Bulletin, December 16, 2011, Grievance and Independent Review Requirements

Last Updated: December 27, 2011

Date: December 16, 2011
To: Insurers Offering Accident and Disability Insurance
From: Theodore K. Nickel, Commissioner of Insurance
Subject: Grievance and Independent Review Requirements

​On December 2, 2011, the Office of Commissioner of Insurance (OCI) issued a statement of scope for issuing an emergency rule relating to repeal of Emergency Rule 1117. Emergency Rule 1117 was promulgated on an emergency basis effective November 16, 2011, and related to grievance and independent review requirements bringing the State of Wisconsin into full compliance with 42 USC 300gg. The OCI will not promulgate Emergency Rule 1117 as a permanent rule.

As a result of these developments, OCI anticipates that the Center for Consumer Information and Insurance Oversight (CCIIO) will withdraw their approval of the Wisconsin process, and the State of Wisconsin will no longer be listed as being compliant. Insurers should be aware that CCIIO will likely be contacting each insurer in the next several weeks regarding this change in status. [CCIIO Final Determination December 21, 2011]

Insurers should make decisions they feel necessary in order to comply with the federal and state standards. Please contact Susan Ezalarab, Director, Bureau of Market Regulation, or J.P. Wieske, Legislative Liaison, regarding questions or concerns. The OCI will be providing guidance on grievance and independent review processes in the near future.