Title 58 — INSURANCE

Compliance with §

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. 58-12-29. Repealed by SL 2007, ch 286 , § 4.

58-12-30 Annual reports of commercial property casualty insurance claims--Exception--Promulgation of rules. 58-12-31 Definitions regarding standards for claims processing. 58-12-32 Application of standards for claims investigation and disposition. 58-12-33 Flagrant or frequent vi…

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…

No insurer shall retain any risk on any one subject of insurance, whether located or to be performed in this state or elsewhere, in an amount exceeding ten percent of its surplus to policyholders. Source: SL 1966, ch 111 , ch 4, § 11 (1).

A "subject of insurance" for the purposes of this chapter, as to insurance against fire and hazards other than windstorm, earthquake, or other catastrophe hazards, includes all properties insured by the same insurer which are customarily considered by underwriters to be subject t…

"Surplus to policyholders" for the purposes of this chapter, in addition to the insurer's capital and surplus, shall be deemed to include any voluntary reserves which are not required pursuant to law, and shall be determined from the last sworn statement of the insurer on file wi…

Reinsurance ceded for which credit is allowed pursuant to chapter 58-14 shall be deducted in determining risk retained. As to surety risks, deductions shall also be made of the amount assumed by any established incorporated cosurety and the value of any security deposited, pledge…

This chapter shall not apply to life or health insurance, annuities, title insurance, insurance of wet marine and transportation risks, workers' compensation insurance, employer's liability coverages, nor to any policy or type of coverage as to which the maximum possible loss to …

As to alien insurers, this chapter shall relate only to risks and surplus to policyholders of the insurer's United States branch. Source: SL 1966, ch 111 , ch 4, § 11 (4).

"Reinsurance" is a contract under which an originating insurer, called the "ceding insurer," procures insurance for itself in another insurer, called the "assuming insurer" or the "reinsurer," with respect to part or all of any insurance risk of the originating insurer. Source: S…

Credit shall be allowed if the reinsurance is ceded to an assuming insurer which is domiciled and licensed in, or in the case of a United States branch of an alien assuming insurer is entered through, a state which employs standards regarding credit for reinsurance substantially …

Credit shall also be allowed if the reinsurance is ceded to an assuming insurer that maintains a trust fund in a qualified United States financial institution for the payment of the valid claims of the assuming insurer's United States ceding insurers, their assigns and successors…

The trust fund in § 58-14-11 for a single assuming insurer shall consist of funds in trust in an amount not less than the assuming insurer's liabilities attributable to reinsurance ceded by United States ceding insurers, and, in addition, the assuming insurer shall maintain a tru…

In the case of a group of incorporated underwriters, the trust in § 58-14-11 shall be in an amount not less than the group's several liabilities attributable to business ceded by United States ceding insurers to any member of the group pursuant to reinsurance contracts issued in …

In the case of a group including incorporated and individual unincorporated underwriters, the trust in § 58-14-11 shall consist of a trusteed account in an amount not less than the respective underwriters' several liabilities attributable to business ceded by United States domici…

The form of the trust in § 58-14-11 and any trust amendments shall be filed with the director of each state in which the ceding insurer beneficiaries of the trust are domiciled. The trust instrument shall provide that contested claims shall be valid and enforceable upon the final…

Credit shall be allowed if the reinsurance is ceded to an assuming insurer not meeting the requirements of § 58-14-8 , 58-14-9 , 58-14-10 , 58-14-11 , or 58-14-16.1 but only with respect to the insurance of risks located in foreign or alien jurisdictions where the reinsurance is …

If the assuming insurer is not licensed, certified, or accredited to transact insurance or reinsurance in this state, the credit permitted by § 58-14-10 or 58-14-11 may not be allowed unless the assuming insurer agrees in the reinsurance agreements: (1) That in the event of the f…

An asset or a reduction from liability for the reinsurance ceded by a domestic insurer to an assuming insurer not meeting the requirements of § 58-14-7 shall be allowed in an amount not exceeding the liabilities carried by the ceding insurer. The reduction shall be in the amount …

Credit shall be allowed under § 58-14-8 , 58-14-9 , or 58-14-10 only as respects cessions of those kinds or classes of business which the assuming insurer is licensed or permitted to write or assume in its state of domicile or, in the case of a United States branch of an alien as…

If a certified reinsurer maintains a trust to fully secure the certified reinsurer's obligations subject to § 58-14-11 and chooses to secure the certified reinsurer's obligations incurred as a certified reinsurer in the form of a multibeneficiary trust, the certified reinsurer sh…

The minimum trusteed surplus requirements are not applicable with respect to a multibeneficiary trust maintained by a certified reinsurer for the purpose of securing obligations incurred under §§ 58-14-16.8 to 58-14-16.13 , inclusive, except that the trust shall maintain a minimu…

With respect to obligations incurred by a certified reinsurer under §§ 58-14-16.8 to 58-14-16.13 , inclusive, if the security is insufficient, the director shall reduce the allowable credit by an amount proportionate to the deficiency and has the discretion to impose further redu…

A certified reinsurer whose certification has been terminated for any reason shall be treated as a certified reinsurer required to secure one hundred percent of the certified reinsurer's obligations. For the purposes of this section, the term, terminated, means revocation, suspen…