February 15, 2016

The Department of Consumer and Business Services, Insurance Division, recently issued administrative rules to assist to clarify recent changes by Senate Bill 411 to ORS 742.524 regarding the notice of denial of charges an insurer must provide to medical providers. As noted in the Rule Summary:

“Prior to SB 411, the statute required the insurers to give notice of denial not more than 60 days after the insurer receives from the provider notice of a claim for services for Personal Injury Protection (PIP) benefits. SB 411 changed this to a requirement that the provider must receive the notice of denial within 60 days after the insurer received the claim for services. The new rule clarifies how to prove "receipt" of the denial by using language similar to language used in the Oregon Rules of Civil Procedure that establishes a presumption of receipt through service by mail with three days added to the prescribed period”

In review of the changes, it may be best practice to have some type of certificate of service or mailing sent with the denial. This would prevent later issues of whether or not the adjuster followed the standard practices or filling out an affidavit after an issue has arisen. Some ideas could be to have stamps made or at the bottom of the form, have a place where the adjuster can fill out the date it was sent and sign, for example:

“I hereby certify that on ______________, 2016, I deposited this document in the United States Mail, postage prepaid to the above listed recipient.

______________”

January 02, 2023