20:06:47:08. Relevant claim
information. A document, record, or other information shall be considered
relevant to a claim if such document, record, or other information:
(1) Was
relied upon in making the benefit determination;
(2) Was
submitted, considered, or generated in the course of making the benefit
determination, without regard to whether such document, record, or other
information was relied upon in making the benefit determination;
(3) Demonstrates
compliance with the administrative processes and safeguards required in making
the benefit determination; and
(4) Constitutes
statement of policy or guidance with respect to the plan concerning the denied
treatment option or benefit for the covered person's diagnosis, without regard
to whether such advice or statement was relied upon in making the benefit
determination.
Source: 30 SDR 39, effective September
28, 2003; 37 SDR 241, effective July 1, 2011.
