Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 60 - Miscellaneous › Part 4 - Record Retention (230-RICR-20-60-4) › Section 230-RICR-20-60-4.6 - Claim File

Current through June 14, 2024
A. A claim file and
				  accompanying records shall be maintained for the calendar year in which the
				  claim is closed plus four (4) years. The claim file shall be maintained so as
				  to show clearly the inception, handling and disposition of each claim. The
				  claim files shall be sufficiently clear and specific so that pertinent events
				  and dates of these events can be reconstructed. A claim file shall, at a
				  minimum, include the following items:
1. For
				  property and casualty: the file or files containing the notice of claim, claim
				  forms, proof of loss or other form of claim submission, settlement demands,
				  accident reports, police reports, adjustors logs, claim investigation
				  documentation, inspection reports, supporting bills, estimates and valuation
				  worksheets, medical records, correspondence to and from insureds and claimants
				  or their representatives, notes, contracts, declaration pages, certificates
				  evidencing coverage under a group contract, endorsements or riders, work
				  papers, any written communication, any documented or recorded telephone
				  communication related to the handling of a claim, including the investigation,
				  payment or denial of the claim, copies of claim checks or drafts, or check
				  numbers and amounts, releases, all applicable notices, correspondence used for
				  determining and concluding claim payments or denials, subrogation and salvage
				  documentation, any other documentation created and maintained in a paper or
				  electronic format, necessary to support claim handling activity, and any claim
				  manuals or other information necessary for reviewing the claim.
2. For life and annuity: the file or files
				  containing the notice of claim, claim forms, proofs of loss, medical records,
				  correspondence to and from insureds and claimants or their representatives,
				  claim investigation documentation, claim handling logs, copies of checks or
				  drafts, check numbers and amounts, releases, correspondence, all applicable
				  notices, and correspondence used for determining and concluding claim payments
				  or denials, any written communication, any documented or recorded telephone
				  communication related to the handling of a claim, including the investigation,
				  and any other documentation, maintained in a paper or electronic format,
				  necessary to support claim handling activity.
3. For health: the file or files containing
				  the notice of claim, claim forms, medical records, bills, electronically
				  submitted bills, proofs of loss, correspondence to and from insureds and
				  claimants or their representatives, claim investigation documentation, health
				  facility pre-admission certification or utilization review documentation, claim
				  handling logs, copies of explanation of benefit statements, any written
				  communication, any documented or recorded telephone communication related to
				  the handling of a claim, including the investigation, copies of checks or
				  drafts, or check numbers and amounts, releases, correspondence, all applicable
				  notices, and correspondence used for determining and concluding claim payments
				  or denials, and any other documentation, maintained in a paper or electronic
				  format, necessary to support claim handling activity.