(a) When a complaint is received by the Department of Insurance (Department) against a limited health service organization (respondent) or producer (respondent), the respondent shall be notified of the complaint. The Department in its notification shall specify the date when a report is to be received from the respondent, which shall be no later than 21 days after notification is sent to the respondent. A failure to reply by the date specified may be followed by a collect telephone call or collect telegram. Repeated instances of failing to reply by the date specified may result in further regulatory action.
     (b) Contents of response or report.
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Terms Used In Illinois Compiled Statutes 215 ILCS 130/3003

  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • individual: shall include every infant member of the species homo sapiens who is born alive at any stage of development. See Illinois Compiled Statutes 5 ILCS 70/1.36

        (1) Each respondent shall supply adequate
    
documentation which explains all actions taken or not taken and which were the basis for the complaint.
        (2) Documents necessary to support the respondent’s
    
position and information requested by the Department, shall be furnished with the respondent’s reply.
        (3) The respondent’s reply shall be duplicate, but
    
duplicate copies of supporting documents shall not be required.
        (4) The respondent’s reply shall include the name,
    
telephone number and address of the individual assigned to the complaint.
        (5) The Department shall respect the confidentiality
    
of medical reports and other documents which by law are confidential. Any other information furnished by a respondent shall be marked “confidential” if the respondent does not wish it to be released to the complainant.
    (c) Follow-up conclusion. Upon receipt of the respondent’s report, the investigating deputy shall evaluate the material submitted; and
        (1) advise the complainant of the action taken and
    
disposition of his complaint;
        (2) pursue further investigation with respondent or
    
complainant; or
        (3) refer the investigation report to the appropriate
    
unit within the Department of Insurance for further regulatory action.
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