Reconsideration of Carrier Decisions on Internal Grievances

(1) The carrier or utilization review organization may offer to the insured or the insured's authorized representative, if any, the opportunity for reconsideration of a carrier's final adverse determination where: (a) relevant medical information was received too late to review within the 30-day time limit; (b) relevant medical information was not received but is expected to become available within a reasonable time period following the written resolution; or (c) for other good cause offered by the insured or insured's authorized representative. (2) When an insured or the insured's authorized representative, if any, chooses to request reconsideration, the carrier or utilization review organization must agree in writing to a new time period for review, but in no event greater than 30 days from the agreement to reconsider the grievance. The time period for requesting external review shall begin to run on the date of the resolution of the reconsidered grievance. (3) Reconsideration is voluntary for the insured. A carrier or utilization review organization may not compel the insured or the insured's authorized representative to submit a grievance for reconsideration.