In response COVID-19, numerous state departments of insurance and other regulatory agencies have issued bulletins and notices setting forth mandatory and voluntary steps for insurers to take or consider to better accommodate policyholders. Many of these measures involve claim-related practices, and the majority require or request that insurers show flexibility to accommodate insureds experiencing hardship during the COVID-19 crisis.
Set forth below is a summary of many of the claim-related measures states have put in place. Certain of these measures directly impact first- and third-party automobile coverage, although some have more general application to broader property and casualty insurance issues.
These summaries are provided as an informational reference only and are not intended as definitive statements of the measures states have put in place. These summaries are not, and should not be, considered legal advice. We encourage carriers to reference the pertinent state agency websites for the complete and most up-to-date bulletins and notices, including the definitive guidance as to whether the measures are mandatory versus voluntary and the time frames for which they are in effect.
Alabama – Alabama Department of Insurance Bulletin No. 2020-09 requests that insurers cooperate with insureds with respect to certain claims handling issues during the COVID-19 crisis. Specifically, the bulletin states with respect to claim reporting and first notice of loss: “In the event that an insured is unaware of a loss or unable to provide notice of a claim, due to factors beyond their control directly as a result of COVID-19, insurers are requested to be lenient in the application of this policy language and consider whether or not late notice of a claim was preventable and if the late-notice actually prejudiced the insurer’s ability to adjust the claim.”
Arizona – Arizona Department of Insurance Regulatory Bulletin 2020-04 encourages insurers to work with insureds so claimants have adequate time to obtain coverage and receive claim payments. The bulletin urges insurers to consider various measures, including extending timeframes for health providers to submit claims and extending times for individuals to undergo medical examinations. Insurers implementing COVID-19 related customer relief programs must make an Informational Filing in SERF to document their programs.
California – The California Department of Insurance issued a notice advising/reminding all insurers that they are required to comply with their contractual, statutory, regulatory and other legal obligations, including their obligations under the state’s Fair Claims Settlement Practices Regulation, in connection with California insurance claims.
Florida – A Florida Division of Workers’ Compensation bulletin discusses telehealth and telemedicine services provided under Chapter 440 of the Florida statute. The bulletin states, “In response to the recent outbreak of COVID-19, the Division of Workers’ Compensation is providing the following information related to telehealth and telemedicine services provided by licensed practitioners to workers’ compensation patients under chapter 440, Florida Statutes. All telehealth and telemedicine services are governed under the Florida Department of Health, section 456.47, Florida Statutes. Authorized services must be in compliance with section 456.47, Florida Statutes and Florida Department of Health Emergency Order 20-002. The provision of telehealth and telemedicine services provided by licensed practitioners must be mutually agreed upon by the carrier and health care provider prior to treatment. Emergency services and care, defined in section 395.002, Florida Statutes, do not require prior authorization. Carriers and health care providers should utilize national coding standards as adopted by the Centers for Medicaid and Medicare Services to accommodate the provision of telehealth and telemedicine services. All telemedicine and telehealth services provided by health care practitioners should be billed with Place of Service Code (POS) 02 on the DFS-F5-DWC-09/CMS-1500 claim form. Reimbursement is according to a mutually agreed upon contract amount or the listed Maximum Reimbursement Allowance (MRA) in the Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2016 Edition.”
Hawaii – Memorandum 2020-3I issued by the Hawaii Insurance Commission encourages insurers to work with insureds to “[e]xtend timeframes to . . . undergo medical examinations.”
Illinois – Illinois Department of Insurance Company Bulletin #2020-09 requests insurers to “consider granting an extension of any policy provisions or other requirements that impose a time limit for an insured or claimant to perform any act, including the submission of a claim or proof of loss, reporting of information, or submission of bills. The Department asks that such extension be for at least 30 days from the last date allowed or required under the contract or allowed or required by the insurer, or longer if considered reasonable given an individual consumer’s circumstance.” The Department of Insurance subsequently issued Company Bulletin 2020-12, requesting that insurers extend the safeguards listed in Company Bulletin 2020-09, above, through May 29, 2020.
Maine – Maine Bureau of Insurance Bulletin 442 requires insurers to “prioritize consumers’ needs” and “make every effort to expedite claims approvals and payments and other essential customer service functions.”
Michigan – Michigan Department of Insurance and Financial Services Bulletin 2020-12-INS requires that “[a]ll claims must continue to be processed and paid in a timely manner.” In addition, “[e]ntities and persons regulated by DIFS must continue to comply with all applicable statutory and regulatory deadlines and requirements unless such deadlines and requirements are expressly waived or modified by the Director.” DIFS states that “[c]ompanies that experience difficulty in meeting any statutory or regulatory deadline or requirement as a result of the COVID-19 pandemic must contact DIFS immediately.” DIFS has also issued Bulletin 2020-16-INS, which advises all insurers to consider flexibility to help insureds avoid additional financial consequences as a result of their inability to file claims on time. These measures include allowing insureds flexibility in filing notices of claim and in submitting to EUO’s. The Bulletin expires 90 days after the expiration of the state of emergency declared by the governor on March 10, 2020, and any extensions thereto. DIFS requests that insurers taking measures to provide such flexibility due to COVID-19 submit their plans regarding implementation steps to DIFS as soon as possible but no later than 7 days after implementation.
Montana – A notice issued by Montana’s Insurance Commissioner encourages insurers to “streamline . . . administrative processes and paperwork to ease consumer burden on consumer burdens.”
New Jersey – New Jersey Department of Banking and Insurance Bulletin No. 20-04 encourages insurers to extend timeframes for insureds to undergo medical examinations.
In addition, DOBI Bulletin No. 20-19 provides guidance to automobile insurers that provide PIP medical expense benefits in NJ regarding the use of telemedicine and telehealth during the COVID-19 pandemic. The bulletin provides that effective immediately and continuing for the duration of the state of emergency, PIP carriers are subject to the following requirements:
(1) Review or establish their telemedicine and telehealth networks to ensure adequacy given the increased demand;
(2) Encourage network providers to utilize telemedicine or telehealth services wherever possible and clinically appropriate to diagnose and treat PIP injuries during the ongoing public health emergency, in order to minimize exposure of provider staff and other patients to those who may have the COVID-19 virus;
(3) Update their procedures to include reimbursement for telehealth services that are provided by a provider in any manner that is practicable and appropriate, including by telephone. PIP carriers should disseminate information on their website, or other reasonable means, to notify individuals of these updates. This would include the use of telephone-only communications to establish a physician-patient relationship and the expanded use of telehealth for the diagnosis, treatment, ordering of tests, and prescribing. PIP carriers are required to update telehealth policies to include telephone-only services within the definition of telehealth;
(4) Reimburse providers that deliver covered services to claimants via telemedicine or telehealth in accordance with this guidance. Carriers may establish requirements for such telemedicine and/or telehealth services, similar to those developed by health insurance carriers in accordance with P.L. 2020, c.3, and guidance issued by the Department, including documentation and recordkeeping, but such requirements may not be more restrictive than those for in-person services. Carriers are not permitted to impose any specific requirements on the technologies used to deliver telemedicine and/or telehealth services (including any limitations on audio-only or live video technologies) during the state of emergency and public health emergency declared pursuant to EO 103;
(5) Ensure that the payment to providers for services delivered via telemedicine or telehealth are not lower than would typically be paid for services rendered via traditional (i.e., in-person) methods, and PIP carriers must notify providers of any instructions that are necessary to facilitate billing for such telehealth services;
(6) May not impose any restriction on the reimbursement for telehealth or telemedicine that requires that the provider who is delivering the services be licensed in a particular state, so long as the provider is in compliance with P.L. 2020, c. 4 and this guidance; and
(7) May not impose additional prior authorization requirements on medically necessary treatment that is delivered via telemedicine or telehealth, instead of via traditional methods, during this public health emergency.
New York – Department of Financial Services Circular Letter No. 7 (2020) urges insurers to “increase . . . resources as necessary to accommodate claim submissions.”
In addition, the New York Workers’ Compensation Board issued a notice of emergency adoption of amendments to 12 NYCRR 325-1.8, 329-1.3, 329-4.2, 333.2 and 348.2 (COVID-19 Telemedicine), providing for telemedicine visits in some circumstances due to the outbreak of COVID-19. The Department of Financial Services has issued an FAQ clarifying that the Workers’ Compensation Board’s emergency regulations regarding telemedicine apply to no-fault. The FAQ states, “The Workers’ Compensation Board promulgated two emergency regulations regarding telemedicine.
The first emergency rulemaking took effect on March 16, 2020. This emergency rulemaking shall apply to all no-fault claims with a date of service on or after March 16, 2020, through April 19, 2020. The Notice of Emergency Adoption was published in the April 1, 2020, edition of the State Register. Information regarding this emergency rulemaking may be found on the Workers’ Compensation Board’s website . . . The Workers’ Compensation Board’s second emergency rulemaking regarding telemedicine took effect on April 20, 2020. This emergency rulemaking shall apply to all no-fault claims with a date of service occurring on or after April 20, 2020. The Notice of Emergency Adoption was published in the May 6, 2020, edition of the State Register and is effective for 90 days from the April 20, 2020 filing. Information regarding this emergency rule may be found on the Workers’ Compensation Board’s website . . .”
North Dakota – North Dakota Insurance Department Bulletin 2020-8 urges insurers to relax proof of loss deadlines and waive limitations relating to the use of out-of-network providers.
Oklahoma – Oklahoma Insurance Department PC Bulletin No. 2020-01 (Amended) requires insurers to “suspend all claims reporting deadlines for the duration of the emergency declaration and extend all policyholder rights or benefits related to deadlines until 90 days after the state of emergency ends.”
Oregon – The Oregon Workers’ Compensation Division adopted temporary changes to OAR 436-009, the “Oregon Medical Fee and Payment Rules,” effective March 25, 2020. Amended Rule 0040 increased the maximum allowable payments for certain telephonic and digital evaluation management services delivered on or after March 8, 2020. In addition, an order issued by the Division of Financial Regulation contains the following directives: “Extend all deadlines for insureds to report claims or submit other communications related to claims. Deadlines that must be waived include, but are not limited to, deadlines to submit initial claims or to respond to communications related to claims payment and processing, grievances and appeals, or utilization review requirements.” In addition, insurers “must take all practicable steps to provide opportunities for insureds to report claims or provide required communications related to claims via methods compatible with social distancing recommendations, including telephonic and online communications and postal mail.” The Division of Financial Regulation also requested that insurers “take all other practicable steps to relieve consumers of duties and obligations under the terms of insurance contracts that could be unusually burdensome due to the impact of the COVID-19 outbreak, especially duties and obligations that could pose a barrier to coverage of items and services urgently needed to respond to the outbreak.”
Rhode Island – Rhode Island Insurance Division Bulletin No. 2020-4 requests insurers to “explore ways to make claims processes easier and more responsive such as electronic delivery of claims payments and remote adjustment of damages.” In addition, Bulletin 2020-5 specifies that all insurers are subject to the Rhode Island governor’s Executive Order 20-06 and must expand access to telemedicine/telehealth services in accordance with Bulletin 2020-01 issued by the state’s Office of Health Insurance Commission on March 20, 2020.
South Carolina – South Carolina Department of Insurance Bulletin Number 2020-02 states that the department “expects” insurers to provide insureds relief, including extending proof of loss deadlines, waiving limitations relating to the use of out-of-network providers and increasing access to telehealth.
Utah – The Utah Labor Commission/Division of Industrial Accidents issued an Emergency Rule that amends R.612-300-1 and R.612-300-4 of the Workers’ Compensation Rules – Medical Care to temporarily add CPT codes for telehealth services which medical providers will utilize for reimbursement. The Rule provides that “[u]nless otherwise governed by contract, payors shall reimburse medical providers for telehealth services at the same rate as the comparable in-person service for the following CPT codes using a 95 modifier: a. Physicians: 99211-99214; b. Physical therapists: 97110, 97164, 97530, 97535; or c. Occupational therapists: 97168.”
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