Title 51, Chapter 1, Section 48
( 51-1-48)
(a) Any claim administrator, health care advisor, private review
agent, or other person or entity which administers benefits or
reviews or adjusts claims under a managed care plan shall exercise
ordinary diligence to do so in a timely and appropriate manner in
accordance with the practices and standards of the profession of the
health care provider generally. Notwithstanding any other provision
of law to the contrary, any injury or death to an enrollee resulting
from a want of such ordinary diligence shall be a tort for which a
recovery may be had against the managed care entity offering such
plan, but no recovery shall be had for punitive damages for such
tort. (b) The provisions of this Code section may not be waived, shifted,
or modified by contract or agreement and responsibility therefor
shall be a duty which shall not be delegated. Any effort to waive,
modify, delegate, or shift liability for a breach of the duty
provided by this Code section, through a contract for
indemnification or otherwise, shall be invalid. (c) This Code section shall not create any liability on the part of
an employer of an enrollee or that employer's employees, unless the
employer is the enrollee's managed care entity. This Code section
shall not create any liability on the part of an employee
organization, a voluntary employee beneficiary organization, or a
similar organization, unless such organization is the enrollee's
managed care entity and makes coverage determinations under a
managed care plan. (d) As used in this Code section and in Code Section 51-1-49, the terms "claim administrator," "enrollee," "health care advisor," and "private review agent" shall be defined as set forth in Chapter 46 of Title 33 except that "enrollee" shall include the enrollee's eligible dependents; "managed care entity" and "managed care plan" shall be defined as set forth in Code Section 33-20A-3; and "independent review" means a review pursuant to Article 2 of Chapter 20A of Title 33, the "Patient's Right to Independent Review Act." |