What if the insurer reconsiders the case after being notified of the request for expedited review; can the insurer reverse its own decision?
Yes, if the decision is based upon consideration of new information provided by the covered person during the external review process. If the insurer decides to reverse its decision, it must notify the covered person, the IRO, and the Department. Immediately upon receipt of written notice from the insurer, the IRO shall cease its review of the case. (See NCGS 58-50-80(g) & (h).
Related Questions
- For denied variance requests, can an insurance carrier attach its peer review decision to the variance request and remain in compliance with the regulations?
- What if the insurer reconsiders the case after being notified of the request for expedited review; can the insurer reverse its own decision?
- If a request for an expedited review, with all necessary information, is received at 9 a.m. on a Friday morning, when is the decision due?
