General Assembly Substitute Bill No. 1031
January Session, 2013 *_____SB01031INS___031513____*
General Assembly
Substitute Bill No. 1031
January Session, 2013
*_____SB01031INS___031513____*
AN ACT CONCERNING THE INSURANCE DEPARTMENT'S AUTHORITY TO PROTECT CONSUMERS.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. Section 38a-436 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2014):
(a) Every individual life insurance policy delivered or issued for delivery to any person in this state shall have printed thereon or attached thereto a notice stating, in substance, that the policy may be returned by the applicant for cancellation by delivering or mailing the policy to the insurer or to the insurance agent through whom it was effected, at any time within ten days after receipt of the policy by the applicant, and that upon the delivery or mailing the policy shall be void ab initio.
(b) The insurer shall maintain proof of the date and manner of its delivery or mailing of the policy and notice for a period of seven years after such delivery or mailing. The insurer may maintain such proof in paper, photographic, mechanical, magnetic or electronic media or in any other form or media or by any other process that accurately demonstrates the date of such delivery or mailing, and shall make such proof available to the commissioner upon request.
Sec. 2. Section 38a-702k of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2014):
(a) The commissioner may place on probation, suspend, revoke or refuse to issue or renew an insurance producer's license or may levy a civil penalty in accordance with the provisions of this title, or may take any combination of such actions, for any one or more of the following causes: (1) Providing incorrect, misleading, incomplete or materially untrue information in the license application; (2) violating any insurance laws, or violating any regulation, subpoena or order of the commissioner or of another state's commissioner; (3) obtaining or attempting to obtain a license through misrepresentation or fraud; (4) improperly withholding, misappropriating or converting any moneys or properties received in the course of doing an insurance business; (5) intentionally misrepresenting the terms of an actual or proposed insurance contract or application for insurance; (6) having been convicted of a felony; (7) having admitted or been found to have committed any insurance unfair trade practice or fraud; (8) using fraudulent, coercive or dishonest practices, or demonstrating incompetence, untrustworthiness or financial irresponsibility in the conduct of business in this state or elsewhere; (9) having an insurance producer license, or its equivalent, denied, suspended or revoked in any other state, province, district or territory; (10) forging another's name to an application for insurance or to any document related to an insurance transaction; (11) improperly using notes or any other reference material to complete an examination for an insurance license; (12) knowingly accepting insurance business from an individual who is not licensed; (13) failing to comply with an administrative or court order imposing a child support obligation; or (14) failing to pay state income tax or comply with any administrative or court order directing payment of state income tax.
(b) If the action by the commissioner is to nonrenew a license or to deny an application for a license, the commissioner shall notify the applicant or licensee and advise, in writing, the applicant or licensee of the reason for the denial or nonrenewal of the applicant's or licensee's license. The applicant or licensee may make written demand upon the commissioner, not later than thirty days after the notice, for a hearing before the commissioner to determine the reasonableness of the commissioner's action. The hearing shall be held not later than twenty days after receipt of such request and shall be held pursuant to section 38a-19.
(c) The license of a business entity may be suspended, revoked or refused if the commissioner finds, after hearing, that an individual licensee's violation was known or should have been known by one or more of the partners, officers or managers acting on behalf of the partnership or corporation and the violation was neither reported to the commissioner nor corrective action taken.
(d) In addition to or in lieu of any applicable denial, suspension or revocation of a license, a person may, after hearing, be subject to a civil fine pursuant to section 38a-774.
(e) In addition to any other penalty imposed on a licensee under this section, the commissioner may order such licensee to pay restitution or the amount of any uninsured claim or loss if the commissioner finds, after hearing, that such licensee has committed a violation described in subdivision (4), (7) or (8) of subsection (a) of this section.
[(e)] (f) The commissioner shall retain the authority to enforce the provisions of, and impose any penalty or remedy authorized by, this title against any person who is under investigation for or charged with a violation of this title even if the person's license or registration has been surrendered or has lapsed by operation of law.
Sec. 3. Subdivision (15) of section 38a-816 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2014):
(15) (A) Failure by an insurer, or any other entity responsible for providing payment to a claimant or health care provider pursuant to an insurance policy, to pay accident and health claims, including, but not limited to, claims for payment or reimbursement to claimants or health care providers, within the time periods set forth in subparagraph (B) of this subdivision, unless the Insurance Commissioner determines that a legitimate dispute exists as to coverage, liability or damages or that the claimant has fraudulently caused or contributed to the loss. Any insurer, or any other entity responsible for providing payment to a claimant or health care provider pursuant to an insurance policy, [who] that fails to pay such a claim or request within the time periods set forth in subparagraph (B) of this subdivision shall pay the claimant or health care provider the amount of such claim plus interest at the rate of fifteen per cent per annum, in addition to any other penalties [which] that may be imposed pursuant to sections 38a-11, 38a-25, 38a-41 to 38a-53, inclusive, 38a-57 to 38a-60, inclusive, 38a-62 to 38a-64, inclusive, 38a-76, 38a-83, 38a-84, 38a-117 to 38a-124, inclusive, 38a-129 to 38a-140, inclusive, 38a-146 to 38a-155, inclusive, 38a-283, 38a-288 to 38a-290, inclusive, 38a-319, 38a-320, 38a-459, 38a-464, 38a-815 to 38a-819, inclusive, 38a-824 to 38a-826, inclusive, and 38a-828 to 38a-830, inclusive. Whenever the interest due a claimant or health care provider pursuant to this section is less than one dollar, the insurer shall deposit such amount in a separate interest-bearing account in which all such amounts shall be deposited. At the end of each calendar year each such insurer shall donate such amount to The University of Connecticut Health Center.
(B) Each insurer or other entity responsible for providing payment to a claimant or health care provider pursuant to an insurance policy subject to this section, shall pay claims not later than:
(i) For claims filed in paper format, sixty days after receipt by the insurer of the claimant's proof of loss form or the health care provider's request for payment filed in accordance with the insurer's practices or procedures, except that when there is a deficiency in the information needed for processing a claim submitted by a health care provider, as determined in accordance with section 38a-477, or a deficiency in the information submitted by a claimant in accordance with the insurer's practices and procedures as reasonably applied to the claimant, the insurer shall (I) send written notice to the claimant or health care provider, as the case may be, of all alleged deficiencies in information needed for processing a claim not later than thirty days after the insurer receives a claim for payment or reimbursement under the contract, and (II) pay claims for payment or reimbursement under the contract not later than thirty days after the insurer receives the information requested; and
(ii) For claims filed in electronic format, twenty days after receipt by the insurer of the claimant's proof of loss form or the health care provider's request for payment filed in accordance with the insurer's practices or procedures, except that when there is a deficiency in the information needed for processing a claim submitted by a health care provider, as determined in accordance with section 38a-477, or a deficiency in the information submitted by a claimant in accordance with the insurer's practices and procedures as reasonably applied to the claimant, the insurer shall (I) notify the claimant or health care provider, as the case may be, of all alleged deficiencies in information needed for processing a claim not later than ten days after the insurer receives a claim for payment or reimbursement under the contract, and (II) pay claims for payment or reimbursement under the contract not later than ten days after the insurer receives the information requested.
(C) As used in this subdivision, "health care provider" means a person licensed to provide health care services under chapter 368d, chapter 368v, chapters 370 to 373, inclusive, 375 to 383c, inclusive, 384a to 384c, inclusive, or chapter 400j.
Sec. 4. (NEW) (Effective January 1, 2014) No insurer, health care center, fraternal benefit society, hospital service corporation, medical service corporation or other entity delivering, issuing for delivery, renewing, amending or continuing any individual or group health insurance policy or health care plan in this state shall offer, deliver or issue for delivery any such policy or plan that (1) includes any provision that reserves discretion to such insurer, health care center, fraternal benefit society, hospital service corporation, medical service corporation or other entity to interpret the terms of such policy or plan, or (2) provides standards of interpretation or review that are inconsistent with the laws of this state.
This act shall take effect as follows and shall amend the following sections:
Section 1 January 1, 2014 38a-436
Sec. 2 January 1, 2014 38a-702k
Sec. 3 January 1, 2014 38a-816(15)
Sec. 4 January 1, 2014 New section
This act shall take effect as follows and shall amend the following sections:
Section 1
January 1, 2014
38a-436
Sec. 2
January 1, 2014
38a-702k
Sec. 3
January 1, 2014
38a-816(15)
Sec. 4
January 1, 2014
New section
INS Joint Favorable Subst.
INS
Joint Favorable Subst.