim submitted via paper, a duplicate claim is submitted while the adjudication of the original claim is still in process;  (2) to any participating provider who balance bills a plan member in violation of the participating provider's agreement with the insurer;  (3) with respect to any time period during which a force majeure prevents the adjudication of claims; or  (4) when payment is made to a plan member.  HISTORY: 2008 Act No. 356, Section 1, eff one year after approval by the Governor (approved June 11, 2008).
SC Code § 38-59-250 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 59 - Claims Practices|Section 38-59-250. Initiation of overpayment recovery efforts.

 (A)(1) An insurer shall initiate any overpayment recovery efforts by sending a written notice to the provider at least thirty business days prior to engaging in the overpayment recovery efforts, other than for recovery of duplicate payments or other similar adjustments relating to:  (a) claims where a provider has received payment for the same services from another payor whose obligation is primary; or  (b) timing or sequence of claims for the same insured that are received by the insurer out of chronological order in which the services were performed.  (2) The written notice required by this section shall include:  (a) the patient's name;  (b) the service date;  (c) the payment amount received by the provider;  (d) a reasonably specific explanation of the change in payment; and  (e) if the claim is submitted pursuant to a provider contract that includes an appeals process, the telephone number or a mailing address through which the provider may initiate an appeal, and the deadline by which an appeal must be received.  (B) An insurer may not initiate overpayment recovery efforts more than eighteen months after the initial payment was received by the provider; however, this time limit does not apply to the initiation of overpayment recovery efforts:  (1) based upon a reasonable belief of fraud or other intentional misconduct;  (2) required by a self-insured plan; or  (3) required by a state or federal government program.  HISTORY: 2008 Act No. 356, Section 1, eff one year after approval by the Governor (approved June 11, 2008); 2012 Act No. 243, Section 1, eff September 16, 2012.
SC Code § 38-59-260 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 59 - Claims Practices|Section 38-59-260. Application of requirements of article.

 The requirements of this article do not apply to claims that are processed under any national account delivery program in which an insurer participates but is not solely responsible for the processing and payment of the claims, or claims for services under a program offered or sponsored by any state or federal governmental entity other than in its capacity as an employer, or both.  HISTORY: 2008 Act No. 356, Section 1, eff one year after approval by the Governor (approved June 11, 2008).
SC Code § 38-59-270 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 59 - Claims Practices|Section 38-59-270. Enforcement; cease and desist orders; penalty; private right of action.

 The Department of Insurance shall enforce the provisions of this article. If, after due notice and hearing, the Director of the Department of Insurance or his designee determines that an insurer has failed to meet the obligations imposed by this article, he shall order the insurer to cease and desist from the practice, to correct any errant business practices, and to make any payments due, including applicable interest. If an insurer does not comply with the order within thirty days, the director or his designee may then impose a penalty as provided in Section 38-2-10. Nothing in this article may be construed to create a private right of action to enforce the specific provisions of this article.  HISTORY: 2008 Act No. 356, Section 1, eff one year after approval by the Governor (approved June 11, 2008).
SC Code § 38-61-10 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 61 - Insurance Contracts Generally|Section 38-61-10. Contracts which are considered made in State.

 All contracts of insurance on property, lives, or interests in this State are considered to be made in the State and all contracts of insurance the applications for which are taken within the State are considered to have been made within this State and are subject to the laws of this State.  HISTORY: Former 1976 Code Section 38-61-10 [1977 Act No. 120 Section 1] recodified as Section 38-81-10 by 1987 Act No. 155, Section 1; Former 1976 Code Section 38-9-20 [1947 (45) 322; 1952 Code Section 37-141; 1962 Code Section 37-141] recodified as Section 38-61-10 by 1987 Act No. 155, Section 1; 1993 Act No. 181, Section 724.
SC Code § 38-61-25 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 61 - Insurance Contracts Generally|Section 38-61-25. Approval procedures to issue or sell exempt commercial policies.

 It is unlawful for an insurer doing business in this State to issue or sell in this State any exempt commercial policy, contract, or certificate until it has been filed with and approved by the director or his designee. A filing that is filed with the department is deemed to have met the requirements of this chapter unless it:  (1) does not meet the requirements of law;  (2) contains any provisions which are unfair, deceptive, ambiguous, misleading, or unfairly discriminatory; or  (3) is going to be solicited by means of advertising, communication, or dissemination of information which is deceptive or misleading.  If a filing is not in compliance with this chapter, the director or his designee shall issue an order specifying in detail the provisions with which the insurer has not complied and stating the time within which the insurer has to comply with the order before the filing is no longer valid. An order issued by the director pursuant to this section must be on a prospective basis only and may not affect a contract issued or made before the effective date of the order. However, this section does not apply to surety contracts or fidelity bonds, except as required in Section 38-15-10, or to insurance contracts, riders, or endorsements prepared to meet special, unusual, peculiar, or extraordinary conditions applying to an individual risk.  HISTORY: 2000 Act No. 235, Section 4.
SC Code § 38-61-30 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 61 - Insurance Contracts Generally|Section 38-61-30. Promulgation of standards for readability of certain contracts and policies.

 The department shall promulgate regulations which establish minimum standards for the readability of each homeowners, dwelling fire, automobile, accident and health, life, and all other forms of personal insurance, excluding commercial, fleet vehicle, and group insurance, which must be complied with by all insurers authorized to do business in this State. The standards shall include, but are not limited to, standards on an index of policy provisions, general organization of text, text readability, type size, type style, type spacing, and general appearance of the insurance contract.  HISTORY: Former 1976 Code Section 38-3-61 [1978 Act No. 550 Section 2] recodified as Section 38-61-30 by 1987 Act No. 155, Section 1; 1993 Act No. 181, Section 724.
SC Code § 38-61-40 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 61 - Insurance Contracts Generally|Section 38-61-40. Compliance with standards for readability of certain contracts and policies; withdrawal of approval or certification on noncomplying documents.

 All insurers licensed to transact insurance business in this State shall comply with the standards prescribed by regulation of the department. The director or his designee is empowered to withdraw approval or certification on all existing policies of commonly purchased insurance that do not comply with Section 38-61-30.  HISTORY: Former 1976 Code Section 38-3-62 [1978 Act No. 550 Section 3] recodified as Section 38-61-40 by 1987 Act No. 155, Section 1; 1993 Act No. 181, Section 724; 2001 Act No. 82, Section 21, eff July 20, 2001.
SC Code § 38-61-50 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 61 - Insurance Contracts Generally|Section 38-61-50. Standards for readability of certain contracts and policies; advice of other agencies concerning standards.

 The director or his designee shall consult with and call upon the expertise of other state agencies, as may be necessary, to determine the standards to be promulgated and, after promulgation, the effectiveness of these standards. This consultation shall include, but is not limited to, the State Department of Education or its successor entity.  HISTORY: Former 1976 Code Section 38-3-63 [1978 Act No. 550 Section 4] recodified as Section 38-61-50 by 1987 Act No. 155, Section 1; 1993 Act No. 181, Section 724.
SC Code § 38-61-60 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 61 - Insurance Contracts Generally|Section 38-61-60. Advertising insurance policy in foreign language; effect on interpretation of policy provided in English.

 (A) If an insurer advertises an insurance policy, or the availability of a foreign language informational sheet, or the availability of a translation of an insurance policy in a language other than English, the insurer only needs to provide an English written insurance policy, so long as the advertisement clearly states that the insurance policy is only available in English. Notwithstanding the use of a language other than English in an advertisement, if there is a dispute, the insurance policy is controlling and an advertisement for an insurance policy, informational sheet, or translation may not be construed to modify or change the insurance policy.  (B) Nothing in this section may be construed to require insurers to provide insurance related services, such as claim services, in a language other than English.  HISTORY: 2006 Act No. 358, Section 1, eff June 9, 2006.
SC Code § 38-61-70 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 61 - Insurance Contracts Generally|Section 38-61-70. Commercial general liability policy; coverage for construction professional doing construction related work; definition of occurrence; application

 (A) For purposes of this section:  (1) "Commercial general liability insurance policy" means a contract of insurance that covers occurrences of damages or injury during the policy period and insures a construction professional for liability arising from construction related work.  (2) "Construction professional" means a person, sole proprietorship, partnership, corporation, limited liability company, or other recognized legal entity that engages in the development, construction, installation, or repair of an improvement to real property.  (3) "Construction related work" means activities by a construction professional involving the development, construction, installation, or repair of an improvement to real property.  (B) Commercial general liability insurance policies shall contain or be deemed to contain a definition of "occurrence" that includes:  (1) an accident, including continuous or repeated exposure to substantially the same general harmful conditions; and  (2) property damage or bodily injury resulting from faulty workmanship, exclusive of the faulty workmanship itself.  (C) This section is not intended to restrict or limit the nature or types of exclusions from coverage that an insurer, including a surplus lines insurer, may include in a commercial general liability insurance policy.  (D) This section applies only to a commercial general liability insurance policy that insures a construction professional for liability arising from construction related work.  (E) This section applies to any pending or future dispute over coverage that would otherwise be affected by this section as to all commercial general liability insurance policies issued in the past, currently in existence, or issued in the future.  HISTORY: 2011 Act No. 26, Section 1, eff May 17, 2011.  Validity  For validity of this section, see Harleysville Mut. Ins. Co. v. State, 401 S.C. 15, 736 S.E.2d 651 (S.C. 2012).  Editor's Note  2011 Act No. 26, Section 3, provides as follows:  "This act takes effect upon approval by the Governor and applies to any pending or future dispute over coverage that would otherwise be affected by this section as to commercial general liability insurance policies issued in the past, currently in existence, or issued in the future."
SC Code § 38-61-80 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 61 - Insurance Contracts Generally|Section 38-61-80. Withdrawing from the market.

 (A) An insurer must not cancel, nonrenew, or otherwise terminate all or substantially all of an entire line or class of business for the purpose of withdrawing from the market in this State unless:  (1) the insurer notified the director, in writing, of the action, including the reasons for such action, and plans for the orderly cessation of business at least one year before the completion of the withdrawal. This item must not be construed to prevent an insurer from canceling, nonrenewing, or terminating policies in the ordinary course of business that are not part of a plan to withdraw from an entire line or class of business or where the insurer, by contract, statute, or otherwise, has the right to take such action; or  (2) the insurer filed a plan of action for the orderly cessation of the insurer's business within a period of time shorter than one year and the plan of action is approved by the director or his designee.  (B) An insurer's rates, rules, and forms filed with the department are considered no longer on file for use with any new business in the market affected by the insurer's withdrawal plan on and after the date the withdrawal plan goes into effect.  (C) This section does not apply to health insurance issuers offering health insurance coverage as defined in Article 3 or Article 5, Chapter 71, Title 38. Health insurance issuers must comply with other applicable provisions of Chapter 71, Title 38 regarding the discontinuance of all or a significant block of business or withdrawal from the market in this State.  HISTORY: 2021 Act No. 13 (H.3585), Section 1, eff April 12, 2021.
SC Code § 38-63-10 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 63 - Individual Life Insurance|Section 38-63-10. Circulation of false or misleading information by life insurers.

 No life insurer doing business in this State and no officer, director, or agent of it may issue or circulate or cause or permit to be issued or circulated any estimate, illustration, circular, or statement of any sort misrepresenting the terms of any policy issued by it, the benefits or advantages promised thereby, or the dividends or shares of surplus to be received thereon or may use any name or title of any policy or class of policies misrepresenting the true nature thereof. Violation of this section by an agent or officer of an insurer is a misdemeanor. If an insurer violates or participates in the violation of this section, the insurer is subject to the penalty provisions of Section 38-2-10.  HISTORY: Former 1976 Code Section 38-63-10 [1985 Act No. 189, Section 1] recodified as Section 38-53-10 by 1987 Act No. 155, Section 1; Former 1976 Code Section 38-9-40 [1947 (45) 322; 1952 Code Section 37-144; 1962 Code Section 37-144] recodified as Section 38-63-10 by 1987 Act No. 155, Section 1; 1988 Act No. 374, Section 32.
SC Code § 38-63-20 (2021)
2021 South Carolina Code of Laws|Title 38 - Insurance|Chapter 63 - Individual Life Insurance|Section 38-63-20. Misrepresentations to induce termination or conversion of life insurance policies.

 No insurer, or its employee or agent, may make any misleading representations or incomplete or fraudulent comparisons of any life insurance policies or insurers for the purpose of inducing, or which may tend to induce, any person to lapse, forfeit, surrender, terminate, return, or convert any life insurance policy.  HISTORY: Former 1976 Code Section 38-63-20 [1985 Act No. 189, Section 1] recodified as Section 38-53-20 by 1987 Act No. 155, Section 1; Former 1976 Code Section 38-9-50 [1956 (49) 1814; 1962 Code Section 37-144.1]; recodified as Section 38-63-20 by 1987 Act No. 155, Section 1; 1988 Act No. 374, Section 33.