Michigan Laws 500.2213c – Disability income insurer; internal grievance procedure; establishment; contents; “grievance” defined
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(1) Each disability income insurer shall establish an internal grievance procedure for persons covered under a disability income policy, certificate, or contract.
(2) An internal grievance procedure under subsection (1) shall include all of the following:
Terms Used In Michigan Laws 500.2213c
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- Commissioner: means the director. See Michigan Laws 500.102
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Contract: A legal written agreement that becomes binding when signed.
- in writing: shall be construed to include printing, engraving, and lithographing; except that if the written signature of a person is required by law, the signature shall be the proper handwriting of the person or, if the person is unable to write, the person's proper mark, which may be, unless otherwise expressly prohibited by law, a clear and classifiable fingerprint of the person made with ink or another substance. See Michigan Laws 8.3q
- Insurer: means an individual, corporation, association, partnership, reciprocal exchange, inter-insurer, Lloyds organization, fraternal benefit society, or other legal entity, engaged or attempting to engage in the business of making insurance or surety contracts. See Michigan Laws 500.106
- person: may extend and be applied to bodies politic and corporate, as well as to individuals. See Michigan Laws 8.3l
(a) Provide for a designated person responsible for administering the grievance procedure.
(b) Provide for a designated person or telephone number for receiving grievances.
(c) Ensure full investigation of a grievance.
(d) Provide for timely notification to the insured as to the progress of an investigation.
(e) Provide for the insured to have the right to have the grievance reviewed by a managerial-level person or group.
(f) Provide for notification to the insured of the results of the insurer’s investigation and, if the insurer upholds its prior determination on the grievance, for advising the insured of his or her right to present the grievance to the commissioner for review.
(g) Provide that a final determination will be made in writing by the insurer not later than 45 calendar days after a grievance is submitted in writing by the insured unless the insurer requires an extension of time to obtain additional information to make a determination with respect to the subject of the grievance. The extension may not exceed 45 days from the end of the initial period unless the initial period is extended due to the insured’s failure to submit information necessary to decide the claim on appeal. If the extension is due to an insured’s failure to submit information, the period for making the determination shall be tolled until the date the insured responds to the request for additional information.
(h) Provide for copies of all grievances and responses to be available at the principal office of the insurer for inspection by the commissioner for 2 years following the year the grievance was filed.
(3) As used in this section, “grievance” means a written complaint by an insured concerning the payment of benefits under a disability income insurance policy.