4-5 Vt. Code R. 4:9 - External review reporting requirements under the Department of Financial Regulation regulations

“External review reporting requirements under the Department of Financial Regulation regulations”

An independent review organization must maintain written records and report to the commissioner of financial regulation that provides information on the external review process.

The report must include in the aggregate for Vermont, and for each insurer:

• The total number of requests for independent external review;
• The number of requests for independent external review resolved;
• The number resolved upholding the adverse determination or final adverse determination and the number resolved reversing the adverse determination or final adverse determination;
• The average length of time for resolution;
• A summary of the types of coverages or cases for which an external review was sought, as provided in the format required by the Commissioner;
• The number of external reviews that were terminated as the result of a reconsideration by the insurer of its adverse determination or final adverse determination after the receipt of additional information from the covered person or the covered person's authorized representative; and
• Any other information the Commissioner may request or require.

The independent review organization must retain the written records for 3 years and make them available at no cost to the Department.