State Law
Wyoming Statutes-Title 26-Chapter 15-Article 1. In General
08/29/2023
Wyoming
Sections 26-15-124 and 26-15-137
Claim to be accepted or rejected, attorney’s fee; Time limit to seek reimbursement for health insurance overpayments
Overpayments / Recoupments, Prompt Payment Deadlines
See the bold text below:
Section 26-15-124. Claim to be accepted or rejected, attorney’s fee
Prompt Payment Deadlines
(a) Claims for benefits under a life, accident or health insurance policy shall be rejected or accepted and paid by the insurer or its agent designated to receive the claims within forty-five (45) days after receipt of the proofs of loss and supporting evidence. Exceptions to the time of forty-five (45) days shall be made for accident and health insurance claims if there is any question as to the validity or the amount of the claim and the question is referred to the Wyoming state medical peer review committee for adjudication. Exceptions shall also be made as authorized by W.S. 26-16-112(a).
(b) Claims for benefits under a property or casualty insurance policy shall be rejected or accepted and paid by the insurer or its agent designated to receive those claims within forty-five (45) days after receipt of the claim and supporting bills.
(c) In any actions or proceedings commenced against any insurance company on any insurance policy or certificate of any type or kind of insurance, or in any case where an insurer is obligated by a liability insurance policy to defend any suit or claim or pay any judgment on behalf of a named insured, if it is determined that the company refuses to pay the full amount of a loss covered by the policy and that the refusal is unreasonable or without cause, any court in which judgment is rendered for a claimant may also award a reasonable sum as an attorney’s fee and interest at ten percent (10%) per year.
Section 26-15-137. Time limit to seek reimbursement for health insurance overpayments.
Overpayments/Recoupments
An action or request for reimbursement of any overpayment of a health insurance claim to a health care provider pursuant to any health insurance contract shall be brought not more than two (2) years after the date the claim was paid. No insurer, assignee of the insurer, or other person, whether acting for himself or another in connection with a health insurance transaction, shall make any claim or seek recovery for reimbursement of any overpayment to a health care provider pursuant to any health insurance contract more than two (2) years after the date the claim was paid, unless the claim was fraudulent. Section 2. This act shall apply to health insurance overpayments made on or after the effective date of this act.
