20:06:21:88Notice to insured.

If an insurer determines that the benefit trigger of a long-term care insurance policy has not been met, the insurer shall provide a clear, written notice to the insured and the insured's authorized representative, if applicable, of all of the following: (1) The reason that the insurer determined that the insured's benefit trigger has not been met; (2) The insured's right to internal appeal in accordance with § 20:06:21:89, and the right to submit new or additional information relating to the benefit trigger denial with the appeal request; and (3) The insured's right, after exhaustion of the insurer's internal appeal process, to have the benefit trigger determination reviewed under the independent review process in accordance with §§ 20:06:21:91 to 20:06:21:100, inclusive.

Source: 36 SDR 209, effective July 1, 2010.