C.R.S. § 10-3-1116

Remedies for unreasonable delay or denial of benefits - required contract provision - frivolous actions - severability - definition - rules.

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10-3-1116. Remedies for unreasonable delay or denial of benefits - required
contract provision - frivolous actions - severability - definition - rules. (1) A first-party claimant as defined in section 10-3-1115 whose claim for payment of benefits
has been unreasonably delayed or denied may bring an action in a district court to
recover reasonable attorney fees and court costs and two times the covered
benefit.

 (2) An insurance policy, insurance contract, or plan that is issued in this state
and that offers health or disability benefits shall not contain a provision purporting
to reserve discretion to the insurer, plan administrator, or claim administrator to
interpret the terms of the policy, contract, or plan or to determine eligibility for
benefits. If an insurance policy, contract, or plan contains such a provision, the
provision is void.

 (3) An insurance policy, insurance contract, or plan that is issued in this state
shall provide that a person who claims health, life, or disability benefits, whose
claim has been denied in whole or in part, and who has exhausted the person's
administrative remedies:

 (a) Is entitled to have the person's claim reviewed de novo in any court with
jurisdiction; and

 (b) Is entitled to a trial by jury.

 (4) The action authorized in this section is in addition to, and does not limit or
affect, other actions available by statute or common law, now or in the future.
Damages awarded pursuant to this section shall not be recoverable in any other
action or claim.

 (5) If the court finds that an action brought pursuant to this section was
frivolous as provided in article 17 of title 13, C.R.S., the court shall award costs and
attorney fees to the defendant in the action.

 (6) If any provision of this section, or of any subsection or portion of this
section, or its application to any person or circumstance is held illegal, invalid, or
unenforceable, no other provisions or applications of this section shall be affected
that can be given effect without the illegal, invalid, or unenforceable provision or
application, and to this end the provisions of this section are severable.

 (7) The general assembly declares that this section is a law regulating
insurance.

 (8) As used in this section, issued in this state refers to every health and
disability insurance policy, insurance contract, insurance certificate, and insurance
agreement existing, offered, issued, delivered, or renewed in the state of Colorado
or providing health or disability benefits to a resident or domiciliary of the state of
Colorado and every employee benefit plan covering a resident or domiciliary of the
state of Colorado, whether or not on behalf of an employer located or domiciled in
Colorado, on or after August 5, 2008, notwithstanding any contractual or statutory
choice-of-law provision to the contrary.

 Source: L. 2008: Entire section added, p. 2173, § 5, effective August 5. L.
2020: (2), (3), and (6) amended and (8) added, (SB 20-176), ch. 301, p. 1499, § 2,
effective September 14.

 Cross references: For the legislative declaration in SB 20-176, see section 1
of chapter 301, Session Laws of Colorado 2020.

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