14 Va. Admin. Code § 5-400-50

Current through Register Vol. 41, No. 9, December 16, 2024

Section 14VAC5-400-50 - Acknowledgment of pertinent communications

A. An insurer, upon receiving notification of a claim shall, within 15 calendar days, acknowledge the receipt of such notice to the claimant unless payment is made within such period of time, except that if a provider submits a claim, acknowledgment of the claim is satisfied if payment or denial of the claim is made to the provider within 21 calendar days. If an acknowledgment is made by means other than writing, an appropriate notation of such acknowledgment shall be made in the claim file of the insurer and dated. Notification given by a claimant to an agent of an insurer shall be notification to the insurer.

B. Upon receipt of any inquiry from the commission respecting a claim, an insurer shall furnish a complete response to the inquiry within 15 calendar days of receipt.

C. An appropriate reply shall be made within 15 calendar days on all other pertinent communications from a claimant that reasonably suggest that a response is expected.

D. Upon receiving notification of a claim, an insurer shall promptly provide necessary claim forms, instructions, and reasonable assistance in order for the claimant to comply with the applicable policy conditions and the insurer's reasonable requirements. Compliance with this subsection within 15 calendar days of notification of a claim shall constitute compliance with subsection A of this section.

14 Va. Admin. Code § 5-400-50

Derived from Regulation 12, Case No. 19961, §6, eff. September 15, 1978; Amended, Virginia Register Volume 33, Issue 22, eff. 1/1/2018.

Statutory Authority: §§ 12.1-13, 38.2-223, and 38.2-510 of the Code of Virginia.