Internal review of insurer’s decisions
7.9 Internal review of insurer’s decisions
A claimant may request an insurer to review any of the following decisions of the insurer made in connection with a claim made by the claimant (an internal review)—
a decision about a merit review matter,
a decision about a medical assessment matter,
a decision about a miscellaneous claims assessment matter.
The claimant must provide the insurer with such information as the insurer may reasonably require and request for the purposes of an internal review.
The Motor Accident Guidelines may make provision for or with respect to the following—
the making of a request for an internal review,
the time within which a request for an internal review is to be made,
the individuals who may or may not conduct an internal review,
the way in which an internal review is to be conducted (including requiring the giving of reasons for and supporting documentation in relation to an insurer’s decision on an internal review).
The insurer is to conduct an internal review in accordance with the Motor Accident Guidelines and is to complete and notify the claimant of the results of the review within 14 days after the request for the review is received by the insurer.
The Motor Accident Guidelines may provide for particular circumstances in which an insurer has a longer period to complete and notify the results of an internal review.
An internal review can consider information that was not provided before the decision being reviewed was made.
An internal review of a decision does not operate to stay the decision or otherwise prevent the taking of action based on the decision.
This Act’s bill:Explanatory memorandumSecond reading speech
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