Shown verbatim: the complete text as captured from the official PDF posted by the Oklahoma Legislature, fetched 2026-07-23. Page and line markers are part of the official record; nothing is edited or removed. The official bill page.
1 STATE OF OKLAHOMA
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2 1st Session of the 60th Legislature (2025)
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3 SENATE BILL 1050 By: Seifried
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6 AS INTRODUCED
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7 An Act relating to the Unfair Claims Settlement
7 Practices Act; amending 36 O.S. 2021, Section 1250.5,
8 as last amended by Section 1, Chapter 214, O.S.L.
8 2023 (36 O.S. Supp. 2024, Section 1250.5), which
9 relates to acts by an insurer constituting unfair
9 claim settlement practice; decreasing allowable time
10 to file certain claim; and providing an effective
10 date.
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13 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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14 SECTION 1. AMENDATORY 36 O.S. 2021, Section 1250.5, as
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15 last amended by Section 1, Chapter 214, O.S.L. 2023 (36 O.S. Supp.
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16 2024, Section 1250.5), is amended to read as follows:
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17 Section 1250.5. Any of the following acts by an insurer, if
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18 committed in violation of Section 1250.3 of this title, constitutes
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19 an unfair claim settlement practice exclusive of paragraph 16 of
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20 this section which shall be applicable solely to health benefit
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21 plans:
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22 1. Failing to fully disclose to first-party claimants,
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23 benefits, coverages, or other provisions of any insurance policy or
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1 insurance contract when the benefits, coverages or other provisions
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2 are pertinent to a claim;
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3 2. Knowingly misrepresenting to claimants pertinent facts or
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4 policy provisions relating to coverages at issue;
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5 3. Failing to adopt and implement reasonable standards for
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6 prompt investigations of claims arising under its insurance policies
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7 or insurance contracts;
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8 4. Not attempting in good faith to effectuate prompt, fair and
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9 equitable settlement of claims submitted in which liability has
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10 become reasonably clear;
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11 5. Failing to comply with the provisions of Section 1219 of
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12 this title;
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13 6. Denying a claim for failure to exhibit the property without
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14 proof of demand and unfounded refusal by a claimant to do so;
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15 7. Except where there is a time limit specified in the policy,
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16 making statements, written or otherwise, which require a claimant to
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17 give written notice of loss or proof of loss within a specified time
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18 limit and which seek to relieve the company of its obligations if
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19 the time limit is not complied with unless the failure to comply
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20 with the time limit prejudices the rights of an insurer. Any policy
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21 that specifies a time limit covering damage to a roof due to wind or
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22 hail must allow the filing of claims after the first anniversary but
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23 no later than twenty-four (24) months after the date of the loss, if
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24 the damage is not evident without inspection;
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1 8. Requesting a claimant to sign a release that extends beyond
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2 the subject matter that gave rise to the claim payment;
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3 9. Issuing checks, drafts or electronic payment in partial
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4 settlement of a loss or claim under a specified coverage which
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5 contain language releasing an insurer or its insured from its total
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6 liability;
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7 10. Denying payment to a claimant on the grounds that services,
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8 procedures, or supplies provided by a treating physician, hospital,
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9 or person or entity licensed or otherwise authorized to provide
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10 health care services were not medically necessary unless the health
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11 insurer or administrator, as defined in Section 1442 of this title,
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12 first obtains an opinion from any provider of health care licensed
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13 by law and preceded by a medical examination or claim review, to the
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14 effect that the services, procedures or supplies for which payment
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15 is being denied were not medically necessary. In the event that
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16 claims for mental health or substance use disorder treatments and
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17 services are under review, the reviewing health care provider shall
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18 have appropriate, qualified, and specialized credentials with
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19 respect to the services and treatments. Upon written request of a
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20 claimant, treating physician, hospital, or authorized person or
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21 entity, the opinion shall be set forth in a written report, prepared
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22 and signed by the reviewing physician. The report shall detail
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23 which specific services, procedures, or supplies were not medically
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24 necessary, in the opinion of the reviewing physician, and an
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1 explanation of that conclusion. A copy of each report of a
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2 reviewing physician shall be mailed by the health insurer, or
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3 administrator, postage prepaid, to the claimant, treating physician,
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4 hospital, or authorized person or entity requesting same within
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5 fifteen (15) days after receipt of the written request. As used in
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6 this paragraph, "physician" means a person holding a valid license
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7 to practice medicine and surgery, osteopathic medicine, podiatric
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8 medicine, dentistry, chiropractic, or optometry, pursuant to the
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9 state licensing provisions of Title 59 of the Oklahoma Statutes;
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10 11. Compensating a reviewing physician, as defined in paragraph
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11 10 of this section, on the basis of a percentage of the amount by
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12 which a claim is reduced for payment;
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13 12. Violating the provisions of the Health Care Fraud
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14 Prevention Act;
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15 13. Compelling, without just cause, policyholders to institute
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16 suits to recover amounts due under its insurance policies or
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17 insurance contracts by offering substantially less than the amounts
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18 ultimately recovered in suits brought by them, when the
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19 policyholders have made claims for amounts reasonably similar to the
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20 amounts ultimately recovered;
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21 14. Failing to maintain a complete record of all complaints
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22 which it has received during the preceding three (3) years or since
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23 the date of its last financial examination conducted or accepted by
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24 the Commissioner, whichever time is longer. This record shall
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1 indicate the total number of complaints, their classification by
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2 line of insurance, the nature of each complaint, the disposition of
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3 each complaint, and the time it took to process each complaint. For
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4 the purposes of this paragraph, "complaint" means any written
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5 communication primarily expressing a grievance;
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6 15. Requesting a refund of all or a portion of a payment of a
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7 claim made to a claimant more than twelve (12) two (2) months or a
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8 health care provider more than eighteen (18) four (4) months after
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9 the payment is made. This paragraph shall not apply:
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10 a. if the payment was made because of fraud committed by
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11 the claimant or health care provider, or
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12 b. if the claimant or health care provider has otherwise
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13 agreed to make a refund to the insurer for overpayment
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14 of a claim;
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15 16. Failing to pay, or requesting a refund of a payment, for
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16 health care services covered under the policy if a health benefit
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17 plan, or its agent, has provided a preauthorization or
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18 precertification and verification of eligibility for those health
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19 care services. This paragraph shall not apply if:
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20 a. the claim or payment was made because of fraud
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21 committed by the claimant or health care provider,
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22 b. the subscriber had a preexisting exclusion under the
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23 policy related to the service provided, or
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1 c. the subscriber or employer failed to pay the
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2 applicable premium and all grace periods and
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3 extensions of coverage have expired;
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4 17. Denying or refusing to accept an application for life
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5 insurance, or refusing to renew, cancel, restrict or otherwise
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6 terminate a policy of life insurance, or charge a different rate
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7 based upon the lawful travel destination of an applicant or insured
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8 as provided in Section 4024 of this title; or
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9 18. As a health insurer that provides pharmacy benefits or a
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10 pharmacy benefits manager that administers pharmacy benefits for a
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11 health plan, failing to include any amount paid by an enrollee or on
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12 behalf of an enrollee by another person when calculating the
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13 enrollee's total contribution to an out-of-pocket maximum,
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14 deductible, copayment, coinsurance or other cost-sharing
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15 requirement.
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16 However, if, under federal law, application of this paragraph
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17 would result in health savings account ineligibility under Section
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18 223 of the federal Internal Revenue Code, as amended, this
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19 requirement shall apply only for health savings accounts with
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20 qualified high-deductible health plans with respect to the
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21 deductible of such a plan after the enrollee has satisfied the
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22 minimum deductible, except with respect to items or services that
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23 are preventive care pursuant to Section 223(c)(2)(C) of the federal
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24 Internal Revenue Code, as amended, in which case the requirements of
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1 this paragraph shall apply regardless of whether the minimum
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2 deductible has been satisfied.
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3 SECTION 2. This act shall become effective November 1, 2025.
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5 60-1-1239 CAD 1/16/2025 2:45:25 PM
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Req. No. 1239 Page 7Every fact on this page links to its source, starting with the official bill record.