Substantive issue definition
Substantive issue means a matter that is integral to the determination of whether the insured is eligible for benefits under a policy and that involves information essential for the insurer to have prior to paying the claim. A substantive issue includes the issues generated by the items described in Sections 31(A)(1) through 31(A)(5). A substantive issue also includes information necessary to pay the claim that the insurer is unable to obtain because the provider refuses to provide it or because it is not available from sources other than the insured or the insured’s authorized representative.
Substantive issue means an issue where a substantive right, interest or privilege of any party is involved that may be prejudiced as opposed to a minor or mere procedural matters dealt with by the office of tax appeals.