Nothing in this title shall limit the ability of the general assembly to direct the accounting principles to be used by insurers authorized in this state in order to create uniformity.
Source: L. 2003: Entire article RC&RE, p. 605, � 1, effective July 1.
Editor's note: This section is similar to former � 10-1-133 as it existed prior to 2002.
10-1-133. Consumer insurance council - creation - advisory body - appointment of members - meetings - repeal. (1) There is hereby created in the division the consumer insurance council, also referred to in this section as the council. The council is an advisory body to the commissioner concerning insurance matters of interest to the public. Nothing in this section divests the commissioner of the commissioner's authority to regulate the business of insurance.
(2) (a) The council consists of at least six and not more than fifteen members appointed by the commissioner, all of whom must represent consumer organizations or be consumers who are not engaged, directly or indirectly, in the insurance industry or any other industry, business, or profession that might present a conflict of interest, as determined by the commissioner, and one of whom must be a consumer whose first language is not English. To the greatest extent possible, the council must reflect the geographic and demographic diversity of the state. Insurance producers, insurance industry representatives, actively practicing health-care providers, and any other individuals who may have a conflict of interest, as determined by the commissioner, are not eligible for membership on the council.
(b) The commissioner shall appoint members of the council in a timely manner. Members shall serve two-year terms with a maximum of three consecutive terms.
(c) Three or more unexcused absences of a member of the council constitute grounds for the removal of the member. The chair of the council, in consultation with the commissioner, shall determine whether a member with three or more unexcused absences may continue service on the council. If a member is removed, the commissioner shall appoint a new member to serve the remaining portion of the two-year term.
(d) Members of the council shall serve without compensation but are entitled to reimbursement for actual and necessary expenses incurred in traveling to and from council meetings, including any required dependent care and dependent or attendant travel, food, and lodging expenses.
(3) (a) The council shall elect a chair from its membership. The chair shall serve a one-year term and may be elected to another one-year term.
(b) The council shall elect a vice-chair from its membership. The vice-chair shall serve in the absence of the chair. The vice-chair shall serve a one-year term and may be elected to another one-year term.
(4) (a) The council shall meet quarterly and may request up to four additional meetings per year. All meetings of the council are open to the public. General meetings of the council shall be held at the office of the division. The council may meet in other locations of the state as agreed upon by the council. Members of the council may participate in meetings via telephonic communications.
(b) A council member may request a special meeting. Requests for special meetings must be made to the chair of the council.
(c) All members of the council may request topics of discussion for the council.
(d) The council must act by consensus.
(e) The council may submit recommendations to the commissioner, including legislative recommendations. If the council submits a recommendation to the commissioner, the commissioner shall provide a response to the council, in a timely manner, regarding the recommendation and how the commissioner will address the recommendation.
(5) This section is repealed, effective September 1, 2029. Before the repeal, the council is scheduled for review in accordance with section 2-3-1203.
Source: L. 2008: Entire section added, p. 158, � 1, effective July 1; (5.5) added, p. 2255, � 8, effective July 1. L. 2009: (5.5) and (6) amended, (SB 09-292), ch. 369, p. 1940, � 9, effective August 5. L. 2019: Entire section RC&RE, (HB 19-1150), ch. 113, p. 483, � 1, effective August 2. L. 2024: (2)(a) amended, (HB 24-1440), ch. 320, p. 2141, � 2, effective May 31.
Editor's note: Subsection (6) provided for the repeal of this section, effective July 1, 2018. (See L. 2008, p. 158.)
10-1-134. Office of insurance ombudsman - plan - report to joint budget committee. On or before September 15, 2008, the commissioner shall present a plan to the joint budget committee of the general assembly regarding the establishment of an office of insurance ombudsman. The plan shall include an assessment of the need to establish the office, a plan to implement the office, and the estimated costs associated with establishing and maintaining the office. The plan shall require the ombudsman to assist consumers with issues related to insurance availability, claims processing, coverage questions, and other matters related to insurance consumer education and assistance.
Source: L. 2008: Entire section added, p. 2247, � 2, effective August 5.
10-1-135. Reimbursement for benefits - limitations - notice - definitions - legislative declaration. (1) The general assembly hereby finds and declares that:
(a) When a payer of benefits seeks repayment of the benefits provided to an injured party, the repayment reduces the amount available to the injured party to compensate him or her for injuries and damages other than the cost of medical care and medical services;
(b) Reimbursement or repayment of benefits should not be permitted when the injured party would not be fully compensated for his or her injuries and damages;
(c) It is in the best interests of the citizens of this state to ensure that each insured injured party recovers full compensation for bodily injury caused by the act or omission of a third party, and that such compensation is not diminished by repayment, reimbursement, or subrogation rights of the payer of benefits;
(d) This law regulating insurance and health benefit plans is intended to ensure that an injured party who recovers damages for bodily injuries caused by a third party and receives benefits pursuant to an insurance policy, contract, or benefit plan is fully compensated for his or her injuries and damages before the payer of benefits may seek repayment of benefits provided to the injured party;
(e) In the absence of this section, payers of benefits may seek repayment of benefits out of a recovery obtained by the injured party without paying attorney fees incurred by the injured party in obtaining the recovery, thereby benefitting from attorney services for which they did not pay;
(f) This section is intended to require a payer of benefits to pay a proportionate share of the attorney fees when the payer of benefits is a beneficiary of the attorney services paid for by the injured party.
(2) As used in this section, unless the context otherwise requires:
(a) Benefits means payment or reimbursement of health-care expenses, health-care services, disability payments, lost wage payments, or any other benefits of any kind, including discounts and write-offs, provided to or on behalf of an injured party under a policy of insurance, contract, or benefit plan with an individual or group, whether or not provided through an employer.
(b) Injured party means a person who has sustained bodily injury as the result of the act or omission of a third party, has pursued a personal injury or similar claim against the third party or has made a claim under his or her uninsured or underinsured motorist coverage, and has received benefits as a policyholder, participant, or beneficiary from the payer of benefits. Injured party includes the personal representative of the estate of an injured party or the legal representative of a person under a disability as provided in article 81 of title 13, C.R.S.
(c) (I) Payer of benefits means any insurer, health maintenance organization, health benefit plan, preferred provider organization, employee benefit plan, other insurance policy or plan, or any other payer of benefits. Payer of benefits includes a fiduciary of an insurer, plan, or other payer of benefits.
(II) Payer of benefits does not include a program of medical assistance under the Colorado Medical Assistance Act, articles 4 to 6 of title 25.5, C.R.S., or the children's basic health plan, as defined in article 8 of title 25.5, C.R.S.
(d) Recovery means recovery of a monetary award from a third party through either settlement or judgment to compensate an injured party for bodily injury sustained as a result of an act or omission of the third party. Recovery includes benefits paid or settlement of claims under uninsured or underinsured motorist coverage pursuant to section 10-4-609.
(3) (a) (I) Reimbursement or subrogation pursuant to a provision in an insurance policy, contract, or benefit plan is permitted only if the injured party has first been fully compensated for all damages arising out of the claim. Any provision in a policy, contract, or benefit plan allowing or requiring reimbursement or subrogation in circumstances in which the injured party has not been fully compensated is void as against public policy.
(II) This paragraph (a) does not limit the right of an insurer to seek reimbursement or subrogation to recover amounts paid for property damage or the right of an insurer providing uninsured or underinsured motorist coverage pursuant to section 10-4-609 to an injured party to pursue claims against an at-fault third party, and any amounts recovered by such insurer shall not be reduced pursuant to paragraph (c) of this subsection (3).
(b) If the injured party is fully compensated and reimbursement or subrogation of benefits is authorized, the reimbursement or subrogation amount cannot exceed the amount actually paid by the payer of benefits to cover benefits under the policy, contract, or benefit plan or, for health-care services provided on a capitated basis, the amount equal to eighty percent of the usual and customary charge for the same services by health-care providers that provide health-care services on a noncapitated basis in the geographic region in which the services are rendered.
(c) The amount recoverable, if any, by the payer of benefits for reimbursement or subrogation shall be reduced by an amount equal to the payer of benefits' proportionate share of the attorney fees and expenses incurred by or on behalf of the injured party in making the recovery, based on the ratio of the amount of attorney fees and expenses incurred to the amount of the recovery.
(d) (I) If the injured party makes a recovery of an amount that is less than the total amount of coverage available under any third-party liability insurance policy or uninsured or underinsured motorist coverage pursuant to section 10-4-609, there is a rebuttable presumption that the injured party has been fully compensated. If the injured party makes a recovery of an amount equal to the total amount of coverage available under all third-party liability insurance policies and uninsured or underinsured motorist coverages, there is a rebuttable presumption that the injured party has not been fully compensated.
(II) If the injured party obtains a judgment, the amount of the judgment is presumed to be the amount necessary to fully compensate the injured party.
(4) (a) (I) Any disputes between the payer of benefits and the injured party regarding entitlement to reimbursement or subrogation shall be resolved in accordance with this paragraph (a), regardless of whether administrative remedies contained in the policy, contract, or benefit plan documents have been exhausted by the injured party.
(II) If the injured party obtains a recovery that is less than the sum of all damages incurred by the injured party and intends to enforce the requirements of subsection (3) of this section, the injured party shall notify the payer of benefits within sixty days of receipt of each recovery. The notice shall include the total amount and source of the recovery; the coverage limits applicable to any available insurance policy, contract, or benefit plan; and the amount of any costs charged to the injured party. If recovery was obtained through a settlement agreement that contains a confidentiality provision that affects the information required by this subparagraph (II), the confidentiality provision is unenforceable as to the disclosure of the required information.
(III) If the payer of benefits disputes that the injured party's recovery is less than the sum of all damages incurred by the injured party, the dispute shall be resolved by arbitration. The payer of benefits may request arbitration of the dispute to determine the extent to which the payer of benefits may be entitled to share in the recovery pursuant to subsection (3) of this section. The payer of benefits may request arbitration no later than sixty days after receipt of any notice under subparagraph (II) of this paragraph (a).
(IV) If the payer of benefits requests arbitration of the dispute, the injured party and the payer of benefits shall jointly choose an arbitrator to resolve the dispute. If the injured party and the payer of benefits cannot agree on an arbitrator, the dispute shall be resolved by a panel of three arbitrators selected as follows:
(A) The injured party shall select one arbitrator;
(B) The payer of benefits shall select one arbitrator; and
(C) The arbitrators chosen by the parties pursuant to sub-subparagraphs (A) and (B) of this subparagraph (IV) shall select the third arbitrator.
(b) If the arbitrator determines that the amount of the recovery does not fully compensate the injured party for his or her damages, the payer of benefits shall have no right to repayment, reimbursement, or subrogation.
(5) A payer of benefits shall not deny or refuse to provide any plan benefits otherwise available to an injured party because of the existence of a potential personal injury or similar claim or the resolution of a personal injury or similar claim.
(6) (a) (I) Except as provided in subparagraph (II) of this paragraph (a), a payer of benefits shall not bring a direct action for subrogation or reimbursement of benefits against a third party allegedly at fault for the injury to the injured party or an insurer providing uninsured motorist coverage.
(II) If an injured party has not pursued a claim against a third party allegedly at fault for the injured party's injuries by the date that is sixty days prior to the date on which the statute of limitations applicable to the claim expires, a payer of benefits may bring a direct action for subrogation or reimbursement of benefits against an at-fault third party. Nothing in this subparagraph (II) precludes an injured party from pursuing a claim against the at-fault third party after the payer of benefits brings a direct action pursuant to this subparagraph (II), and the payer of benefits' right to reimbursement or subrogation is limited by subsection (3) of this section.
(b) A third party shall not include a payer of benefits that is claiming repayment or reimbursement pursuant to subsection (3) of this section as a copayee on any check or draft in payment of a settlement with or judgment for or on behalf of the injured party.
(7) (a) A payer of benefits shall not delay, withhold, or otherwise reduce benefits:
(I) Because the obligation to pay benefits results from an act or omission for which a third party may be liable; or
(II) As a means of enforcing or attempting to enforce a claim for reimbursement or subrogation.
(b) Nothing in this subsection (7) prohibits the coordination of benefits between or among payers of benefits.
(8) When a payer of benefits obtains reimbursement of benefits paid in accordance with this section, the payer of benefits shall apply the amount of the reimbursement as a credit against any lifetime maximum benefit contained in the policy, plan, or contract under which the benefits were paid.
(9) Any language in an insurance policy, contract, or benefit plan that is contrary to this section is void and unenforceable. Although such language is unenforceable, nothing in this section requires an insurer to modify and refile with the commissioner, prior to the standard filing date, an insurance policy, contract, or benefit plan that contains language that is contrary to this section.
(10) Nothing in this section modifies:
(a) The requirement of section 13-21-111.6, C.R.S., regarding the reduction of damages based on amounts paid for the damages from a collateral source. The fact or amount of any collateral source payment or benefits shall not be admitted as evidence in any action against an alleged third-party tortfeasor or in an action to recover benefits under section 10-4-609.
(b) Lien rights of hospitals pursuant to section 38-27-101, C.R.S., or of the department of health care policy and financing pursuant to section 25.5-4-301 (5), C.R.S.; or
(c) Subrogation and lien rights granted to workers' compensation carriers or self-insured employers pursuant to section 8-41-203, C.R.S.
Source: L. 2010: Entire section added, (HB 10-1168), ch. 164, p. 575, � 1, effective August 11.
10-1-136. Insurance policies - language other than English - increasing access for non-English-speaking consumers - definitions. (1) An insurer may conduct transactions in a language other than English.
(2) An insurer authorized to offer insurance in this state may provide insurance policies, endorsements, riders, and any explanatory or advertising materials in a language other than English. If an insurer opts to provide an insurance policy, endorsement, or rider to the customer in a language other than English, the insurer must also provide the English version at the same time. In the event of a dispute or complaint regarding the insurance or advertising materials, the English language version of the insurance document controls the resolution of the dispute or complaint.
(3) (a) A non-English-language policy delivered or issued for delivery in this state is deemed to comply with articles 4 and 16 of this title 10 if the insurer certifies that the policy is translated:
(I) From an English-language policy that complies with this title 10;
(II) Correctly; and
(III) By a certified translator who has certified that the policy is correctly translated or, if a certified translator is not available to translate the policy from English into a language for which the American Translators Association certifies translators, by a qualified translator who has certified that the policy is correctly translated.
(b) An insurer shall maintain copies of all translated policies, endorsements, riders, and any explanatory or advertising materials and make them available for review by the commissioner upon request.
(3.5) The commissioner shall use councils established within the division, including the producer advisory council and any other councils established by the commissioner, to engage with bilingual insurance producers to discuss the insurance market for non-English-speaking consumers, including ways to increase access to insurance products and services for non-English-speaking consumers.
(4) As used in this section:
(a) American Translators Association means the national, nonprofit professional association, or its successor organization, that offers certification for translators.
(b) Certified translator means an individual who is certified as a translator by the American Translators Association.
Source: L. 2013: Entire section added, (HB 13-1233), ch. 17, p. 622, � 31, effective August 7. L. 2014: (2) amended, (HB 14-1282), ch. 128, p. 452, � 1, effective August 6. L. 2023: (3) amended and (4) added, (HB 23-1004), ch. 64, p. 228, � 1, effective January 1, 2024. L. 2024: (3.5) added, (HB 24-1440), ch. 320, p. 2142, � 3, effective May 31.
10-1-137. Electronic delivery of documents - when permitted - definitions - consent - construction with other laws. (1) As used in this section, unless the context otherwise requires:
(a) Delivered or delivery by electronic means to a party includes:
(I) Delivery to an electronic mail address at which the party has consented to receive notices or documents; and
(II) Posting on an electronic network or website accessible to the party via the internet, mobile application, computer, mobile device, tablet, or any other electronic device if the party is given separate notice of the posting by either:
(A) Electronic mail to the electronic mail address at which the party has consented to receive notice; or
(B) Any other delivery method that has been consented to by the party.
(b) Party means any recipient of a notice or document required as part of an insurance transaction. The term includes an applicant, an insured, a policyholder, and an annuity contract holder.
(2) Subject to subsection (4) of this section, any notice to a party or any other document required under applicable law in an insurance transaction or that is to serve as evidence of insurance coverage may be delivered, stored, and presented by electronic means if it meets the requirements of the Uniform Electronic Transactions Act, article 71.3 of title 24, C.R.S.
(3) Delivery of a notice or document in accordance with this section is equivalent to any delivery method required under applicable law, including delivery by first-class mail; first-class mail, postage prepaid; certified mail; certificate of mail; or certificate of mailing.
(4) A notice or document may be delivered by electronic means by an insurer to a party under this section if:
(a) The party has affirmatively consented to that method of delivery and has not withdrawn the consent;
(b) The party, before giving consent, is provided with a clear and conspicuous statement informing the party of:
(I) Any right or option of the party to have the notice or document provided or made available in paper or another nonelectronic form;
(II) The right of the party to withdraw consent to have a notice or document delivered by electronic means and any conditions or consequences imposed if the consent is withdrawn;
(III) Whether the party's consent applies:
(A) Only to the particular transaction as to which the notice or document must be given; or
(B) To identified categories of notices or documents that may be delivered by electronic means during the course of the party's relationship with the insurer;
(IV) The means, after consent is given, by which the party may obtain a paper copy of a notice or document delivered by electronic means; and
(V) The procedure a party must follow to withdraw consent to have a notice or document delivered by electronic means and to update information needed to contact the party electronically;
(c) The party:
(I) Before giving consent, is provided with a statement of the hardware and software requirements for access to and retention of a notice or document delivered by electronic means; and
(II) Consents electronically, or confirms consent electronically, in a manner that reasonably demonstrates that the party can access information in the electronic form that will be used for notices or documents delivered by electronic means as to which the party has given consent; and
(d) If, after the party consents, a change in the hardware or software requirements needed to access or retain a notice or document delivered by electronic means creates a material risk that the party will not be able to access or retain a subsequent notice or document to which the consent applies, the insurer:
(I) Provides the party with a statement of:
(A) The revised hardware and software requirements for access to and retention of a notice or document delivered by electronic means; and
(B) The right of the party to withdraw consent without the imposition of any condition or consequence that was not disclosed under subparagraph (II) of paragraph (b) of this subsection (4); and
(II) Provides the party with a complete and updated version of the information listed in paragraph (b) of this subsection (4).
(5) This section does not affect any requirement related to the content or timing of a notice or other document required under applicable law.
(6) If a provision of this title or other applicable law requiring a notice or document to be provided to a party expressly requires verification or acknowledgment of receipt of the notice or document, the notice or document may be delivered by electronic means only if the method used provides for verification or acknowledgment of receipt.
(7) The legal effectiveness, validity, or enforceability of any contract or policy of insurance executed by a party shall not be denied solely because of the failure to obtain electronic consent or confirmation of consent of the party in accordance with subparagraph (II) of paragraph (c) of subsection (4) of this section.
(8) (a) A withdrawal of consent by a party:
(I) Does not affect the legal effectiveness, validity, or enforceability of a notice or document delivered by electronic means to the party before the withdrawal of consent is effective; and
(II) Is effective within a reasonable period of time after receipt of the withdrawal by the insurer.
(b) An insurer's failure to comply with paragraph (d) of subsection (4) of this section may be treated, at the election of the party, as a withdrawal of consent for purposes of this section.
(9) This section does not apply to a notice or document delivered by electronic means before August 6, 2014, to a party who, before that date, had consented to receive notice or documents in an electronic form otherwise allowed by law.
(10) If the consent of a party to receive certain notices or documents in an electronic form is on file with an insurer before August 6, 2014, and the insurer intends to deliver additional notices or documents to such party in an electronic form pursuant to this section, then, before delivering the additional notices or documents by electronic means, the insurer shall notify the party of:
(a) Any notices or documents that may be delivered by electronic means under this section that were not previously delivered electronically; and
(b) The party's right to withdraw consent to have notices or documents delivered by electronic means.
(11) (a) Except as otherwise provided by law, if an oral communication or a recording of an oral communication from a party can be reliably stored and reproduced by an insurer, the oral communication or recording qualifies as a notice or document delivered by electronic means for purposes of this section.
(b) If a provision of this title or other applicable law requires a signature or notice or document to be notarized, acknowledged, verified, or made under oath, the requirement is satisfied if the electronic signature of the person authorized to perform those acts, together with all other information required to be included by the provision, is attached to or logically associated with the signature, notice, or document.
(12) (a) This section shall not be construed to modify, limit, or supersede the provisions of the federal Electronic Signatures in Global and National Commerce Act, Pub.L. 106-229, as amended.
(b) In the event of any conflict between this section and the Uniform Electronic Transactions Act, article 71.3 of title 24, C.R.S., this section controls.
Source: L. 2014: Entire section added, (HB 14-1344), ch. 207, p. 762, � 1, effective August 6.
10-1-138. Internet posting of standard insurance provisions - conditions - notice of revisions. (1) Notwithstanding any provision of section 10-1-137 to the contrary, standard insurance policies and endorsements that do not contain personally identifiable information may be mailed, delivered, or posted on the insurer's website. If the insurer elects to post insurance policies and endorsements on its website in lieu of mailing or delivering them to the insured, it shall comply with all of the following conditions:
(a) The policies and endorsements must be accessible on the website and remain so for as long as the policies are in force.
(b) The policies and endorsements must be posted in a manner that enables the insured to print and save the policies and endorsements using programs or applications that are widely available on the internet and free to use.
(c) The insurer shall provide the following information in, or simultaneously with, each declarations page provided at the time of issuance of the initial policy and any renewals of that policy:
(I) A description of the exact policy and endorsement forms purchased by the insured;
(II) A method by which the insured may obtain, upon request and without charge, a paper or electronic copy of each policy and endorsement purchased by the insured; and
(III) The internet address where the insured's policies and endorsements are posted.
(d) The insurer shall archive its expired policies and endorsements for at least five years and make them available upon request.
(e) The insurer shall provide the insured with notice, in the same manner in which the insurer customarily communicates with the insured, of:
(I) Any changes to the forms or endorsements;
(II) The insured's right to obtain, upon request and without charge, a paper copy of the forms or endorsements; and
(III) The internet address where the forms or endorsements are posted.
Source: L. 2014: Entire section added, (HB 14-1344), ch. 207, p. 762, � 1, effective August 6.