North Carolina General Statutes 90-21.55. External review decision
Terms Used In North Carolina General Statutes 90-21.55
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Insured or enrollee: means a person that is insured by or enrolled in a health benefit plan under a policy, plan, certificate, or contract issued or delivered in this State by an insurer. See North Carolina General Statutes 90-21.50
- Managed care entity: means an insurer that:
- Successor external review process: means an external review process equivalent in all respects to N. See North Carolina General Statutes 90-21.50
- Testimony: Evidence presented orally by witnesses during trials or before grand juries.
(a) Either the insured or enrollee or the personal representative of the insured or enrollee or the managed care entity may use an external review decision made in accordance with N.C. Gen. Stat. § 58-50-75 through N.C. Gen. Stat. § 58-50-95, or made in accordance with any successor external review process, as evidence in any cause of action which includes an action brought under this Part, provided that an adequate foundation is laid for the introduction of the external review decision into evidence and the testimony is subject to cross-examination.
(b) Any information, documents, or other records or materials considered by the Independent Review Organization licensed under Part 4 of Article 50 of Chapter 58 of the N.C. Gen. Stat., or the successor review process, in conducting its review shall be admissible in any action commenced under this Article in accordance with Chapter 8 of the N.C. Gen. Stat. and the North Carolina Rules of Evidence. (2001-446, s. 4.7.)