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Section 314 - Prohibited provisions.

UT Code § 31A-21-314 (2019) (N/A)
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(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.

(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.

(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

(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.

(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

(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.

(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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Section 314 - Prohibited provisions.