33-19-303. Reasons for adverse underwriting decisions.
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33-19-303 . Reasons for adverse underwriting decisions.
(1)If an adverse underwriting decision is made, the insurance institution or insurance producer responsible for the decision shall:
(a)either provide the applicant, policyholder, or individual proposed for coverage with the specific reason or reasons for the adverse underwriting decision in writing or advise the person that upon written request, the person may receive the specific reason or reasons in writing; and
(b)provide the applicant, policyholder, or individual proposed for coverage with a summary of the rights established under subsection
(2)and 33-19-301 and 33-19-302 .
(2)If a written request is received within 90 business days from the date of the mailing of notice or other communication of an adverse underwriting decision to an applicant, policyholder, or individual proposed for coverage, the insurance institution or insurance producer shall within 21 business days from the date of receipt of the written request furnish the person:
(a)the specific reason or reasons for the adverse underwriting decision, in writing, if the information was not initially furnished in writing pursuant to subsection (1)(a);
(b)the specific items of personal and privileged information that support those reasons; however:
(i)the insurance institution or insurance producer is not required to furnish specific items of privileged information if it has a reasonable suspicion, based upon specific information available for review by the commissioner, that the applicant, policyholder, or individual proposed for coverage has engaged in criminal activity, fraud, material misrepresentation, or material nondisclosure; and
(ii)specific items of medical record information supplied by a medical care institution or medical professional must be disclosed either directly to the individual about whom the information relates or to a medical professional designated by the individual and licensed to provide medical care with respect to the condition to which the information relates, whichever the insurance institution or insurance producer prefers; and
(c)the names and addresses of the institutional sources that supplied the specific items of information pursuant to subsection (2)(b), except that the identity of any medical professional or medical care institution must be disclosed either directly to the individual or to the designated medical professional, whichever the insurance institution or insurance producer prefers.
(3)The obligations imposed by this section upon an insurance institution or insurance producer may be satisfied by another insurance institution or insurance producer that is authorized to act on its behalf.
(4)When an adverse underwriting decision results solely from an oral request or inquiry, the explanation of reasons and summary of rights required by subsection
(1)may be given orally but must be made in writing at the request of the applicant, policyholder, or individual.