# S.D. Codified Laws § 58-17I-7: Review of adverse determination--Time for filing--Designation and notice of reviewers--Scope of review

> South Dakota · Statutes · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17I_S58-17I-7

## Section

- **Citation:** S.D. Codified Laws § 58-17I-7
- **Heading:** Review of adverse determination--Time for filing--Designation and notice of reviewers--Scope of review
- **Jurisdiction:** South Dakota
- **Kind:** Statutes
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** SD Code / Title 58 / Chapter 17I / Section 58-17I-7

## Text

Within one hundred eighty days after the date of receipt of a notice of an adverse determination sent pursuant to chapter 58-17H , any covered person or the covered person's authorized representative may file a grievance with the health carrier requesting a first level review of the adverse determination. The health carrier shall provide the covered person with the name, address, and telephone number of a person or organizational unit designated to coordinate the first level review on behalf of the health carrier. In providing for a first level review under this section, the health carrier shall ensure that the review conducted in a manner under this section to ensure the independence and impartiality of the individuals involved in making the first level review decision. In ensuring the independence and impartiality of individuals involved in making the first level review decision, no health carrier may make decisions related to such individuals regarding hiring, compensation, termination, promotion or other similar matters based upon the likelihood that the individual will support the denial of benefits.

The health carrier shall designate one or more health care providers who have appropriate training and experience in the field of medicine involved in the medical judgment to evaluate the adverse determination. No health care provider may have been involved in the initial adverse determination. In conducting the review, a reviewer shall take into consideration all comments, documents, records, and other information regarding the request for services submitted by the covered person or the covered person's authorized representative, without regard to whether the information was submitted or considered in making the initial adverse determination.

Source: SL 2011, ch 219, § 79.

## Nearby sections

- [S.D. Codified Laws § 58-17I-1 Definitions](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17I_S58-17I-1.md)
- [S.D. Codified Laws § 58-17I-2 Health benefit plan defined](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17I_S58-17I-2.md)
- [S.D. Codified Laws § 58-17I-3 Urgent care request defined](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17I_S58-17I-3.md)
- [S.D. Codified Laws § 58-17I-4 Register of grievances required--Information to be compiled--Maintenance](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17I_S58-17I-4.md)
- [S.D. Codified Laws § 58-17I-6 Grievance procedures--Filing--Certificate of compliance--Contact information](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17I_S58-17I-6.md)
- [S.D. Codified Laws § 58-17I-7 Review of adverse determination--Time for filing--Designation and notice of reviewers--Scope of review](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17I_S58-17I-7.md)
- [S.D. Codified Laws § 58-17I-8 Rights of covered person or authorized representative on review--Access to documentation](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17I_S58-17I-8.md)
- [S.D. Codified Laws § 58-17I-9 Time for decision and notice--Calculation of time periods](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17I_S58-17I-9.md)
- [S.D. Codified Laws § 58-17I-10 Procedures for providing new or additional evidence](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17I_S58-17I-10.md)
- [S.D. Codified Laws § 58-17I-11 Issuance of decision--Required contents](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17I_S58-17I-11.md)
- [S.D. Codified Laws § 58-17I-12 Expedited review for adverse determinations involving urgent care requests--Appointment of peers for review](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17I_S58-17I-12.md)
- [S.D. Codified Laws § 58-17I-13 Transmission of necessary information for certain expedited reviews](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17I_S58-17I-13.md)
- [S.D. Codified Laws § 58-17I-14 Expedited review decision not initial determination for benefits--Notification--Time periods--Continuation of service involving concurrent review urgent care requests](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17I_S58-17I-14.md)
- [S.D. Codified Laws § 58-17I-15 Expedited review decision--Notification--Required contents](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17I_S58-17I-15.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17I_S58-17I-7. Check the current official text before relying on it. Not legal advice.