reglab/statecodes huggingface dataset:
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 11 - Form And Contents Of Insurance Policies › Section 58-11-76 - Construction with other time periods.

58-11-76. Construction with other time periods.
If a rate filing or marketing material is required to be filed or approved for a specific policy form, the time frames for review, approval or disapproval, resubmission, and re-review of those rates or materials shall be the same as those provided in §§58-11-64 to 58-11-76, inclusive, for the review of policy forms.
Source:
SL 2008, ch 261, §13.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 11 - Form And Contents Of Insurance Policies › Section 58-11-77 - Appeal of disapproval of rate or policy form filing.

58-11-77. Appeal of disapproval of rate or policy form filing.
Any insurer may make a written request to the director to appeal a disapproval of a rate or policy form filing pursuant to this chapter, by requesting a hearing within thirty days of the date of the disapproval. A notice of hearing shall be issued within thirty days of receipt of a written request. The hearing shall be held pursuant to the provisions of chapter 1-26.
Source:
SL 2015, ch 248, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 11A - Life And Health Policy Language Simplification › Section 58-11A-1 - Definitions.

58-11A-1. Definitions.
Terms used in this chapter, unless the context otherwise clearly requires:
(1)"Company" or "insurer," any life or health insurance company, fraternal benefit society, nonprofit health service corporation, nonprofit hospital service corporation, nonprofit medical service corporation, prepaid health plan, dental care plan, vision care plan, pharmaceutical plan, health maintenance organization, or any similar organization;
(2)"Policy" or "policy form," any policy, contract, plan, or agreement of life or health insurance, including credit life insurance and credit health insurance, delivered or issued for delivery in this state by any company subject to this chapter; any certificate, contract or policy issued by a fraternal benefit society; and any certificate issued pursuant to a group insurance policy delivered or issued for delivery in this state;
(3)"Text," all printed matter except the following:
(a)The name and address of the insurer; the name, number, or title of the policy; the table of contents or index; captions and subcaptions; specification pages, schedules, or tables; and
(b)Any policy language which is drafted to conform to the requirements of any federal law, regulation, or agency interpretation; any policy language required by any collectively bargained agreement; any medical terminology; any words which are defined in the policy; and any policy language required by law or regulation. However, the insurer may identify the language or terminology excepted by this section and may certify, in writing, that the language or terminology is entitled to be excepted by this section.
Source:
SL 1981, ch 360, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 11A - Life And Health Policy Language Simplification › Section 58-11A-2 - Policies subject to chapter.

58-11A-2. Policies subject to chapter.
This chapter applies to any policy delivered or issued for delivery in this state by any company on or after the date such forms must be approved under this chapter, but nothing in this chapter applies to:
(1)Any policy which is a security subject to federal jurisdiction;
(2)Any group policy covering a group of one thousand or more lives at date of issue, other than a group credit life insurance policy or a group credit health insurance policy. However, this may not exempt any certificate issued pursuant to a group policy delivered or issued for delivery in this state;
(3)Any group annuity contract which serves as a funding vehicle for pension, profit-sharing, or deferred compensation plans;
(4)Any form used in connection with, as a conversion from, as an addition to or in exchange pursuant to a contractual provision for a policy delivered or issued for delivery on a form approved or permitted to be issued prior to the dates such forms must be approved under this chapter; or
(5)The renewal of a policy delivered or issued for delivery prior to the dates such forms must be approved under this chapter.
Source:
SL 1981, ch 360, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 11A - Life And Health Policy Language Simplification › Section 58-11A-3 - Reading ease--Printing--Style--Index or table of contents.

58-11A-3. Reading ease--Printing--Style--Index or table of contents.
In addition to any other requirements of law, no policy forms, except as stated in §58-11A-4, may be delivered or issued for delivery in this state on or after the dates such forms must be approved under this chapter, unless:
(1)The text achieves a minimum score of forty on the Flesch Reading Ease Test or an equivalent score on any other comparable test;
(2)It is printed, except for specification pages, schedules, and tables, in not less than ten point type, one point leaded;
(3)The style, arrangement, and overall appearance of the policy give no undue prominence to any portion of the text of this policy or to any endorsements or riders; and
(4)It contains a table of contents or an index of the principal sections of the policy if the policy has more than three thousand words printed on three or fewer pages of text or if the policy has more than three pages, regardless of the number of words.
Source:
SL 1981, ch 360, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 11A - Life And Health Policy Language Simplification › Section 58-11A-4 - Alternate reading ease tests.

58-11A-4. Alternate reading ease tests.
Other reading tests may be approved by the director of the Division of Insurance for use as an alternative to the Flesch Reading Ease Tests if it is comparable in result to the Flesch Reading Ease Test.
Source:
SL 1981, ch 360, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 11A - Life And Health Policy Language Simplification › Section 58-11A-5 - Certificate concerning reading ease--Additional information--Evaluation of attachments to policy.

58-11A-5. Certificate concerning reading ease--Additional information--Evaluation of attachments to policy.
Filings subject to this chapter shall be accompanied by a certificate signed by an officer of the insurer stating that it meets the minimum reading ease score on the test used or stating that the score is lower than the minimum required by §58-11A-3 but should be approved in accordance with §58-11A-7. To confirm the accuracy of any certification, the director of the Division of Insurance may require the submission of further information to verify the certification in question. At the option of the insurer, riders, endorsements, applications, and other forms made a part of the policy may be scored as separate forms or as part of the policy with which they may be used.
Source:
SL 1981, ch 360, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 11A - Life And Health Policy Language Simplification › Section 58-11A-6 - Variation of reading ease requirement--Grounds.

58-11A-6. Variation of reading ease requirement--Grounds.
The director of the Division of Insurance may authorize a lower score than the Flesch Reading Ease Score required in §58-11A-3 whenever, in his sole discretion, he finds that a lower score will provide a more accurate reflection of the readability of a policy form, is warranted by the nature of a particular policy form or type or class of policy forms or is caused by certain policy language which is drafted to conform to the requirements of any state law, regulation, or agency interpretation.
Source:
SL 1981, ch 360, §6.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 11A - Life And Health Policy Language Simplification › Section 58-11A-7 - Other laws governing policy contents.

58-11A-7. Other laws governing policy contents.
A policy form meeting the requirements of §58-11A-3 shall be approved notwithstanding the provisions of any other laws which specify the content of policies if the policy form provides the policyholders and claimants protection not less favorable than they would be entitled to under such laws.
Source:
SL 1981, ch 360, §7.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 11A - Life And Health Policy Language Simplification › Section 58-11A-8 - Dates after which policies must comply with this chapter--Extension.

58-11A-8. Dates after which policies must comply with this chapter--Extension.
Except as provided in §58-11A-2, this chapter applies to all policy forms filed on or after July 1, 1983. No policy form may be delivered or issued for delivery in this state on or after July 1, 1986, unless approved by the director of the Division of Insurance or permitted to be issued under this chapter. Any policy form which has been approved or permitted to be issued prior to July 1, 1986, and which meets the standards set by this chapter, need not be refiled for approval but may continue to be lawfully delivered or issued for delivery in this state upon the filing with the director of a list of such forms identified by form number and accompanied by a certificate as to each such form in the manner provided in §58-11A-5. The director may, in his sole discretion, extend the dates in this section.
Source:
SL 1981, ch 360, §8.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 11A - Life And Health Policy Language Simplification › Section 58-11A-9 - Law permitting issuance of policies after form on file for specified period.

58-11A-9. Law permitting issuance of policies after form on file for specified period.
Nothing in this chapter may be construed to negate any law of this state permitting the issuance of any policy form after it has been on file for the time period specified.
Source:
SL 1981, ch 360, §9.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-1 - Forms for proof of loss--Furnishing by insurer on request.

58-12-1. Forms for proof of loss--Furnishing by insurer on request.
An insurer shall furnish, upon written request of any person claiming to have a loss under an insurance contract issued by such insurer, forms of proof of loss for completion by such person, but such insurer shall not, by reason of the requirement so to furnish forms, have any responsibility for or with reference to the completion of such proof or the manner of any such completion or attempted completion.
Source:
SL 1966, ch 111, ch 22, §29.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-2 - Acts of insurer not constituting waiver of policy provision or defense.

58-12-2. Acts of insurer not constituting waiver of policy provision or defense.
Without limitation of any right or defense of an insurer, none of the following acts by an insurer shall be deemed to constitute a waiver of any provision of a policy or of any defense of the insurer thereunder:
(1)Acknowledgment of the receipt of notice of loss or claim under the policy;
(2)Furnishing forms for reporting a loss or claim, for giving information relative thereto, or for making proof of loss or receiving or acknowledging receipt of any such forms or proof completed or uncompleted;
(3)Investigating any loss or claim under any policy.
Source:
SL 1966, ch 111, ch 22, §30.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-3 - Attorney fees--Recovery in action against self-insured employer or insurer failing to pay loss--Other remedies not barred.

58-12-3. Attorney fees--Recovery in action against self-insured employer or insurer failing to pay loss--Other remedies not barred.
In all actions or proceedings hereafter commenced against any employer who is self-insured, or insurance company, including any reciprocal or interinsurance exchange, on any policy or certificate of any type or kind of insurance, if it appears from the evidence that such company or exchange has refused to pay the full amount of such loss, and that such refusal is vexatious or without reasonable cause, the Department of Labor and Regulation, the trial court and the appellate court, shall, if judgment or an award is rendered for plaintiff, allow the plaintiff a reasonable sum as an attorney's fee to be recovered and collected as a part of the costs, provided, however, that when a tender is made by such insurance company, exchange or self-insurer before the commencement of the action or proceeding in which judgment or an award is rendered and the amount recovered is not in excess of such tender, no such costs shall be allowed. The allowance of attorney fees hereunder shall not be construed to bar any other remedy, whether in tort or contract, that an insured may have against the same insurance company or self-insurer arising out of its refusal to pay such loss.
Source:
SL 1966, ch 111, ch 32, §7; SL 1971, ch 264; SL 1972, ch 262; SL 1976, ch 311; SL 1988, ch 397; SL 2011, ch 1 (Ex. Ord. 11-1), §33, eff. Apr. 12, 2011.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-3.1 - Separate hearing on attorney fees--Adding to judgment--Time allowed to request hearing.

58-12-3.1. Separate hearing on attorney fees--Adding to judgment--Time allowed to request hearing.
The determination of entitlement to an allowance of attorney fees as costs and the amount thereof under §58-12-3 shall be made by the court or the Department of Labor and Regulation at a separate hearing of record subsequent to the entry of a judgment or award in favor of the person making claim against the insurance company, and, if an allowance is made, the amount thereof shall be inserted in or added to the judgment or award. Such a hearing shall be afforded upon the request of the claimant made within ten days after entry of the judgment or award.
Source:
SL 1973, ch 298; SL 2011, ch 1 (Ex. Ord. 11-1), §33, eff. Apr. 12, 2011.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-4 - Life and health insurance--Exemption of benefits and proceeds from execution.

58-12-4. Life and health insurance--Exemption of benefits and proceeds from execution.
The proceeds of a policy of life or health insurance to the total amount of twenty thousand dollars only, in the absence of any agreement or assignment to the contrary, shall inure to the separate use of the insured, his surviving spouse, or children, as the case may be, independently of the creditors of any of them and shall not be subject to the payment of the debts of any one or all of such persons, notwithstanding that the proceeds may be payable directly to the insured or surviving spouse or children as the named beneficiary or beneficiaries or otherwise; and the proceeds of an endowment policy, payable to the insured on attaining a certain age, to the extent of twenty thousand dollars shall at all times be exempted from the debts of such spouse or children of the insured; and the avails of any life or health insurance or other sum of money not exceeding twenty thousand dollars made payable by any mutual aid or benevolent society to any member or beneficiary spouse or children or both shall likewise be exempt.
Source:
SL 1966, ch 111, ch 22, §31.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-5 - "Annuity contract" defined.

58-12-5. Annuity contract defined.
An annuity contract within the meaning of §§58-12-6 to 58-12-10, inclusive, shall be any obligation to pay certain sums at stated times, during life or lives, or for a specified term or terms, issued for a valuable consideration, regardless of whether or not such sums are payable to one or more persons, jointly or otherwise but does not include payments under life insurance contracts at stated times during life or lives, or for a specified term or terms.
Source:
SL 1966, ch 111, ch 22, §32 (3).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-6 - Exemption of annuity contract benefits, rights, privileges, and options from execution.

58-12-6. Exemption of annuity contract benefits, rights, privileges, and options from execution.
The benefits, rights, privileges, and options which under any annuity contract heretofore or hereafter issued are due or prospectively due the annuitant, shall not be subject to execution nor shall the annuitant be compelled to exercise any such rights, powers, or options, nor shall creditors be allowed to interfere with or terminate the contract, except as provided by §§58-12-7 to 58-12-9, inclusive.
Source:
SL 1966, ch 111, ch 22, §32 (1).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-7 - Premiums paid on annuity with intent to defraud creditors not exempt from execution.

58-12-7. Premiums paid on annuity with intent to defraud creditors not exempt from execution.
Section 58-12-6 does not apply to amounts paid as premium on any such annuity with the intent to defraud creditors, with interest thereon, and of which the creditor has given the insurer written notice at its home office prior to the making of the payments to the annuitant out of which the creditor seeks to recover. Any such notice shall specify the amount claimed or such facts as will enable the insurer to ascertain such amount, and shall set forth such facts as will enable the insurer to ascertain the annuity contract, the annuitant and the payment sought to be avoided on the ground of fraud.
Source:
SL 1966, ch 111, ch 22, §32 (1) (a).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-8 - Maximum amount of annuity exemption--Excess subject to levy.

58-12-8. Maximum amount of annuity exemption--Excess subject to levy.
The total exemption under §58-12-6 of benefits presently due and payable to any annuitant periodically or at stated times under all annuity contracts under which he is an annuitant, shall not at any time exceed two hundred and fifty dollars per month for the length of time represented by such installments, and such periodic payments in excess of two hundred and fifty dollars per month shall be subject to levy in the manner provided by law and the rules of court.
Source:
SL 1966, ch 111, ch 22, §32 (1) (b).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-9 - Application of excess annuities to judgment--Factors considered.

58-12-9. Application of excess annuities to judgment--Factors considered.
If the total benefits presently due and payable to any annuitant under all annuity contracts under which he is an annuitant, shall at any time exceed payment at the rate of two hundred and fifty dollars per month, then the court may order such annuitant to pay to a judgment creditor or apply on the judgment, in installments, such portion of such excess benefits as to the court may appear just and proper, after due regard for the reasonable requirements of the judgment debtor and his family, if dependent upon him, as well as any payments required to be made by the annuitant to other creditors under prior court orders.
Source:
SL 1966, ch 111, ch 22, §32 (1) (c).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-10 - Benefits, rights, privileges, or options nontransferable under annuity contract--Not subject to commutation--Exemption from execution.

58-12-10. Benefits, rights, privileges, or options nontransferable under annuity contract--Not subject to commutation--Exemption from execution.
If an annuity contract so provides, the benefits, rights, privileges, or options accruing under such contract to a beneficiary or assignee shall not be transferable nor subject to commutation, and if the benefits are payable periodically or at stated times, the same exemptions and exceptions contained in §§58-12-6 to 58-12-9, inclusive, for the annuitant, shall apply with respect to such beneficiary or assignee.
Source:
SL 1966, ch 111, ch 22, §32 (2).
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-11 - Payments under life or health insurance policy or annuity contract discharge insurer.

58-12-11. Payments under life or health insurance policy or annuity contract discharge insurer.
Whenever the proceeds of or payments under a life or health insurance policy or annuity contract heretofore or hereafter issued become payable in accordance with the terms of such policy or contract, or the exercise of any right or privilege thereunder, payment thereof by the insurer in accordance therewith or in accordance with any written assignment thereof shall fully discharge the insurer from all claims under the policy or contract unless, before payment is made, the insurer has received at its home office written notice by or on behalf of some other person that such other person claims to be entitled to such payment or some interest in the policy or contract.
Source:
SL 1966, ch 111, ch 22, §28.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-12 - Use of uniform health insurance claim forms.

58-12-12. Use of uniform health insurance claim forms.
The director shall prescribe the use of nationally recognized uniform health insurance claim forms for hospitals and other medical or dental providers and for governmental agencies which shall be used and accepted by all insurers transacting health insurance, providing medical coverage through a personal automobile policy, workers' compensation, or otherwise providing coverage for medical services and by all hospitals and medical providers, and by governmental agencies of the state that require insurance claim forms for their records. The director shall also prescribe the use of nationally recognized uniform explanation of benefit forms by insurers.
Source:
SL 1994, ch 381, §5.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-13 - Use of claim forms required by federal law excepted.

58-12-13. Use of claim forms required by federal law excepted.
An insurer, governmental agency, hospital, or other medical or dental provider does not violate §58-12-12 by using a claim form or explanation of benefit form which the insurer, governmental agency, hospital, or other medical or dental provider has been required to use by federal law.
Source:
SL 1994, ch 381, §6.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-14 - Promulgation of rules for uniform health insurance claim forms.

58-12-14. Promulgation of rules for uniform health insurance claim forms.
The director of insurance may, pursuant to chapter 1-26, promulgate rules for the creation, design, implementation, and use of uniform health insurance claim forms and explanation of benefit forms.
Source:
SL 1994, ch 381, §7.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-15 - "Paintless dent repair" defined.

58-12-15. Paintless dent repair defined.
For the purposes of §§58-12-15 to 58-12-18, inclusive, paintless dent repair is any auto body repair that removes minor dents by using specifically designed tools to manipulate and flex the metal from the backside of the dent without the necessity of sanding, priming, or painting.
Source:
SL 2000, ch 239, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-16 - Motor vehicle insurer must provide sufficient compensation to restore vehicle to prior condition--Adjustment for paintless dent repair permitted--Conditions.

58-12-16. Motor vehicle insurer must provide sufficient compensation to restore vehicle to prior condition--Adjustment for paintless dent repair permitted--Conditions.
Any insurer providing commercial or personal motor vehicle insurance in this state responsible for repairing a damaged vehicle for which it is liable shall provide sufficient compensation to the insured to restore the vehicle to substantially the same physical condition as prior to the damage, regardless of whether the insured actually chooses to repair the vehicle. The insurer may adjust claims based in whole or in part upon the paintless dent repair method if:
(1)The damage is such that the paintless dent repair method is likely to place the damaged area or a portion thereof in substantially the same condition as prior to the damage;
(2)A paintless dent repair shop holding a South Dakota sales tax license is willing to perform the work as estimated within a reasonable time frame in the local market area of the insured; and
(3)The written estimate provided to the insured prominently discloses the following:
(a)That the repair estimate is based in whole or in part upon the paintless dent repair method. Each item of damage adjusted using that method shall be identified;
(b)That paintless dent repair may not be the appropriate repair method for all types of damage;
(c)That, if the insurer is liable for the damage listed on the estimate, the insurer shall provide sufficient compensation to restore the vehicle to substantially the same physical condition; and
(d)That for any damage which paintless dent repair is appropriate, the insured may choose not to repair the vehicle or to have the vehicle repaired using a different method of repair. If the insured chooses either of these options, the insurer is liable only for the cost of the paintless dent repair method.
However, if the insurer pays the claim based upon the paintless dent repair method and paintless dent repair was attempted but was unsuccessful, the insurer is liable for any repairs necessary to the area repaired by paintless dent repair, using the conventional method of repair, to restore the vehicle to substantially the same physical condition as prior to the damage.
Source:
SL 2000, ch 239, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-17 - Compensation when paintless dent repair method inappropriate--Requiring unreasonable travel prohibited--Repair shop as payee only if insured agrees.

58-12-17. Compensation when paintless dent repair method inappropriate--Requiring unreasonable travel prohibited--Repair shop as payee only if insured agrees.
If, for any portion of the vehicle's damage that the insurer has a duty to repair, the paintless dent repair method is inappropriate, the insurer shall compensate the insured for the amount necessary to complete the repairs in the local market area of the insured. The insurer may not require the insured to travel an unreasonable distance to obtain a repair estimate or to have the vehicle repaired. The insurer may not name a repair shop as payee on a compensation check or draft unless agreed to by the insured.
Source:
SL 2000, ch 239, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-18 - Compliance with § 58-12-16.

58-12-18. Compliance with §58-12-16.
An insurer may comply with §58-12-16 by entering into an agreement with a repairer that guarantees repairs and by notifying the insured of such an agreement.
Source:
SL 2000, ch 239, §4.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-19 - Clean claim defined.

58-12-19. Clean claim defined.
As used in §§58-12-19 to 58-12-21, inclusive, the term, clean claim, means a claim for which there is no need for additional information to determine eligibility or adjudicate the claim. The term, clean claim, does not include a claim for payment of expenses incurred during a period of time for which premiums are delinquent, except to the extent otherwise required by law or a claim for which fraud is suspected.
Source:
SL 2001, ch 273, §1.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-20 - Time limits for processing clean claims--Time limit for additional information required.

58-12-20. Time limits for processing clean claims--Time limit for additional information required.
Each clean claim shall be paid to the person entitled thereto, denied, or settled within thirty calendar days after receipt by the carrier if submitted electronically and within forty-five calendar days after receipt by the carrier and if the claim is payable under the plan. If the resolution of an otherwise clean claim requires additional information, the carrier shall, within thirty calendar days after receipt of the claim, give the provider, policyholder, insured, or patient, as appropriate, a full explanation of what additional information is needed in order to determine eligibility or adjudicate the claim. The person receiving a request for additional information shall submit all additional information requested by the carrier within thirty calendar days after receipt of such request.
Source:
SL 2001, ch 273, §2.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-21 - Applicability of §§ 58-12-19 to 58-12-21--Certain policies exempt--No private right of action.

58-12-21. Applicability of §§58-12-19 to 58-12-21--Certain policies exempt--No private right of action.
Sections 58-12-19 to 58-12-21, inclusive, apply to any health insurer or health maintenance organization that issues health insurance coverage pursuant to chapters 58-17, 58-18, 58-18B, 58-37A, 58-38, 58-39, 58-40, and 58-41. Nothing in §§58-12-19 to 58-12-21, inclusive, apply to disability income policies or certificates, accident only, credit health, workers' compensation, long-term care, medicare supplement, automobile medical payment, or other types of health insurance that are not medical expense policies or certificates. Nothing in §§58-12-19 to 58-12-21, inclusive, grants a private right of action.
Source:
SL 2001, ch 273, §3.
2023 South Dakota Codified Laws › Title 58 - Insurance › Chapter 12 - Insurance Claims And Benefits › Section 58-12-22 - Information from insurer's database to Department of Social Services--Data match against recipients--Disclosure--Liability.

58-12-22. Information from insurer's database to Department of Social Services--Data match against recipients--Disclosure--Liability.
Within sixty days of a request from the department, the department and an insurer shall negotiate an acceptable format for the transmission of information from the insurer's database of policy holders, sponsors, subscribers, covered individuals in South Dakota, and coverage dates. The format must include the data elements, medium, frequency of reporting, any costs of the insurer to be reimbursed, and procedures that will be followed when a data match is found. The Department of Social Services shall match the name, address, date of birth, and social security number if available, of the insured's policyholders, sponsors, subscribers, and covered individuals against the medicaid eligible recipients and recipients of support enforcement services as defined in subdivision 25-7A-1(19).
Upon discovery of a match, the department may incorporate the following information into its recipient database:
(1)The name, address, date of birth, social security number if available, and the unique health care identification number of the covered individual;
(2)The name, address, date of birth, social security number if available, policy number, and 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;
(4)Types of covered services under the plan or policy;
(5)Coverage effective date and termination of coverage date for each covered individual; and
(6)The name and address of the claim administrator for the policy or plan.
The department may not use or disclose any information provided by the insurer other than as permitted or required by law. The insurer may not be held liable for the release of insurance coverage information to the department or the director by any party when done so under the authority of §§58-12-22 to 58-12-28, inclusive.
Source:
SL 2005, ch 263, §1; SL 2021, ch 210, § 5.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.