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Utah Code Title 31A. Insurance Code § 31A-21-314. Prohibited provisions

Current as of January 01, 2025 | Updated by Findlaw Staff

(1) As used in this section:

(a) “Reserving discretionary authority” means a policy provision that:

(i) has the effect of conferring discretion on an insurer, or other claim administrator, to:

(A) determine eligibility for benefits; or

(B) interpret the terms or provisions of the policy, contract, certificate, or agreement; and

(ii) could lead to a deferential standard of review by a reviewing court.

(b) “Reserving discretionary authority” does not include a policy provision that:

(i) informs an insured that, as part of the insurer's routine operations, the insurer applies the terms of the contract for:

(A) making a decision, including making a determination regarding eligibility, or receipt of benefits or claims; or

(B) explaining the insurer's policies and procedures; and

(ii) does not give rise to a deferential standard of review by a reviewing court.

(2) An insurance policy subject to this chapter may not contain a provision:

(a) requiring the insurance policy to be construed according to the laws of another jurisdiction except as necessary to meet the requirements of compulsory insurance laws of other jurisdictions;

(b) depriving Utah courts of jurisdiction over an action against the insurer, except as provided in permissible arbitration provisions;

(c) limiting the right of action against the insurer to less than three years from the date the cause of action accrues; or

(d) for life insurance or accident and health insurance, reserving discretionary authority.

(3) For purposes of Subsection (2)(c), the cause of action accrues on a fidelity bond on the date the insurer first denies all or part of a claim made under the fidelity bond.

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Cite this article: FindLaw.com - Utah Code Title 31A. Insurance Code § 31A-21-314. Prohibited provisions - last updated January 01, 2025 | https://codes.findlaw.com/ut/title-31a-insurance-code/ut-code-sect-31a-21-314/

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