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April 8, 2009

Time to Make Our Final Stand and Defeat SB 61 - Bill Requiring Licensed Doctors to Review All Property/Casualty Insurance Policy Medical Benefits Claims Denials and Insurance Coverage Determinations

SB 61 is up for 3rd Reading in the Colorado House of Representatives any day now. It has been on the legislative calendar for the past two days but has been laid-over by the supporters of the bill so that they can rally votes to pass the proposed legislation.

THIS IS OUR LAST CHANCE in the legislature to kill this bill and avoid the implementation of a bill that will fundamentally alter the way property/casualty insurance claims are adjusted.

SB 61 requires any internal review, independent medical examination (IME), or utilization review (UR) of workers' compensation, property/casualty, 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.

NAMIC opposes SB 61 and has personally asked members of the House 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 for professional assistance when there is an actual need for such expertise.
  • 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 resulting 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 the state of Colorado ACT NOW and have your employees and insurance producers contact members of the House of Representatives. TIME IS OF THE ESSENCE!

CONTACT YOUR STATE REPRESENTATIVE TODAY! If you do not know who your representative is, visit to find out.