1. (a) Each carrier should establish a time limit after which full or partial payment should be made. When payment of a claim is necessarily delayed for reasons other than the application of a COB provision, investigation of other valid coverage should be conducted concurrently so as to create no further delay in the ultimate payment of benefits. Occasionally, this will necessitate a carrier making payment as the primary carrier with a right of recovery in the event that subsequent investigation proves that payment as a secondary carrier should have been made.
2. (b) There should be continued and improved education of claim personnel, stressing accurate and prompt completion of the HIC Duplicate Coverage Inquiry (DUP-1) Form by the inquiring carrier and the responding carrier. This education effort should also be encouraged through local claim associations. Claim personnel should be encouraged to make every effort to speed up exchange of COB information.

For the purpose of determining the applicability of and implementing the terms of this provision of this Plan or any provision of similar purpose of any other Plan, the insurer or service plan may, release to or obtain from any other insurance company or other organization or person any information, with respect to any person, which the insurer or service plan deems to be necessary for such purposes. Any person claiming benefits under this Plan shall furnish to the insurer or service plan such information as may be necessary to implement this provision.

Instructions

Carriers are urged to use the following claims administration procedures to expedite claim payments where COB is involved:

Note: Authority cited: Sections 10270.94, 10270.98, 11515 and 11515.5, Insurance Code. Reference: Sections 791.06, 10270.98 and 11515.5, Insurance Code.

History

1. Amendment filed 1-8-86; effective thirtieth day thereafter (Register 86, No. 2).