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HOUSE OF REPRESENTATIVES - FLOOR VERSION
STATE OF OKLAHOMA
1st Session of the 60th Legislature (2025)
ENGROSSED SENATE
BILL NO. 1050 By: Seifried of the Senate
and
Newton and Deck of the
House
An Act relating to the Unfair Claims Settlement
Practices Act; amending 36 O.S. 2021, Section 1250.5,
as last amended by Section 1, Chapter 214, O.S.L.
2023 (36 O.S. Supp. 2024, Section 1250.5), which
relates to acts by an insurer constituting unfair
claim settlement practice; decreasing allowable time
to file certain claim ; and providing an effective
date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 36 O.S. 2021, Section 1250.5, as
last amended by Section 1, Chapter 214, O.S.L. 2023 (36 O.S. Supp.
2024, Section 1250.5), is amended to read as follows:
Section 1250.5. Any of the following acts by an insurer, if
committed in violation of Section 1250.3 of this title, constitutes
an unfair claim settlement practice exclusive of paragraph 16 of
this section which shall be applicable solely to health benefit
plans:
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1. Failing to fully disclose to fi rst-party claimants,
benefits, coverages, or other provisions of any insurance policy or
insurance contract when the benefits, coverages or other provi sions
are pertinent to a claim;
2. Knowingly misrepresenting to claimants pertinent facts or
policy provisions relating to coverages at issue;
3. Failing to adopt and implement reasonable standards for
prompt investigations of claims arising under its in surance policies
or insurance contracts;
4. Not attempting in good faith to effectuate prompt, fair and
equitable settlement of claims submitted in which liability has
become reasonably clear;
5. Failing to comply with the provisions of Section 1219 of
this title;
6. Denying a claim for failure to exhibit the property without
proof of demand and unfounded refusal by a claimant to do so;
7. Except where there is a time limit specified in the policy,
making statements, written or otherwise, which require a claimant to
give written notice of loss or proof of loss within a specified time
limit and which seek t o relieve the company of its obligations if
the time limit is not complied with unless the failure to comply
with the time limit prejudices the rights of an insurer. Any policy
that specifies a time limit covering damage to a roof due to wind or
hail must allow the filing of claims after the first anniversary but
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no later than twenty -four (24) months after the date of the loss, if
the damage is not evid ent without inspection;
8. Requesting a claimant to sign a release that extends beyond
the subject matter that gave rise to the claim payment;
9. Issuing checks, drafts or electronic payment in partial
settlement of a loss or claim under a specified cove rage which
contain language releasing an insurer or its insured from its total
liability;
10. Denying payment to a claimant on the grounds that services,
procedures, or supplies provided by a treating physician, hospital,
or person or entity licensed or o therwise authorized to provide
health care services were not medically necessary unless the health
insurer or administrator, as defined in Section 1442 of this title,
first obtains an opinion from any provider of health care licensed
by law and preceded by a medical examination or claim review, to the
effect that the services, procedures or supplies for which payment
is being denied were not medically necessary. In the event that
claims for mental health or substance use disorder treatments and
services are under review, the reviewing health care provider shall
have appropriate, qualified, and specialized cre dentials with
respect to the services and treatments. Upon written request of a
claimant, treating physician, hospital, or authorized person or
entity, the opinion shall be set forth in a written report, prepared
and signed by the reviewing physician. The report shall detail
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which specific services, procedures, or supplies were not medically
necessary, in the opinion of the reviewing physician, and an
explanation of that conclusion. A copy of each report of a
reviewing physician shall be mailed by the he alth insurer, or
administrator, postage prepaid, to the claimant, treating physician,
hospital, or authorized person or entity requesting same within
fifteen (15) days after receipt of the written request. As used in
this paragraph, “physician” means a person holding a valid license
to practice medicine and surgery, osteopathic medicine, podiatric
medicine, dentistry, chiropractic, or optometry, pursuan t to the
state licensing provisions of Title 59 of the Oklahoma Statutes;
11. Compensating a reviewing p hysician, as defined in paragraph
10 of this section, on the basis of a percentage of the amount by
which a claim is reduced for payment;
12. Violating the provisions of the Health Care Fraud
Prevention Act;
13. Compelling, without just cause, policyholders to institute
suits to recover amounts due under its insurance policies or
insurance contracts by offering substantially less than the amounts
ultimately recovered in suits brought by them, when the
policyholders have made claims for amounts reasonably similar to the
amounts ultimately recovered;
14. Failing to maintain a complete record of all complaints
which it has received during the preceding th ree (3) years or since
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the date of its last financial examination conducted or accepted by
the Commissioner, whichever time is longer. This record shall
indicate the total number of complaints, their classification by
line of insurance, the nature of each complaint, the disposition of
each complaint, and the time it took to process each complaint. For
the purposes of this paragraph, “complaint” means any written
communication primarily expressing a grievance;
15. Requesting a refund of all or a portion o f a payment of a
claim made to a claimant more than twelve (12) six (6) months or a
health care provider more than eighteen (18) twelve (12) months
after the payment is made. This paragraph shall not apply:
a. if the payment was made because of fraud comm itted by
the claimant or health care provider, or
b. if the claimant or health care provider has otherwis e
agreed to make a refund to the insurer for overpayment
of a claim;
16. Failing to pay, or requesting a refund of a payment, for
health care services covered under the policy if a health benefit
plan, or its agent, has provided a preauthorization or
precertification and verification of eligibility for those health
care services. This paragraph shall not apply if:
a. the claim or payment was made becau se of fraud
committed by the claimant or health care provider,
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b. the subscriber had a preexisting exclus ion under the
policy related to the service provided, or
c. the subscriber or employer failed to pay the
applicable premium and all grace periods and
extensions of coverage have expired;
17. Denying or refusing to accept an application for life
insurance, or refusing to renew, cancel, restrict or otherwise
terminate a policy of life insurance, or charge a different rate
based upon the lawful travel dest ination of an applicant or insured
as provided in Section 4024 of this title; or
18. As a health insurer that provides pharmacy benefits or a
pharmacy benefits manager that administers pharmacy benefits for a
health plan, failing to include any amount pai d by an enrollee or on
behalf of an enrollee by another person when calculating the
enrollee’s total contribution to an out -of-pocket maximum,
deductible, copayment, coinsurance or other cost -sharing
requirement.
However, if, under federal law, application of this paragraph
would result in health savings account ineligibility under Section
223 of the federal Internal Revenue Code, as amended, this
requirement shall apply only for health savings accounts with
qualified high-deductible health plans with respe ct to the
deductible of such a plan after the enrollee has satisfied the
minimum deductible, except with respect to items or services that
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are preventive care pursuant to Section 223(c)(2)(C) of the federal
Internal Revenue Code, as amended, in which case the requirements of
this paragraph shall apply regardless of whether the minimum
deductible has been sati sfied.
SECTION 2. This act shall become effective November 1, 2025.
COMMITTEE REPORT BY: COMMITTEE ON JUDICIARY AND PUBLIC SAFETY , dated
04/17/2025 – DO PASS.