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 add specific protections for health benefit plans, including stricter timelines for filing claims (24 months for roof damage), requirements for medical necessity denials, and new rules for handling complaints and refunds. The changes expand consumer protections for health insurance claimants while clarifying procedures for insurers.

Scope change

The bill's scope was expanded to specifically address health benefit plans with additional requirements for medical necessity determinations, complaint tracking, and refund timelines that differ from general insurance practices.

REQUIREMENT

Added new requirements for health insurers to obtain medical opinions before denying claims for mental health or substance use disorder treatments, with specific credentialing standards for reviewing physicians.

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

Added prohibition on compensating reviewing physicians based on a percentage of reduced claim amounts.

Added requirement for written reports from reviewing physicians detailing which specific services were deemed not medically necessary when denying claims.

TIMELINE

Changed the deadline for filing roof damage claims from one year to 24 months after the loss date when damage is not evident without inspection.

Reduced the refund request deadline from 12-18 months to 2-4 months after payment is made for claimants or health care providers.

SB1050 (3-24-25) (SEIFRIED) FA1.PDF → Floor (House) · 4 edits

MODERATE

This bill amends Oklahoma's Unfair Claims Settlement Practices Act to reduce time limits for filing claims and strengthen protections for claimants. The House version modifies the timeline for requesting refunds and clarifies requirements for medical necessity determinations in health insurance claims.

Scope change

The bill applies to all insurers in Oklahoma but adds specific protections for health benefit plans regarding medical necessity reviews and mental health/substance use disorder treatment claims.

TIMELINE

Reduced the allowable time for requesting refunds of claim payments from 12 months to 6 months for claimants, and from 18 months to 12 months for health care providers.

REQUIREMENT

Added specific requirements for health insurers to obtain independent medical opinions before denying claims for mental health or substance use disorder treatments, with provisions for written reports.

Added language requiring policies covering wind or hail roof damage to allow claims to be filed up to 24 months after the loss if damage is not evident without inspection.

Modified the requirement for insurers to maintain complaint records, extending the retention period to three years or since the last financial examination, whichever is longer.

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

MINOR

This bill amends Oklahoma's Unfair Claims Settlement Practices Act to adjust time limits for filing insurance claims and clarify refund request timelines. The changes extend the window for filing certain property damage claims and modify when insurers can request refunds of overpayments, affecting consumer protection and claims processing standards.

Scope change

The bill maintains the same scope of applying to unfair claims settlement practices but modifies specific timeframes and procedural requirements for claims and refunds.

TIMELINE

Extended the time limit for filing claims for roof damage due to wind or hail from 12 months to 24 months after the date of loss, if damage is not evident without inspection.

Changed the timeframe for requesting refunds of payments made to claimants from 12 months to 6 months after payment is made.

Changed the timeframe for requesting refunds of payments made to health care providers from 18 months to 12 months after payment is made.

Introduced → Engrossed · 6 edits · Mar 27, 2025

MODERATE

This bill amends Oklahoma's Unfair Claims Settlement Practices Act to strengthen consumer protections by adding new prohibited insurer practices, clarifying time limits for filing claims, and improving transparency requirements for medical claim denials and complaint records.

Scope change

The bill expands the scope of prohibited unfair practices by insurers and adds specific protections for health care claimants and policyholders.

REQUIREMENT

Added requirement that insurers must allow filing wind or hail damage claims within 24 months after loss if damage isn't obvious without inspection, extending the previous one-year limit.

Added prohibition on requesting refunds of claim payments made to claimants more than 12 months after payment or to health care providers more than 18 months after payment.

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

Modified medical necessity denial requirements to require written reports from reviewing physicians detailing specific services denied and the reasoning, to be mailed within 15 days of request.

Added prohibition on requesting refunds of payments made to health care providers more than 12 months after payment when preauthorization was obtained.

TECHNICAL

Changed bill status from 'Introduced' to 'Engrossed' indicating it has passed through committee and floor consideration in both chambers.

Engrossed → Enrolled (final version) · 3 edits · May 5, 2025

MINOR

The bill transitioned from an Engrossed version to an Enrolled (final) version, primarily involving formatting and structural changes rather than substantive policy modifications. The core content of the Unfair Claims Settlement Practices Act remains consistent, though some paragraph numbering and text organization were adjusted during finalization.

Scope change

No substantive change to the scope or applicability of the bill. The law continues to govern unfair claims settlement practices by insurers in Oklahoma.

TECHNICAL

Header text changed from 'ENGROSSED SENATE' to 'ENROLLED SENATE' indicating the bill has passed both houses and is in its final form ready for signature.

Paragraph numbering and formatting were reorganized throughout the document, with some paragraphs renumbered (e.g., original paragraph 11 became paragraph 10 in some sections) and text consolidated.

Page breaks and layout were adjusted between the Engrossed and Enrolled versions, with page numbers and formatting markers removed or repositioned.

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

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