Insurance Law 4913 — Legislation

Legislation Search OpenLegislation Statutes Search Term Search icon Search previous SECTION 4912 Standards for certification up TITLE 2 Right to External Appeal next SECTION 4914 Procedures for external appeals of adverse determinations Viewing most recent revision (from 2014-09-22) View historical revision as of: -- Choose a Date -- 2014-09-22 Share Facebook Email SECTION 4913 Conflict of interest Insurance (ISC) CHAPTER 28, ARTICLE 49, TITLE 2 § 4913. Conflict of interest. (a) No external appeal agent or officer, director, or management employee thereof; or clinical peer reviewer employed or engaged thereby to conduct any external appeal pursuant to this title, shall have any material professional affiliation, material familial affiliation, material financial affiliation, or other affiliation prescribed pursuant to regulation, with any of the following: (1) the health care plan; (2) any officer, director, or management employee of the health care plan; (3) any health care provider, physician's medical group, independent practice association, or provider of pharmaceutical products or services or durable medical equipment, proposing to provide or supply the health service; (4) the facility at which the health service would be provided; (5) the developer or manufacturer of the principal health service which is the subject of the appeal; or (6) the insured whose health care service is the subject of the appeal, or the insured's designee. (b) Notwithstanding subsection (a) of this section, the superintendent shall promulgate regulations to minimize any conflict of interest where such conflict may be unavoidable.