ENROLLED
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ACT No. 91
Regular Session, 2012
HOUSE BILL NO. 564
BY REPRESENTATIVE JOHNSON
AN ACT1
To enact R.S. 22:1188.1, relative to long-term care insurance; to provide for prompt2
payment of long-term care insurance claims; to provide for definitions; to provide3
for applicability; to provide with respect to violations; and to provide for related4
matters.5
Be it enacted by the Legislature of Louisiana:6
Section 1. R.S. 22:1188.1 is hereby enacted to read as follows: 7
ยง1188.1. Prompt payment of clean claims8
A. For purposes of this Section:9
(1) "Claim" means a request for payment of benefits under an in-force10
policy, regardless of whether the benefit claimed is covered under the policy or any11
terms or conditions of the policy have been met.12
(2) "Clean claim" means a claim that has no defect or impropriety, including13
any lack of required substantiating documentation, such as satisfactory evidence of14
expenses incurred or particular circumstances requiring special treatment that15
prevents timely payment from being made on the claim.16
B. Within thirty business days after receipt of a claim for benefits under a17
long-term care insurance policy or certificate, an insurer shall pay such claim if it is18
a clean claim or send a written notice acknowledging the date of receipt of the claim19
and either of the following:20
(1) That the insurer is declining to pay all or part of the claim and the21
specific reason or reasons for denial.22
(2) That additional information is necessary to determine if all or part of the23
claim is payable and the specific additional information that is necessary.24 ENROLLEDHB NO. 564
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C. Within thirty business days after receipt of all requested additional1
information pursuant to Paragraph (B)(2) of this Section, an insurer shall pay a claim2
for benefits under a long-term care insurance policy or certificate if it is a clean claim3
or send a written notice that the insurer is declining to pay all or part of the claim and4
the specific reason or reasons for denial.5
D. If an insurer fails to comply with Subsection B or C of this Section, such6
insurer shall pay interest at the rate of one percent per month on the amount of the7
claim that should have been paid but that remains unpaid forty-five business days8
after the receipt of the claim pursuant to Subsection B of this Section or after receipt9
of all requested additional information pursuant to Subsection C of this Section. The10
interest payable pursuant to this Subsection shall be included in any late11
reimbursement without requiring the person who filed the original claim to make any12
additional claim for such interest.13
E. The provisions of this Section shall not apply where the insurer has a14
reasonable basis supported by specific information that such claim was fraudulently15
submitted.16
F. Any violation of this Section by an insurer if committed flagrantly and in17
conscious disregard of the provisions of this Section with such frequency as to18
constitute a general business practice shall be considered a violation of R.S. 22:196319
et seq.20
SPEAKER OF THE HOUSE OF REPRESENTATI VES
PRESIDENT OF THE SENATE
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED: