Effective: September 6, 2012
Latest Legislation: House Bill 341 - 129th General Assembly
(A) Nothing in this chapter shall be construed to create a cause of action against any of the following:
(1) An employer that provides health care benefits to employees through a health plan issuer;
(2) A clinical reviewer or independent review organization that participates in an external review under this chapter;
(3) A health plan issuer that provides coverage for benefits pursuant to this chapter.
(B) An independent review organization and any clinical reviewer an independent review organization uses in conducting an external review under this chapter is not liable in damages in a civil action for injury, death, or loss to person or property and is not subject to professional disciplinary action for making, in good faith, any finding, conclusion, or determination required to complete the external review.
(C) This section does not grant immunity from civil liability or professional disciplinary action to an independent review organization or clinical reviewer for an action that is outside the scope of authority granted under this chapter.
Structure Ohio Revised Code
Chapter 3922 | External Review
Section 3922.01 | Definitions.
Section 3922.02 | Request for Review of Adverse Benefit Determination.
Section 3922.03 | Internal Appeal Processes; Review of Final Determination.
Section 3922.04 | Exhaustion of Issuer's Internal Appeal Process.
Section 3922.05 | Opportunities for External Review by Independent Review Organization.
Section 3922.06 | Reconsideration by Issuer.
Section 3922.07 | Information Considered for Review.
Section 3922.08 | Provisions Applicable to Standard Reviews; Timing;.
Section 3922.09 | Request for Expedited External Review.
Section 3922.11 | Review by Superintendent of Insurance.
Section 3922.12 | Effect of Decision.
Section 3922.13 | Accreditation of Independent Review Organizations.
Section 3922.14 | Additional Actions for Accreditation.
Section 3922.15 | Qualifications for Clinical Reviewers.
Section 3922.16 | Construction of Chapter; Limitations on Liability.
Section 3922.17 | Maintenance of Records; Reports.
Section 3922.18 | Payment of Costs.
Section 3922.19 | Disclosure of External Review Procedures.
Section 3922.20 | Admissibility of Written Decision or Medicare Reimbursement Standards.
Section 3922.21 | Confidentiality.