<html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>span { white-space: pre-wrap; } p.sc5540522-813c-4d0f-b6ed-6b558c90a90bNormal { text-align: justify; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; margin-top: 0; margin-left: 0; margin-right: 0; margin-bottom: .001pt; } span.sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont-000000 { color: #0000FF; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont-000001 { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sc5540522-813c-4d0f-b6ed-6b558c90a90b000002 { font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont-000003 { color: #0000FF; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } </style></head><body><div><p dir="ltr" class="sc5540522-813c-4d0f-b6ed-6b558c90a90bNormal"><span xml:space="preserve" class="sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont">    </span><a href="https://sdlegislature.gov/Rules?Rule=20:06:21:89"><span class="sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont-000000">20:06:21:89</span></a><span class="sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont-000001">.  Internal appeal.</span><span xml:space="preserve" class="sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont"> The insured or the insured's authorized representative may appeal the insurer's adverse benefit trigger determination by sending a written request to the insurer, along with any additional supporting information, within 120 calendar days after the insured and the insured's authorized representative, if applicable, receives the insurer's benefit determination notice. The internal appeal shall be considered by an individual or group of individuals designated by the insurer. However, no individual involved in making the initial benefit determination may be involved in making the internal appeal decision. The internal appeal shall be completed and written notice of the internal appeal decision shall be sent to the insured and the insured's authorized representative, if applicable, within 30 calendar days of the insurer's receipt of all necessary information upon which a final determination can be made.</span></p><p dir="ltr" class="sc5540522-813c-4d0f-b6ed-6b558c90a90bNormal"><span xml:space="preserve" class="sc5540522-813c-4d0f-b6ed-6b558c90a90b000002"> </span></p><p dir="ltr" class="sc5540522-813c-4d0f-b6ed-6b558c90a90bNormal"><span xml:space="preserve" class="sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont">    A rebuttable presumption that the notice was received by the insured within five days of mailing exists if the insurer can provide proof of actual properly addressed mailing or proof of standard office practice or procedure designed to ensure that items are properly addressed and mailed. If no proof of actual mailing or proof of standard office practice or procedure is provided, there is no presumption of receipt by the insured.</span></p><p dir="ltr" class="sc5540522-813c-4d0f-b6ed-6b558c90a90bNormal"><span xml:space="preserve" class="sc5540522-813c-4d0f-b6ed-6b558c90a90b000002"> </span></p><p dir="ltr" class="sc5540522-813c-4d0f-b6ed-6b558c90a90bNormal"><span xml:space="preserve" class="sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont">    </span><span class="sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont-000001">Source:</span><span xml:space="preserve" class="sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont"> 36 SDR 209, effective July 1, 2010.</span></p><p dir="ltr" class="sc5540522-813c-4d0f-b6ed-6b558c90a90bNormal"><span xml:space="preserve" class="sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont">    </span><span class="sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont-000001">General Authority:</span><span xml:space="preserve" class="sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-4"><span class="sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont-000003">58-17B-4</span></a><span class="sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont">.</span></p><p dir="ltr" class="sc5540522-813c-4d0f-b6ed-6b558c90a90bNormal"><span xml:space="preserve" class="sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont">    </span><span class="sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont-000001">Law Implemented:</span><span xml:space="preserve" class="sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=58-17B-4"><span class="sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont-000003">58-17B-4</span></a><span class="sc5540522-813c-4d0f-b6ed-6b558c90a90bDefaultParagraphFont">.</span></p><p dir="ltr" class="sc5540522-813c-4d0f-b6ed-6b558c90a90bNormal"><span xml:space="preserve" class="sc5540522-813c-4d0f-b6ed-6b558c90a90b000002"> </span></p></div></body></html>