1. (1) An independent review is available to a claimant regardless of the dollar amount of the claim involved.

2. (2)(a) A claimant has 180 calendar days after receiving a notice of a final adverse benefit determination to file a request with the commissioner for an independent review.

   1. (b) A claimant shall use the Independent Review Request Form available on the department's website, https://insurance.utah.gov, or a substantially similar form, to file a request.
   2. (c) A request for an independent review sent to a carrier instead of to the commissioner shall be forwarded to the commissioner by the carrier within one business day of receipt.
3. (3) A carrier shall pay to the independent review organization the cost of conducting the independent review.
4. (4) The independent review decision is binding on the carrier and the claimant except to the extent that other remedies are available under federal or state law.

5. (5)(a) If a carrier fails to provide the requested information to an independent review organization, as outlined in Subsections R590-261-9(2)(b), R590-261-10(3)(b), and R590-261-11(3)(b), the independent review organization may terminate the independent review and make a decision to reverse the adverse benefit determination.

   1. (b) Within one business day after making a decision under Subsection (5)(a), the independent review organization shall notify:

      1. (i) the claimant;
      2. (ii) the carrier; and
      3. (iii) the commissioner.

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