This subchapter applies to all insurers as defined in §21.2502
of this title (relating to Definitions). The purpose of this subchapter
is to prescribe the minimum information required to be maintained
in the complaint record of an insurer, to provide a recommended format
for the maintenance of such a record by insurers, and to require presentation
of such information at the time of examination of insurers or upon
other request for complaint record information by the department.
Complaint record maintenance provisions of this subchapter apply to
all complaints of an insurer not specifically excepted by this subchapter,
including complaints relating to the claims settlement practices of
an insurer.
(1) This subchapter does not apply to complaints received
and maintained by Health Maintenance Organizations. Insurance Code
Chapter 843, Subchapter G, as amended, as well as §11.205 of
this title (relating to Additional Documents to be Available for Review),
expressly and specifically provide for complaint record maintenance
by HMOs.
(2) This subchapter does not apply to the complaints
received by an insurer in its capacity as a utilization review agent.
Complaint record maintenance and reporting for such complaints are
addressed in §19.1705 of this title (relating to General Standards
of Utilization Review).
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