1. A. In the administration, servicing, or processing of any accident and health insurance policy, every insurer shall reimburse all clean claims of an insured, an assignee of the insured, or a health care provider within forty-five (45) calendar days after receipt of the claim by the insurer.

2. B. As used in this section:

   1. 1. "Accident and health insurance policy" or "policy" means any policy, certificate, contract, agreement or other instrument that provides accident and health insurance, as defined in Section 703 of this title, to any person in this state; 2. "Clean claim" means a claim that has no defect or impropriety, including a lack of any required substantiating documentation, or particular circumstance requiring special treatment that impedes prompt payment; and
   2. 3. "Insurer" means any entity that provides an accident and health insurance policy in this state, including but not limited to, a licensed insurance company, a not-for-profit hospital service and medical indemnity corporation, a fraternal benefit society, a multiple employer welfare arrangement, or any other entity subject to regulation by the Insurance Commissioner.
3. C. If a claim or any portion of a claim is determined to have defects or improprieties, including a lack of any required substantiating documentation, or particular circumstance requiring special treatment, the insured, assignee of the insured, or health care provider shall be notified in writing within thirty (30) calendar days after receipt of the claim by the insurer. The written notice shall specify the portion of the claim that is causing a delay in processing and explain any additional information or corrections needed. Failure of an insurer to provide the insured, assignee of the insured, or health care provider with the notice shall constitute prima facie evidence that the claim will be paid in accordance with the terms of the policy.
4. D. Upon receipt of the additional information or corrections which led to the claim’s being delayed and a determination that the information is accurate, an insurer shall either pay or deny the claim or a portion of the claim within forty-five (45) calendar days.

5. E. Payment shall be considered made on:

   1. 1. The date a draft or other valid instrument which is equivalent to the amount of the payment is placed in the United States mail in a properly addressed, postpaid envelope; or
   2. 2. If not so posted, the date of delivery.
6. F. An overdue payment shall bear simple interest at the rate of ten percent (10%) per year.
7. G. In the event litigation should ensue based upon such a claim, the prevailing party shall be entitled to recover a reasonable attorney's fee to be set by the court and taxed as costs against the party or parties who do not prevail.
8. H. The provisions of this section shall not apply to the Oklahoma Life and Health Insurance Guaranty Association or to the Oklahoma Property and Casualty Insurance Guaranty Association.

Laws 1975, HB 1181, c. 301, § 1, eff. October 1, 1975; Amended by Laws 1986, HB 1983, c. 251, § 12, eff. November 1, 1986; Amended by Laws 1987, HB 1030, c. 175, § 8, eff. November 1, 1987; Amended by Laws 1992, SB 622, c. 74, § 1, eff. September 1, 1992; Amended by Laws 1997, SB 223, c. 156, § 1, eff. November 1, 1997 (superseded document available); Amended by Laws 1997, SB 327, c. 418, § 50, eff. November 1, 1997 (superseded document available); Amended by Laws 2001, SB 192, c. 65, § 1, eff. November 1, 2001 (superseded document available).