SB 1050: Unfair Claims Settlement Practices Act; decreasing allowable time to file certain claim. Effective date. - Oklahoma

Floor (House) → Floor (Senate) · 6 edits

MODERATE

This bill amends Oklahoma's Unfair Claims Settlement Practices Act to strengthen protections for health insurance claimants. The Senate version adds new requirements for insurers regarding medical necessity determinations, complaint record-keeping, and payment timelines, while also clarifying time limits for filing certain property damage claims.

Scope change

The bill's scope expanded to include more specific requirements for health benefit plans and added stricter rules for medical necessity reviews and complaint documentation.

REQUIREMENT

Added new requirement that health insurers must obtain a medical opinion before denying payment for services, unless the claim is for mental health or substance use disorder treatments under review.

Requires health insurers to provide written reports explaining denied medical services to claimants, physicians, and hospitals within 15 days of request.

Requires insurers to maintain detailed complaint records including classification, nature, disposition, and processing time for complaints received in the preceding three years.

Prohibits insurers from compensating reviewing physicians based on a percentage of the amount by which a claim is reduced for payment.

TIMELINE

Changed the time limit for filing property damage claims from 12 months to 24 months for wind or hail damage not evident without inspection.

Reduced the refund request deadline for health care providers from 18 months to 4 months after payment is made.

SB1050 (3-24-25) (SEIFRIED) FA1.PDF → Floor (House) · 5 edits

MODERATE

This bill amends Oklahoma's Unfair Claims Settlement Practices Act to reduce time limits for filing certain insurance claims and clarify requirements for insurers. The House version modifies the original Senate amendment to decrease allowable timeframes for claim filing from 12 to 6 months for general claims and from 18 to 12 months for healthcare provider claims. It also adds specific protections for mental health and substance use disorder treatment claims.

Scope change

The bill applies to all insurers operating in Oklahoma and specifically addresses health benefit plans, with new requirements for reviewing physicians and medical necessity determinations.

TIMELINE

Reduced time limit for filing certain insurance claims from 12 months to 6 months after the loss date

Reduced time limit for requesting refunds from healthcare providers from 18 months to 12 months after payment

REQUIREMENT

Added specific protections requiring specialized credentials for reviewing mental health and substance use disorder treatment claims

Added requirement that insurers must provide written reports from reviewing physicians detailing why services were deemed not medically necessary

Added requirement that roof damage claims due to wind or hail must allow filing within 24 months if damage is not evident without inspection

Enrolled (final version) → SB1050 (3-24-25) (SEIFRIED) FA1.PDF · 3 edits

MINOR

This bill amendment modifies the time limits for filing insurance claims related to wind or hail damage. The original version allowed claims to be filed within 12 months, while the amendment extends this to 6 months. Additionally, the amendment changes the refund timeline for payments made to healthcare providers from 18 months to 12 months. These changes affect how long policyholders have to file claims and when insurers can request refunds of overpayments.

Scope change

The bill's scope remains focused on unfair claims settlement practices under the Unfair Claims Settlement Practices Act, but the specific time thresholds for filing claims and requesting refunds have been adjusted.

TIMELINE

Extended the allowable time to file claims for wind or hail damage from 12 months to 6 months after the date of loss, if damage is not evident without inspection.

Reduced the time limit for requesting refunds of payments made to healthcare providers from 18 months to 12 months after payment is made.

Adjusted the time limit for requesting refunds of payments made to claimants from 12 months to 6 months after payment is made.

Engrossed → Enrolled (final version) · 5 edits · May 5, 2025

MODERATE

This bill transitioned from an Engrossed version to an Enrolled (final) version, incorporating substantive policy changes to Oklahoma's Unfair Claims Settlement Practices Act. The final version adds new protections for mental health and substance use disorder claims, clarifies refund requirements for health care services, and introduces restrictions on insurers denying claims based on travel destinations. Several paragraph numbers were reorganized, and the text was consolidated into a cleaner format while maintaining the core regulatory framework.

Scope change

The bill's scope remains focused on regulating unfair claims settlement practices by insurers in Oklahoma, with specific emphasis on health benefit plans. The applicability was slightly expanded to include restrictions on life insurance underwriting based on travel destinations.

ELIGIBILITY

Added specific protections for mental health and substance use disorder treatments, requiring reviewers to have specialized credentials and providing detailed written explanations for denials.

Added new provision prohibiting insurers from denying or charging different rates for life insurance based on lawful travel destinations.

REQUIREMENT

Modified refund requirements for health care services to include three specific exceptions: fraud, preexisting exclusions, and unpaid premiums with expired grace periods.

Modified the refund request timeline for health care providers from eighteen months to twelve months after payment is made.

TECHNICAL

Text was reorganized and consolidated from multiple pages into a cleaner format, with paragraph numbers renumbered and some content merged for clarity.

Introduced → Engrossed · 5 edits · Mar 27, 2025

MODERATE

This bill modifies Oklahoma's Unfair Claims Settlement Practices Act by updating the list of unfair practices insurers can engage in. The changes include adding new restrictions on requesting refunds after payments, clarifying time limits for filing certain claims, and strengthening requirements for handling medical necessity denials. These updates aim to better protect consumers from unfair insurance practices and provide clearer timelines for claim resolution.

Scope change

The bill expands the scope of prohibited unfair practices by insurers, particularly regarding refund requests and medical necessity determinations, while maintaining the existing framework of the Unfair Claims Settlement Practices Act.

REQUIREMENT

Added new provision prohibiting insurers from requesting refunds of claim payments made to claimants more than 12 months after payment, and to healthcare providers more than 18 months after payment, with specific exceptions for fraud or agreed overpayments.

Modified the medical necessity denial process to require insurers to obtain opinions from qualified healthcare providers before denying payment, with specific requirements for mental health and substance use disorder cases.

Added requirement for insurers to maintain detailed records of all complaints including classification, nature, disposition, and processing time for at least 3 years or since last financial examination.

Added requirement that reviewing physicians' opinions on medical necessity must be provided in written reports within 15 days of request, detailing specific services denied and the rationale.

TIMELINE

Modified time limits for filing claims related to wind or hail damage to roofs, extending the filing window to 24 months after loss for damage not evident without inspection.

Unfair Claims Settlement Practices Act; decreasing allowable time to file certain claim. Effective date.

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