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March 29, 2009

Colorado Bill Requiring Licensed Doctors to Review All P/C Insurance Policy Medical Benefits Claims Denials, Insurance Coverage Determinations Scheduled for Public Hearing March 30

SB 61 requires any internal review, independent medical examination, or utilization review of workers' compensation, property/casualty insurance, and health insurance be conducted by a licensed doctor who has appropriate expertise in the “same or similar specialties” as would typically manage the case being reviewed. The bill also requires written denials of benefits to identify the health-care professional on whose opinion the denial is based.

The proposed legislation is scheduled for a public hearing on Monday, March 30 at 1:30 p.m. (MDT) in room LSB-A.

NAMIC opposes the bill and has personally asked members of the House Health and Human Services Committee to VOTE “NO” on SB 61 for the following reasons:

  • It is an unnecessary fix to a standard, cost-effective, and time-tested auto insurance claims practice of using trained adjusters and nurses to process basic insurance claims and to use medical experts to assist them when there is an actual need for a medical expert's professional assistance. For all practical purposes, SB 61 would require medical experts to be involved from the very beginning of the auto insurance claim process in ALL denials of claims or policy coverage decisions.
  • The proposed bill will be a monumental insurance cost-driver that will substantially increase claims-adjusting overhead costs and legal defense costs that will result from plaintiff attorneys asserting the argument that SB 61 authorizes them to file a bad faith lawsuit whenever the insurance claim denial is initially made by a person who is not a medical expert specializing in the particular health-care treatment or diagnosis at issue.
  • SB 61 does not provide consumers with any new legal protections; it merely provides trial lawyers with a new basis for asserting a bad faith claim.
  • The proposed bill is impractical and unworkable because a "same or similar specialty" medical professional may be difficult to find in certain localities and could prevent consumers from securing the medical assistance of experts.

NAMIC requests that its member companies writing insurance in Colorado encourage their employees, insurance producers, and policyholders to contact members of the House Health and Human Services Committee before the public hearing Monday afternoon to express their concerns with SB 61.

The recent proposed amendment to the bill (L015) does not address ANY of the insurance industry’s concerns, as the bill’s sponsor has alleged; all the amendment does is resolve the Constitutional Law Commerce Clause problem that existed in the bill as a result of the previous requirement that the doctor involved in the utilization review, claims denial, and coverage determination be a doctor licensed in Colorado.

Emails may be sent to House Health and Human Services Committee Members:

Direct questions to NAMIC State Affairs Manager Christian J. Rataj at

Posted: Sunday, March 29, 2009 12:00:00 AM. Modified: Sunday, March 29, 2009 12:34:07 PM.

317.875.5250 - Indianapolis  |  202.628.1558 - Washington, D.C.

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