Mich. Admin. Code R. 500.1508 - Complaint-resolution process; notice of rights; private informal managerial-level conference
Current through Vol. 22-05, April 1, 2022
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Rule 8. (1) At the time of a denial of insurance as defined in R 500.1501, the insurer or agent making the denial shall notify a person of his or her right to appeal the decision if he or she has reason to believe that such denial is improper.
(2) The notice of a person's right to appeal shall be in language understandable to a person of ordinary intelligence and shall contain, but need not be limited to, an explanation of all of the following:
(a) The procedure to be followed in the complaint resolution process, including the option to request a private informal managerial level conference.
(b) The person's right to request and receive, subject to a reasonable copying charge, copies of information relating to the denial. A reasonable copying charge shall not exceed the rate charged for copying by the Michigan Insurance Bureau in accordance with Act No.
442 of the Public Acts of 1976, as amended, being S15.231 et seq. of the Michigan Compiled Laws. The commissioner shall inform insurers of the maximum allowable copying charge on an annual basis.
(c) The person's right to participate in an informal process for complaint resolution. This process shall be concluded within 30 days of the complaint to the insurer and may include discussions by telephone, by mail, and by a private, informal, managerial-level
conference. If the conference is by means of a telephone conference, the insurer shall identify all persons by name and title who are listening to the phone conference. In addition, the insurer shall either provide toll-free telephone service or pay all telephone charges associated with such telephone conferences. If the private managerial-level conference is to be conducted by telephone, the notice shall indicate the telephone number which the insured must call and inform the insured that he or she may call collect if a toll-free number is not provided.
(d) The person's right to bring the matter before the commissioner for resolution if the insurer's internal complaint resolution process fails to resolve the dispute.
(e) The person's right to appoint another person to act on his or her behalf throughout the appeals process set forth in these rules.
History: 1981 AACS.