Title 27, INSURANCE

Sec. 13. A violation of this chapter does not create a private cause of action. As added by P.L.226-2023, SEC.20.

Sec. 2. (a) As used in this chapter, "automobile policy" means a policy providing one (1) or more of the types of insurance described in Class 2(f) of IC 27-1-5-1. (b) The term includes an automobile policy under which the insured vehicle designated in the policy is rated as priv…

Sec. 3. (a) As used in this chapter, "homeowner's policy" means a policy that provides: (1) coverage for: (A) damage to or the destruction of: (i) a structure; or (ii) a unit within a structure; that is used as a residence by one (1) or more individuals; and (B) damage to or the …

Sec. 4. As used in this chapter, "insured" means an individual who is the first named insured on the declarations page of a personal automobile or homeowner's policy. As added by P.L.226-2023, SEC.20.

Sec. 5. As used in this chapter, "insurer" refers to an insurer (as defined in IC 27-1-2-3) that issues a personal automobile or homeowner's policy. As added by P.L.226-2023, SEC.20.

Sec. 6. (a) As used in this chapter, "material change" means a premium increase of more than ten percent (10%) over and above the increases in the insurer's filed rate plan, including base rate increases and any other changes to the insurer's filed rate plan. (b) The term does no…

Sec. 7. As used in this chapter, "personal automobile or homeowner's policy" means: (1) an automobile policy; or (2) a homeowner's policy; that is underwritten on an individual basis for an individual, family, or household. As added by P.L.226-2023, SEC.20.

Sec. 8. (a) An insurer that makes a material change to an insured's personal automobile or homeowner's policy shall provide a written notice to the insured that: (1) explains the principal factors for the material change; or (2) states that the insured has a right to request and …

Sec. 9. (a) A written notice provided under section 8(a)(1) or 8(c) of this chapter: (1) must: (A) be sufficiently clear; and (B) use language sufficiently specific; to enable the insured to identify the basis for the insurer's decision to make the material change; (2) must inclu…

Sec. 1. (a) As used in this chapter, "accident and sickness insurance policy" means an insurance policy that provides one (1) or more of the kinds of insurance described in Class 1(b) and 2(a) of IC 27-1-5-1. (b) The term does not include the following: (1) Accident only, credit,…

Sec. 10. An insurer shall establish and maintain a grievance procedure that complies with the requirements of this chapter for the resolution of grievances initiated by a covered individual. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.

Sec. 11. The commissioner may examine the grievance procedure of any insurer. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.

Sec. 12. An insurer shall maintain all grievance records received by the insurer after the most recent examination of the insurer's grievance procedure by the commissioner. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.

Sec. 13. (a) An insurer shall provide, at the request of the insured, covered individual, or legal representative of the insured or covered individual, and upon policy issuance, at each policy renewal, and with any notice of denial of a claim, timely, adequate, and appropriate no…

Sec. 14. (a) A covered individual may file a grievance orally or in writing. (b) An insurer shall make available to covered individuals a toll free telephone number through which a grievance may be filed. The toll free telephone number must: (1) be staffed by a qualified represen…

Sec. 15. (a) An insurer shall establish procedures to assist covered individuals in filing grievances. (b) A covered individual may designate a representative to file a grievance for the covered individual and to represent the covered individual in a grievance under this chapter.…

Sec. 16. (a) An insurer shall establish written policies and procedures for the timely resolution of grievances filed under this chapter. The policies and procedures must include the following: (1) An acknowledgment of the grievance, given orally or in writing, to the covered ind…

Sec. 17. (a) An insurer shall establish written policies and procedures for the timely resolution of appeals of grievance decisions. The procedures for registering and responding to oral and written appeals of grievance decisions must include the following: (1) Written or oral ac…

Sec. 18. An insurer may not take action against a provider solely on the basis that the provider represents a covered individual in a grievance filed under this chapter. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.

Sec. 19. (a) An insurer shall each year file with the commissioner a description of the grievance procedure of the insurer established under this chapter, including: (1) the total number of grievances handled through the procedure during the preceding calendar year; (2) a compila…

Sec. 2. As used in this chapter, "commissioner" refers to the insurance commissioner appointed under IC 27-1-1-2. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13. Amended by P.L.1-2002, SEC.113.

Sec. 20. The department may adopt rules under IC 4-22-2 to implement this chapter. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.

Sec. 3. As used in this chapter, "covered individual" means an individual who is covered under an accident and sickness insurance policy. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.

Sec. 4. As used in this chapter, "department" refers to the department of insurance. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.

Sec. 5. As used in this chapter, "external grievance" means the independent review under IC 27-8-29 of a grievance filed under this chapter. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.

Sec. 6. As used in this chapter, "grievance" means any dissatisfaction expressed by or on behalf of a covered individual regarding: (1) a determination that a service or proposed service is not appropriate or medically necessary; (2) a determination that a service or proposed ser…

Sec. 7. As used in this chapter, "grievance procedure" means a written procedure established and maintained by an insurer for filing, investigating, and resolving grievances and appeals. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.

Sec. 8. As used in this chapter, "insured" means: (1) an individual whose employment status or other status except family dependency is the basis for coverage under a group accident and sickness insurance policy; or (2) in the case of an individual accident and sickness insurance…

Sec. 9. As used in this chapter, "insurer" means any person who delivers or issues for delivery an accident and sickness insurance policy or certificate in Indiana. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13.

Sec. 1. The commissioner may augment a penalty imposed under IC 27-13-24-1(b) by an amount equal to the sum that the commissioner calculates to be the damages suffered by enrollees or other members of the public. The commissioner may direct that any penalty imposed under this sec…

Sec. 2. If the commissioner has cause to believe that a violation of this article by a health maintenance organization has occurred or is threatened, the commissioner may give notice to: (1) the health maintenance organization; and (2) the other persons who appear to be involved …

Sec. 3. Proceedings under section 2 of this chapter are not governed by any formal procedural requirements and may be conducted in a manner the commissioner considers appropriate under the circumstances. However, a conference under section 2 of this chapter may not result in a ru…

Sec. 4. (a) The commissioner may issue an order directing: (1) a health maintenance organization; or (2) a representative of a health maintenance organization; to cease and desist from engaging in any act or practice that violates this article. (b) Within ten (10) days after a ce…

Sec. 5. In the case of a violation of this article, if the commissioner elects not to issue a cease and desist order, or in the event of noncompliance with a cease and desist order issued under section 4 of this chapter, the commissioner may institute a proceeding to obtain injun…

Sec. 6. Notwithstanding any other provision of this article, if a health maintenance organization fails to comply with the net worth requirement of this article, the commissioner may take appropriate action to assure that the continued operation of the health maintenance organiza…

Sec. 7. This article does not preclude the department from investigating complaints, grievances, or appeals on behalf of enrollees or providers. As added by P.L.69-1998, SEC.11.

Sec. 1. As used in this chapter, "commission" refers to the Indiana political subdivision risk management commission established by this chapter. As added by P.L.162-1986, SEC.1.

Sec. 10. (a) The political subdivision risk management fund is established for the purpose of: (1) paying the liabilities of political subdivisions to the extent specified in this chapter; (2) receiving assessments paid by political subdivisions to replenish the fund and to pay t…

Sec. 11. All political subdivisions are eligible for membership in the fund. Each member of the fund: (1) shall contribute to the fund in the amount of the assessment charged the member under this chapter; (2) shall pay the annual surcharge levied against the member under this ch…

Sec. 12. (a) The commission shall impose an assessment to be paid by each member of the fund. The assessments to be paid by members of the fund shall be set in fairness to all members, based upon the uniform application of actuarial principles and underwriters' rating principles.…

Sec. 13. (a) The commission shall pay liabilities of members of the fund in accordance with rules established by the commission. (b) Payment from the fund for any liability covered under IC 34-13-3 (or IC 34-4-16.5 before its repeal) or for any other liability designated under ru…

Sec. 14. (a) In order to be eligible for payment under this chapter, a liability of a political subdivision must arise out of a claim based upon an act or omission that takes place while the political subdivision is a member of the fund. (b) The maximum amount payable from the fu…

Sec. 15. (a) A political subdivision may become a member of the fund by filing a written notice of its intent to become a member with the commission by the date exactly six (6) months before the expiration date of the liability insurance policy covering the political subdivision …

Sec. 16. (a) The governor shall appoint the initial members of the commission by May 1, 1986. (b) The commission shall adopt rules under IC 4-22-2 for the implementation of this chapter by October 1, 1986, and shall adopt other rules as required after that date. As added by P.L.1…

Sec. 17. (a) As used in this section: (1) "basic fund" refers to the political subdivision risk management fund established by this chapter; and (2) "catastrophic fund" refers to the political subdivision catastrophic liability fund established by IC 27-1-29.1. (b) Before July 1,…

Sec. 2. As used in this chapter, "fund" refers to the political subdivision risk management fund established by this chapter. As added by P.L.162-1986, SEC.1.