(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.
An insurance policy, insurance contract, or plan that is issued in this state and thatoffers 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.
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:
Is entitled to have the person's claim reviewed de novo in any court with jurisdiction;and
Is entitled to a trial by jury.
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.
If the court finds that an action brought pursuant to this section was frivolous asprovided in article 17 of title 13, C.R.S., the court shall award costs and attorney fees to the defendant in the action.
If any provision of this section, or of any subsection or portion of this section, or itsapplication 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.
The general assembly declares that this section is a law regulating insurance.
As used in this section, "issued in this state" refers to every health and disabilityinsurance 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.
Editor's note: Section 3 of chapter 301 (SB 20-176), Session Laws of Colorado 2020, provides that the act changing this section applies 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 September 14, 2020, notwithstanding any contractual or statutory choice-of-law provision to the contrary.
Cross references: For the legislative declaration in SB 20-176, see section 1 of chapter 301, Session Laws of Colorado 2020.