CODE OF VIRGINIA

BINDING NATURE OF EXTERNAL REVIEW DECISION (§ 38.2-3564)

A. An external review decision is binding on the health carrier. Failure to
comply with the assigned independent review organization’s external review
decision shall be a knowing and willful violation of this section and subject to
one or more of the following: (i) punishment as provided in § 38.2-218, (ii)
the suspension or revocation of any license issued by the Commission, or (iii)
any order that may be issued by the Commission pursuant to § 38.2-219.

B. An external review decision is binding on the covered person except to the
extent the covered person has other remedies available under applicable federal
or state law.

C. A covered person or his authorized representative may not file a subsequent
request for external review involving the same adverse determination or final
adverse determination for which the covered person has already received an
external review decision.

HISTORY: 2011, c. 788.