58-3-7.4. Insurer's claim files subject to examination--File maintenance requirements.
Each insurer's claim files for policies or certificates are subject to examination pursuant to chapter 58-3 by the director of insurance. To aid in the examination:
(1)The insurer shall maintain claim data that is accessible and retrievable for examination. An insurer shall be able to provide the claim number, line of coverage, date of loss, and date of payment of the claim, date of denial, or date closed without payment. This claim data shall be available for all open and closed files for five years;
(2)Detailed documentation shall be contained in each claim file in order to permit reconstruction of the insurer's activities relative to each claim;
(3)Each relevant document within the claim file shall be noted as to date received, date processed, or date mailed. Dated correspondence is sufficient to document the date mailed for the purposes of this subdivision;
(4)For those insurers that do not maintain hard copy files, claim files shall be accessible from a computer, microfilm, Cathode Ray Tube (CRT), micrographics, or other similar electronic means and be capable of duplication to hard copy; and
(5)Claim information obtained in a telephone conversation or personal interview with any source which is used in the claim determination shall be documented in the claim file.
Source: SL 1997, ch 283, §5; SL 2009, ch 257, §1.
Structure South Dakota Codified Laws
Chapter 03 - Examination Of Insurers And Insurance Producers
Section 58-3-1 - Examination of insurers--Scope.
Section 58-3-1.1 - Company defined.
Section 58-3-2 - Examination of alien insurer--Limited extent.
Section 58-3-3.1 - Examination assessment fee--Insurance examination fund established for proceeds.
Section 58-3-3.2 - Payments from insurance examination fund.
Section 58-3-5 - Examination of agents, managers, and promoters.
Section 58-3-6 - Place where examination conducted.
Section 58-3-7 - Information to be available--Cooperation of persons being examined.
Section 58-3-7.1 - Observance of guidelines and procedures by examiner.
Section 58-3-7.3 - Examination under oath--Authority of director or examiner.
Section 58-3-7.4 - Insurer's claim files subject to examination--File maintenance requirements.
Section 58-3-8 - Examination disclosing inadequate records--Correction of accounts.
Section 58-3-10 - Examination reports required.
Section 58-3-11 - Contents of examination reports.
Section 58-3-12.2 - Market conduct examination--Draft examination report.
Section 58-3-12.3 - Draft examination report not governed by §§ 58-3-10 to 58-3-18.
Section 58-3-12.4 - Confidentiality of draft examination report.
Section 58-3-13 - Filed examination report admissible in evidence.
Section 58-3-14 - Withholding of report from public inspection.
Section 58-3-15 - Expenses of examination paid by person examined.
Section 58-3-18 - Confidential investigative hearing--Inconsistencies in examination report.
Section 58-3-19 - Conducting hearing--Discovery.
Section 58-3-20 - Use of information discovered during examination for legal or regulatory action.
Section 58-3-23 - Preclusion of examiner--Grounds.
Section 58-3-25 - Implementation of examination report's recommendations.