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SB 1010

AN ACT CONCERNING THE BURDEN OF PROOF DURING ADVERSE DETERMINATION AND UTILIZATION REVIEW.

2025 Regular Session Introduced by Saud Anwar and 1 co-sponsor

SB 1010 redefines proof requirements for disputing Connecticut insurance coverage denials and utilization reviews, affecting how patients and providers challenge medical service limitations.

REF. TO JOINT COMM. ON Insurance and Real Estate
#adverseevents(medical) #healthinsuranceclaimsdenials #utilizationreview
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Bill Summary · SB 1010

Legislative bill overview

SB 1010 modifies the burden of proof standards in Connecticut's insurance utilization review and adverse determination processes. The bill appears to shift evidentiary requirements for parties challenging insurance coverage decisions, though specific technical amendments are not provided in the summary. This affects how insurance companies and patients/providers dispute denial or limitation of medical services.

Why is this important

Insurance utilization review denials can prevent patients from accessing needed medical treatments, making the burden of proof allocation a critical procedural safeguard. Shifting this burden affects the practical ability of patients and providers to challenge denials, potentially influencing healthcare access and costs. The change also impacts insurance company operations and their litigation exposure.

Potential points of contention

  • Patient access vs. insurer efficiency: Lowering the insurer's burden of proof could make it easier to deny claims, reducing insurer costs but potentially blocking legitimate care; raising it increases patient access but may increase premiums and administrative costs
  • Standards alignment: Unclear whether Connecticut's burden aligns with federal insurance regulation standards, creating potential compliance complexity
  • Definition of "adverse determination": The scope of which decisions are covered (routine denials vs. emergency care, etc.) will significantly impact practical effects but may be contentious to define

Compiled from official sources — confirm details with the bill’s official record.

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