South Carolina H 3566: Cyril Robinson

Bill Text

2025-2026 Bill 3566 Text of Previous Version (Feb. 05, 2025) - South Carolina Legislature Online 

South Carolina General Assembly
126th Session, 2025-2026

Bill 3566

Indicates Matter Stricken
Indicates New Matter

(Text matches printed bills. Document has been reformatted to meet World Wide Web specifications.)

A bill

TO AMEND THE SOUTH CAROLINA CODE OF LAWS by ENACTing THE 
"FAIR CLAIMS ACCOUNTABILITY ACT" BY ADDING SECTION 37-4-305 SO AS TO ESTABLISH 
THE HEALTHCARE CLAIMS CONSUMER ASSISTANCE PROGRAM ("H-CAP") AND TO PROVIDE THAT 
A HEALTH PLAN OR INSURER IN THIS STATE MAY NOT WRONGFULLY DENY OR 
INSUFFICIENTLY COVER A VALID CONSUMER INSURANCE CLAIM.

Be it enacted by the 
General Assembly of the State of South Carolina:

SECTION 1. This act may be cited as the "Fair Claims Accountability Act."

SECTION 2. Chapter 4, Title 37 of the S.C. Code is amended by 
adding:

 Section 
37-4-305. (A)(1) The Healthcare 
Claims Consumer Assistance Program ("H-CAP") is established within the 
Department of Consumer Affairs to provide support for consumers, including 
prospective consumers, of health insurance and to customer assistance programs 
and public and private health insurance assistance programs.

 (2) 
The services provided by H-CAP may include:

 (a) 
assisting consumers with filing complaints and appeals with a group health 
plan, health insurance carrier, or independent review organization and 
providing information about the internal and external appeal and grievance 
processes of a group health plan, health insurance carrier, or independent 
review organization;

 (b) 
assisting consumers and health plans or insurers to settle health insurance 
conflicts, disputed claims, and claim denials;

 (c) 
collecting, tracking, and quantifying inquiries regarding health insurance and 
problems encountered by consumers;

 (d) 
educating consumers on their rights and responsibilities with respect to health 
insurance coverage;

 (e) 
assisting consumers with obtaining health insurance coverage by providing 
information, referrals, or other assistance;

 (f) 
assisting with obtaining federal health insurance premium tax credits under 
Section 368 of the United States Internal Revenue Code of 1986, as amended; and

 (g) 
providing information to the public about the services of H-CAP through a 
comprehensive outreach program and a toll-free telephone number.

 (B) All 
health plans and insurers in this State are required to place a prominent, 
plain-language notice about H-CAP assistance on the front page of all health 
insurance explanation of benefits, denials, or other plan-related 
communications.

 (C) 
The Department of Consumer Affairs is authorized to contract with a nonprofit, 
independent health insurance consumer assistance entity, which may not be a 
health plan or insurer or affiliate thereof, to operate the consumer assistance 
program.

 (D) 
The H-CAP shall work with the department to fulfill the data collection and 
reporting requirements set forth in this section.

 (E) It 
is unlawful for a health plan or insurer in this State to wrongfully deny or 
insufficiently cover a valid consumer insurance claim. The department is 
authorized to take disciplinary measures, including the imposition of civil 
penalties and awarding of damages against injured consumers, against a licensee 
when the department determines that the licensee has committed an act or 
omission constituting grounds for disciplinary action, as specified. The department 
also may refer violations to the Attorney General for civil enforcement under South 
Carolina consumer protection and insurance laws.

 (F) In 
the event that the department or a court finds that a health plan or insurer 
has wrongfully denied or insufficiently covered a valid consumer insurance 
claim:

 (1) 
The health plan or insurer is automatically liable to pay the policyholder 
double the amount it is found to have wrongfully denied or insufficiently 
covered plus all reasonable attorney's fees incurred to pursue a regulatory 
complaint or litigation for the pursuit of action against the health plan or 
insurer.

 (2) 
The department or a court may assess an additional amount in damages to the 
health plan or insurer, the entirety of which must be paid to the policyholder, 
if the department or a court assesses that the harm to the policyholder caused 
by the wrongful claim denial is severe. When assessing an additional amount in 
damages against a health plan or insurer, the department or a court shall 
determine the appropriate amount in damages payable to the policyholder based 
on one or more factors, as applicable, including:

 (a) 
the nature, scope, and gravity of the violation;

 (b) 
the severity of the potential harm to the policyholder in terms of loss of 
life, loss of health, emotional distress, or financial harm;

 (c) 
the nature and extent to which the plan cooperated with the department;

 (d) 
the nature and extent to which the plan aggravat