Insurance regulators in Washington state are implementing long-term care insurance (LTCI) prompt-payment rules developed by the National Association of Insurance Commissioners (NAIC).
The NAIC put the rules in its Long-Term Care Insurance Model Regulation, and state lawmakers enacted a statute that adopts the rules in Washington state earlier this year.
To put the new statute in effect, regulators have drafted rules that create a new definition of a “clean” LTCI claim and require an insurer to pay a clean claim within 30 days or else give its reason for denying the claim or seeking more information.
The provisions would not apply if the insurer had a reasonable basis supported by specific information to believe the claim was fraudulent.
Regulators plan to hold a hearing on the proposed regulations in Tumwater, Wash., Oct. 23.