<html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><meta http-equiv='content-language' content='en-us'/><title>SDLRC - Codified Law 58-3-7.4 - Insurer's claim files subject to examination--File maintenance requirements. </title><meta name="Generator" content="PowerTools for Open XML" /><style>span { white-space: pre-wrap; } p.s2073916Normal { 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.s2073916SENU { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s2073916CL { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } p.s2073916Normal-000000 { text-indent: 0.50in; 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.s2073916DefaultParagraphFont { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } p.s2073916Normal-000001 { margin-left: 0.70in; text-indent: -0.45in; text-align: justify; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; margin-top: 0; margin-right: 0; margin-bottom: .001pt; } span.s2073916000002 { font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s2073916SCL { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s2073916SCL-000003 { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } body { text-decoration-skip-ink: none; } </style></head><body><div><p dir="ltr" class="s2073916Normal"><a href="https://sdlegislature.gov/Statutes/Codified_Laws/DisplayStatute.aspx?Type=Statute&amp;Statute=58-3-7.4"><span class="s2073916SENU">58-3-7.4</span></a><span xml:space="preserve" class="s2073916SENU">. </span><span class="s2073916CL">Insurer's claim files subject to examination--File maintenance requirements.</span></p><p dir="ltr" class="s2073916Normal-000000"><span xml:space="preserve" class="s2073916DefaultParagraphFont">Each insurer's claim files for policies or certificates are subject to examination pursuant to chapter </span><a href="https://sdlegislature.gov/Statutes/Codified_Laws/DisplayStatute.aspx?Type=Statute&amp;Statute=58-3"><span class="s2073916DefaultParagraphFont">58-3</span></a><span xml:space="preserve" class="s2073916DefaultParagraphFont"> by the director of insurance. To aid in the examination:</span></p><p dir="ltr" class="s2073916Normal-000001"><span class="s2073916DefaultParagraphFont">(1)    The insurer shall maintain claim data that is accessible and retrievable for examination. An insurer shall be able to provide the claim number, line of coverage, date of loss, and date of payment of the claim, date of denial, or date closed without payment. This claim data shall be available for all open and closed files for five years;</span></p><p dir="ltr" class="s2073916Normal-000001"><span class="s2073916DefaultParagraphFont">(2)    Detailed documentation shall be contained in each claim file in order to permit reconstruction of the insurer's activities relative to each claim;</span></p><p dir="ltr" class="s2073916Normal-000001"><span class="s2073916DefaultParagraphFont">(3)    Each relevant document within the claim file shall be noted as to date received, date processed, or date mailed. Dated correspondence is sufficient to document the date mailed for the purposes of this subdivision;</span></p><p dir="ltr" class="s2073916Normal-000001"><span class="s2073916DefaultParagraphFont">(4)    For those insurers that do not maintain hard copy files, claim files shall be accessible from a computer, microfilm, Cathode Ray Tube (CRT), micrographics, or other similar electronic means and be capable of duplication to hard copy; and</span></p><p dir="ltr" class="s2073916Normal-000001"><span class="s2073916DefaultParagraphFont">(5)    Claim information obtained in a telephone conversation or personal interview with any source which is used in the claim determination shall be documented in the claim file.</span></p><p dir="ltr" class="s2073916Normal"><span xml:space="preserve" class="s2073916000002"> </span></p><p dir="ltr" class="s2073916Normal"><span class="s2073916SCL">Source:</span><span xml:space="preserve" class="s2073916SCL-000003"> SL 1997, ch 283, § 5; SL 2009, ch 257, § 1.</span></p></div></body></html>