1. (1) the carrier agrees to waive the internal review process;

2. (2) the carrier did not comply with its internal review process, except for a minor violation that:

   1. (a) does not cause prejudice or harm to the claimant; and
   2. (b) is not part of a pattern or practice of violations; or
3. (3) the claimant requests an expedited independent review pursuant to Section R590-261-10 at the same time the claimant requests an expedited internal review.

A carrier's internal review process shall be exhausted before an independent review unless:

KEY: health benefit plan insurance

Date of Last Change: August 27, 2025

Notice of Continuation: May 19, 2026

Authorizing, and Implemented or Interpreted Law: 31A-22-629; 31A-2-201; 31A-2-212