US Laws, Codes, Statutes & Cases

                                  TITLE  41
                                  INSURANCE
                                  CHAPTER 56
                           PROMPT PAYMENT OF CLAIMS
    41-5605.  EXCEPTIONS. (1) The time periods set forth in section 41-5602,
Idaho Code, shall not apply to claims that the insurer reasonably believes
involve fraud or misrepresentation by the practitioner or facility or the
beneficiary or to instances where the insurer has not been provided the
information necessary to evaluate the claim after notice has been given
requesting additional information by the insurer as required by section
41-5602(5), Idaho Code.
    (2)  The time periods set forth in section 41-5602, Idaho Code, shall not
apply to claims that the insurer reasonably believes require medical records,
including accident reports, for the purpose of investigating whether a claim
is valid for subrogation, or the coordination of benefits payable by the
insurer with benefits payable by another insurer or payable under federal or
state law.
    (3)  An insurer is not required to comply with the time periods set forth
in section 41-5602, Idaho Code, if the insurer is in compliance with a
contract with the practitioner or facility which specifies different payment
requirements. Payments made within the time periods set forth in section
41-5602, Idaho Code, for the purpose of this chapter, shall be deemed to be
made in a reasonable and timely manner.
    (4)  An insurer is not required to comply with the periods set forth in
section 41-5602, Idaho Code, if the fee or premium entitling a beneficiary to
insurance benefits has not been paid in full.
    (5)  An insurer is not required to comply with the time periods set forth
in section 41-5602, Idaho Code, if failure to comply is due to an act of God,
bankruptcy, an act of a governmental authority responding to an act of God or
emergency or the result of a strike, walkout or other labor dispute, or act of
terrorism.