Title 58, INSURANCE

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 federa…

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.

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 painti…

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 …

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…

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.

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 p…

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 t…

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…

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 , inclusiv…

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…

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 ins…

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,…

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 …

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…

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 , …

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.

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 …

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 pe…

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 exces…

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 …

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, fidel…

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 , inc…

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 pr…

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 s…

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 th…

The director may promulgate rules, pursuant to chapter 1-26 , to carry out the purposes of §§ 58-12-31 to 58-12-37 , inclusive. In promulgating rules, the director shall consider the impact of the rule on the cost and availability of insurance in this state and the degree of prot…

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, independ…

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 payab…

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 sh…

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…

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 repre…

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 credi…