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General Assembly Raised Bill No. 5255
February Session, 2020
LCO No. 1241
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING LI VING ORGAN DONOR INS URANCE
DISCRIMINATION.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 38a-1 of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective January 1, 2021): 2
Terms used in this title and section 2 of this act, unless it appears from 3
the context to the contrary, shall have a scope and meaning as set forth 4
in this section. 5
(1) "Affiliate" or "affiliated" means a person that directly, or indirectly 6
through one or more intermediaries, controls, is controlled by or is 7
under common control with another person. 8
(2) "Alien insurer" means any insurer that has been chartered by or 9
organized or constituted within or under the laws of any jurisdiction or 10
country without the United States. 11
(3) "Annuities" means all agreements to make periodical payments 12
where the making or continuance of all or some of the series of the 13 Raised Bill No. 5255
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payments, or the amount of the payment, is dependent upon the 14
continuance of human life or is for a specified term of years. This 15
definition does not apply to payments made under a policy of life 16
insurance. 17
(4) "Commissioner" means the Insurance Commissioner. 18
(5) "Control", "controlled by" or "under common control with" means 19
the possession, direct or indirect, of the power to direct or cause the 20
direction of the management and policies of a person, whether through 21
the ownership of voting securities, by contract other than a commercial 22
contract for goods or nonmanagement services, or otherwise, unless the 23
power is the result of an official position with the person. 24
(6) "Domestic insurer" means any insurer that has been chartered by, 25
incorporated, organized or constituted within or under the laws of this 26
state. 27
(7) "Domestic surplus lines insurer" means any domestic insurer that 28
has been authorized by the commissioner to write surplus lines 29
insurance. 30
(8) "Foreign country" means any jurisdiction not in any state, district 31
or territory of the United States. 32
(9) "Foreign insurer" means any insurer that has been chartered by or 33
organized or constituted within or under the laws of another state or a 34
territory of the United States. 35
(10) "Insolvency" or "insolvent" means, for any insurer, that it is 36
unable to pay its obligations when they are due, or when its admitted 37
assets do not exceed its liabilities plus the greater of: (A) Capital and 38
surplus required by law for its organization and continued operation; 39
or (B) the total par or stated value of its authorized and issued capital 40
stock. For purposes of this subdivision "liabilities" shall include but not 41
be limited to reserves required by statute or by regulations adopted by 42
the commissioner in accordance with the provisions of chapter 54 or 43 Raised Bill No. 5255
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specific requirements imposed by the commissioner upon a subject 44
company at the time of admission or subsequent thereto. 45
(11) "Insurance" means any agreement to pay a sum of money, 46
provide services or any other thing of value on the happening of a 47
particular event or contingency or to provide indemnity for loss in 48
respect to a specified subject by specified perils in return for a 49
consideration. In any contract of insurance, an insured shall have an 50
interest which is subject to a risk of loss through destruction or 51
impairment of that interest, which risk is assumed by the insurer and 52
such assumption shall be part of a general scheme to distribute losses 53
among a large group of persons bearing similar risks in return for a 54
ratable contribution or other consideration. 55
(12) "Insurer" or "insurance company" includes any person or 56
combination of persons doing any kind or form of insurance business 57
other than a fraternal benefit society, and shall include a receiver of any 58
insurer when the context reasonably permits. 59
(13) "Insured" means a person to whom or for whose benefit an 60
insurer makes a promise in an insurance policy. The term includes 61
policyholders, subscribers, members and beneficiaries. This definition 62
applies only to the provisions of this title and does not define the 63
meaning of this word as used in insurance policies or certificates. 64
(14) "Life insurance" means insurance on human lives and insurances 65
pertaining to or connected with human life. The business of life 66
insurance includes granting endowment benefits, granting additional 67
benefits in the event of death by accident or accidental means, granting 68
additional benefits in the event of the total and permanent disability of 69
the insured, and providing optional methods of settlement of proceeds. 70
Life insurance includes burial contracts to the extent provided by 71
section 38a-464. 72
(15) "Mutual insurer" means any insurer without capital stock, the 73
managing directors or officers of which are elected by its members. 74 Raised Bill No. 5255
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(16) "Person" means an individual, a corporation, a partnership, a 75
limited liability company, an association, a joint stock company, a 76
business trust, an unincorporated organization or other legal entity. 77
(17) "Policy" means any document, including attached endorsements 78
and riders, purporting to be an enforceable contract, which 79
memorializes in writing some or all of the terms of an insurance 80
contract. 81
(18) "State" means any state, district, or territory of the United States. 82
(19) "Subsidiary" of a specified person means an affiliate controlled 83
by the person directly, or indirectly through one or more intermediaries. 84
(20) "Unauthorized insurer" or "nonadmitted insurer" means an 85
insurer that has not been granted a certificate of authority by the 86
commissioner to transact the business of insurance in this state or an 87
insurer transacting business not authorized by a valid certificate. 88
(21) "United States" means the United States of America, its territories 89
and possessions, the Commonwealth of Puerto Rico and the District of 90
Columbia. 91
Sec. 2. (NEW) (Effective January 1, 2021) (a) No insurer delivering, 92
issuing for delivery, renewing, amending or continuing a life insurance 93
policy, long-term care insurance policy or a policy providing disability 94
income protection coverage in this state on or after January 1, 2021, shall 95
make any distinction or discriminate against an individual in delivering, 96
issuing for delivery, renewing, amending, continuing, offering, 97
withholding or cancelling such policy, or in the terms of such policy, 98
solely because such individual is a living organ donor. 99
(b) Any violation of this section shall be deemed an unfair method of 100
competition and unfair and deceptive act or practice in the business of 101
insurance under section 38a-816 of the general statutes, as amended by 102
this act. 103
Sec. 3. Section 38a-816 of the 2020 supplement to the general statutes 104 Raised Bill No. 5255
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is repealed and the following is substituted in lieu thereof (Effective 105
January 1, 2021): 106
The following are defined as unfair methods of competition and 107
unfair and deceptive acts or practices in the business of insurance: 108
(1) Misrepresentations and false advertising of insurance policies. 109
Making, issuing or circulating, or causing to be made, issued or 110
circulated, any estimate, illustration, circular or statement, sales 111
presentation, omission or comparison which: (A) Misrepresents the 112
benefits, advantages, conditions or terms of any insurance policy; (B) 113
misrepresents the dividends or share of the surplus to be received, on 114
any insurance policy; (C) makes any false or misleading statements as 115
to the dividends or share of surplus previously paid on any insurance 116
policy; (D) is misleading or is a misrepresentation as to the financial 117
condition of any person, or as to the legal reserve system upon which 118
any life insurer operates; (E) uses any name or title of any insurance 119
policy or class of insurance policies misrepresenting the true nature 120
thereof; (F) is a misrepresentation, including, but not limited to, an 121
intentional misquote of a premium rate, for the purpose of inducing or 122
tending to induce to the purchase, lapse, forfeiture, exchange, 123
conversion or surrender of any insurance policy; (G) is a 124
misrepresentation for the purpose of effecting a pledge or assignment of 125
or effecting a loan against any insurance policy; or (H) misrepresents 126
any insurance policy as being shares of stock. 127
(2) False information and advertising generally. Making, publishing, 128
disseminating, circulating or placing before the public, or causing, 129
directly or indirectly, to be made, published, disseminated, circulated or 130
placed before the public, in a newspaper, magazine or other publication, 131
or in the form of a notice, circular, pamphlet, letter or poster, or over any 132
radio or television station, or in any other way, an advertisement, 133
announcement or statement containing any assertion, representation or 134
statement with respect to the business of insurance or with respect to 135
any person in the conduct of his insurance business, which is untrue, 136
deceptive or misleading. 137 Raised Bill No. 5255
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(3) Defamation. Making, publishing, disseminating or circulating, 138
directly or indirectly, or aiding, abetting or encouraging the making, 139
publishing, disseminating or circulating of, any oral or written 140
statement or any pamphlet, circular, article or literature which is false 141
or maliciously critical of or derogatory to the financial condition of an 142
insurer, and which is calculated to injure any person engaged in the 143
business of insurance. 144
(4) Boycott, coercion and intimidation. Entering into any agreement 145
to commit, or by any concerted action committing, any act of boycott, 146
coercion or intimidation resulting in or tending to result in unreasonable 147
restraint of, or monopoly in, the business of insurance. 148
(5) False financial statements. Filing with any supervisory or other 149
public official, or making, publishing, disseminating, circulating or 150
delivering to any person, or placing before the public, or causing, 151
directly or indirectly, to be made, published, disseminated, circulated or 152
delivered to any person, or placed before the public, any false statement 153
of financial condition of an insurer with intent to deceive; or making any 154
false entry in any book, report or statement of any insurer with intent to 155
deceive any agent or examiner lawfully appointed to examine into its 156
condition or into any of its affairs, or any public official to whom such 157
insurer is required by law to report, or who has authority by law to 158
examine into its condition or into any of its affairs, or, with like intent, 159
wilfully omitting to make a true entry of any material fact pertaining to 160
the business of such insurer in any book, report or statement of such 161
insurer. 162
(6) Unfair claim settlement practices. Committing or performing with 163
such frequency as to indicate a general business practice any of the 164
following: (A) Misrepresenting pertinent facts or insurance policy 165
provisions relating to coverages at issue; (B) failing to acknowledge and 166
act with reasonable promptness upon communications with respect to 167
claims arising under insurance policies; (C) failing to adopt and 168
implement reasonable standards for the prompt investigation of claims 169
arising under insurance policies; (D) refusing to pay claims without 170 Raised Bill No. 5255
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conducting a reasonable investigation based upon all available 171
information; (E) failing to affirm or deny coverage of claims within a 172
reasonable time after proof of loss statements have been completed; (F) 173
not attempting in good faith to effectuate prompt, fair and equitable 174
settlements of claims in which liability has become reasonably clear; (G) 175
compelling insureds to institute litigation to recover amounts due under 176
an insurance policy by offering substantially less than the amounts 177
ultimately recovered in actions brought by such insureds; (H) 178
attempting to settle a claim for less than the amount to which a 179
reasonable man would have believed he was entitled by reference to 180
written or printed advertising material accompanying or made part of 181
an application; (I) attempting to settle claims on the basis of an 182
application which was altered without notice to, or knowledge or 183
consent of the insured; (J) making claims payments to insureds or 184
beneficiaries not accompanied by statements setting forth the coverage 185
under which the payments are being made; (K) making known to 186
insureds or claimants a policy of appealing from arbitration awards in 187
favor of insureds or claimants for the purpose of compelling them to 188
accept settlements or compromises less than the amount awarded in 189
arbitration; (L) delaying the investigation or payment of claims by 190
requiring an insured, claimant, or the physician of either to submit a 191
preliminary claim report and then requiring the subsequent submission 192
of formal proof of loss forms, both of which submissions contain 193
substantially the same information; (M) failing to promptly settle claims, 194
where liability has become reasonably clear, under one portion of the 195
insurance policy coverage in order to influence settlements under other 196
portions of the insurance policy coverage; (N) failing to promptly 197
provide a reasonable explanation of the basis in the insurance policy in 198
relation to the facts or applicable law for denial of a claim or for the offer 199
of a compromise settlement; (O) using as a basis for cash settlement with 200
a first party automobile insurance claimant an amount which is less than 201
the amount which the insurer would pay if repairs were made unless 202
such amount is agreed to by the insured or provided for by the 203
insurance policy. 204 Raised Bill No. 5255
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(7) Failure to maintain complaint handling procedures. Failure of any 205
person to maintain complete record of all the complaints which it has 206
received since the date of its last examination. This record shall indicate 207
the total number of complaints, their classification by line of insurance, 208
the nature of each complaint, the disposition of these complaints, and 209
the time it took to process each complaint. For purposes of this 210
subsection "complaint" means any written communication primarily 211
expressing a grievance. 212
(8) Misrepresentation in insurance applications. Making false or 213
fraudulent statements or representations on or relative to an application 214
for an insurance policy for the purpose of obtaining a fee, commission, 215
money or other benefit from any insurer, producer or individual. 216
(9) Any violation of any one of sections 38a-358, 38a-446, 38a-447, 38a-217
488, 38a-825, 38a-826, 38a-828 and 38a-829. None of the following 218
practices shall be considered discrimination within the meaning of 219
section 38a-446 or 38a-488 or a rebate within the meaning of section 38a-220
825: (A) Paying bonuses to policyholders or otherwise abating their 221
premiums in whole or in part out of surplus accumulated from 222
nonparticipating insurance, provided any such bonuses or abatement of 223
premiums shall be fair and equitable to policyholders and for the best 224
interests of the company and its policyholders; (B) in the case of policies 225
issued on the industrial debit plan, making allowance to policyholders 226
who have continuously for a specified period made premium payments 227
directly to an office of the insurer in an amount which fairly represents 228
the saving in collection expense; (C) readjustment of the rate of premium 229
for a group insurance policy based on loss or expense experience, or 230
both, at the end of the first or any subsequent policy year, which may be 231
made retroactive for such policy year. 232
(10) Notwithstanding any provision of any policy of insurance, 233
certificate or service contract, whenever such insurance policy or 234
certificate or service contract provides for reimbursement for any 235
services which may be legally performed by any practitioner of the 236
healing arts licensed to practice in this state, reimbursement under such 237 Raised Bill No. 5255
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insurance policy, certificate or service contract shall not be denied 238
because of race, color or creed nor shall any insurer make or permit any 239
unfair discrimination against particular individuals or persons so 240
licensed. 241
(11) Favored agent or insurer: Coercion of debtors. (A) No person 242
may (i) require, as a condition precedent to the lending of money or 243
extension of credit, or any renewal thereof, that the person to whom 244
such money or credit is extended or whose obligation the creditor is to 245
acquire or finance, negotiate any policy or contract of insurance through 246
a particular insurer or group of insurers or producer or group of 247
producers; (ii) unreasonably disapprove the insurance policy provided 248
by a borrower for the protection of the property securing the credit or 249
lien; (iii) require directly or indirectly that any borrower, mortgagor, 250
purchaser, insurer or producer pay a separate charge, in connection 251
with the handling of any insurance policy required as security for a loan 252
on real estate or pay a separate charge to substitute the insurance policy 253
of one insurer for that of another; or (iv) use or disclose information 254
resulting from a requirement that a borrower, mortgagor or purchaser 255
furnish insurance of any kind on real property being conveyed or used 256
as collateral security to a loan, when such information is to the 257
advantage of the mortgagee, vendor or lender, or is to the detriment of 258
the borrower, mortgagor, purchaser, insurer or the producer complying 259
with such a requirement. 260
(B) (i) Subparagraph (A)(iii) of this subdivision shall not include the 261
interest which may be charged on premium loans or premium 262
advancements in accordance with the security instrument. (ii) For 263
purposes of subparagraph (A)(ii) of this subdivision, such disapproval 264
shall be deemed unreasonable if it is not based solely on reasonable 265
standards uniformly applied, relating to the extent of coverage required 266
and the financial soundness and the services of an insurer. Such 267
standards shall not discriminate against any particular type of insurer, 268
nor shall such standards call for the disapproval of an insurance policy 269
because such policy contains coverage in addition to that required. (iii) 270
The commissioner may investigate the affairs of any person to whom 271 Raised Bill No. 5255
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this subdivision applies to determine whether such person has violated 272
this subdivision. If a violation of this subdivision is found, the person in 273
violation shall be subject to the same procedures and penalties as are 274
applicable to other provisions of section 38a-815, subsections (b) and (e) 275
of section 38a-817 and this section. (iv) For purposes of this section, 276
"person" includes any individual, corporation, limited liability 277
company, association, partnership or other legal entity. 278
(12) Refusing to insure, refusing to continue to insure or limiting the 279
amount, extent or kind of coverage available to an individual or 280
charging an individual a different rate for the same coverage because of 281
physical disability, mental or nervous condition as set forth in section 282
38a-488a or intellectual disability, except where the refusal, limitation or 283
rate differential is based on sound actuarial principles or is related to 284
actual or reasonably anticipated experience. 285
(13) Refusing to insure, refusing to continue to insure or limiting the 286
amount, extent or kind of coverage available to an individual or 287
charging an individual a different rate for the same coverage solely 288
because of blindness or partial blindness. For purposes of this 289
subdivision, "refusal to insure" includes the denial by an insurer of 290
disability insurance coverage on the grounds that the policy defines 291
"disability" as being presumed in the event that the insured is blind or 292
partially blind, except that an insurer may exclude from coverage any 293
disability, consisting solely of blindness or partial blindness, when such 294
condition existed at the time the policy was issued. Any individual who 295
is blind or partially blind shall be subject to the same standards of sound 296
actuarial principles or actual or reasonably anticipated experience as are 297
sighted persons with respect to all other conditions, including the 298
underlying cause of the blindness or partial blindness. 299
(14) Refusing to insure, refusing to continue to insure or limiting the 300
amount, extent or kind of coverage available to an individual or 301
charging an individual a different rate for the same coverage because of 302
exposure to diethylstilbestrol through the female parent. 303 Raised Bill No. 5255
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(15) (A) Failure by an insurer, or any other entity responsible for 304
providing payment to a health care provider pursuant to an insurance 305
policy, to pay accident and health claims, including, but not limited to, 306
claims for payment or reimbursement to health care providers, within 307
the time periods set forth in subparagraph (B) of this subdivision, unless 308
the Insurance Commissioner determines that a legitimate dispute exists 309
as to coverage, liability or damages or that the claimant has fraudulently 310
caused or contributed to the loss. Any insurer, or any other entity 311
responsible for providing payment to a health care provider pursuant 312
to an insurance policy, who fails to pay such a claim or request within 313
the time periods set forth in subparagraph (B) of this subdivision shall 314
pay the claimant or health care provider the amount of such claim plus 315
interest at the rate of fifteen per cent per annum, in addition to any other 316
penalties which may be imposed pursuant to sections 38a-11, 38a-25, 317
38a-41 to 38a-53, inclusive, 38a-57 to 38a-60, inclusive, 38a-62 to 38a-64, 318
inclusive, 38a-76, 38a-83, 38a-84, 38a-117 to 38a-124, inclusive, 38a-129 319
to 38a-140, inclusive, 38a-146 to 38a-155, inclusive, 38a-283, 38a-288 to 320
38a-290, inclusive, 38a-319, 38a-320, 38a-459, 38a-464, 38a-815 to 38a-819, 321
inclusive, 38a-824 to 38a-826, inclusive, and 38a-828 to 38a-830, 322
inclusive. Whenever the interest due a claimant or health care provider 323
pursuant to this section is less than one dollar, the insurer shall deposit 324
such amount in a separate interest-bearing account in which all such 325
amounts shall be deposited. At the end of each calendar year each such 326
insurer shall donate such amount to The University of Connecticut 327
Health Center. 328
(B) Each insurer or other entity responsible for providing payment to 329
a health care provider pursuant to an insurance policy subject to this 330
section, shall pay claims not later than: 331
(i) For claims filed in paper format, sixty days after receipt by the 332
insurer of the claimant's proof of loss form or the health care provider's 333
request for payment filed in accordance with the insurer's practices or 334
procedures, except that when there is a deficiency in the information 335
needed for processing a claim, as determined in accordance with section 336
38a-477, the insurer shall (I) send written notice to the claimant or health 337 Raised Bill No. 5255
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care provider, as the case may be, of all alleged deficiencies in 338
information needed for processing a claim not later than thirty days 339
after the insurer receives a claim for payment or reimbursement under 340
the contract, and (II) pay claims for payment or reimbursement under 341
the contract not later than thirty days after the insurer receives the 342
information requested; and 343
(ii) For claims filed in electronic format, twenty days after receipt by 344
the insurer of the claimant's proof of loss form or the health care 345
provider's request for payment filed in accordance with the insurer's 346
practices or procedures, except that when there is a deficiency in the 347
information needed for processing a claim, as determined in accordance 348
with section 38a-477, the insurer shall (I) notify the claimant or health 349
care provider, as the case may be, of all alleged deficiencies in 350
information needed for processing a claim not later than ten days after 351
the insurer receives a claim for payment or reimbursement under the 352
contract, and (II) pay claims for payment or reimbursement under the 353
contract not later than ten days after the insurer receives the information 354
requested. 355
(C) As used in this subdivision, "health care provider" means a person 356
licensed to provide health care services under chapter 368d, chapter 357
368v, chapters 370 to 373, inclusive, 375 to 383c, inclusive, 384a to 384c, 358
inclusive, or chapter 400j. 359
(16) Failure to pay, as part of any claim for a damaged motor vehicle 360
under any automobile insurance policy where the vehicle has been 361
declared to be a constructive total loss, an amount equal to the sum of 362
(A) the settlement amount on such vehicle plus, whenever the insurer 363
takes title to such vehicle, (B) an amount determined by multiplying 364
such settlement amount by a percentage equivalent to the current sales 365
tax rate established in section 12-408. For purposes of this subdivision, 366
"constructive total loss" means the cost to repair or salvage damaged 367
property, or the cost to both repair and salvage such property, equals or 368
exceeds the total value of the property at the time of the loss. 369 Raised Bill No. 5255
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(17) Any violation of section 42-260, by an extended warranty 370
provider subject to the provisions of said section, including, but not 371
limited to: (A) Failure to include all statements required in subsections 372
(c) and (f) of section 42-260 in an issued extended warranty; (B) offering 373
an extended warranty without being (i) insured under an adequate 374
extended warranty reimbursement insurance policy or (ii) able to 375
demonstrate that reserves for claims contained in the provider's 376
financial statements are not in excess of one-half the provider's audited 377
net worth; (C) failure to submit a copy of an issued extended warranty 378
form or a copy of such provider's extended warranty reimbursement 379
policy form to the Insurance Commissioner. 380
(18) With respect to an insurance company, hospital service 381
corporation, health care center or fraternal benefit society providing 382
individual or group health insurance coverage of the types specified in 383
subdivisions (1), (2), (4), (6), (10), (11) and (12) of section 38a-469, 384
refusing to insure, refusing to continue to insure or limiting the amount, 385
extent or kind of coverage available to an individual or charging an 386
individual a different rate for the same coverage because such 387
individual has been a victim of family violence. 388
(19) With respect to an insurance company, hospital service 389
corporation, health care center or fraternal benefit society providing 390
individual or group health insurance coverage of the types specified in 391
subdivisions (1), (2), (3), (4), (6), (9), (10), (11) and (12) of section 38a-469, 392
refusing to insure, refusing to continue to insure or limiting the amount, 393
extent or kind of coverage available to an individual or charging an 394
individual a different rate for the same coverage because of genetic 395
information. Genetic information indicating a predisposition to a 396
disease or condition shall not be deemed a preexisting condition in the 397
absence of a diagnosis of such disease or condition that is based on other 398
medical information. An insurance company, hospital service 399
corporation, health care center or fraternal benefit society providing 400
individual health coverage of the types specified in subdivisions (1), (2), 401
(3), (4), (6), (9), (10), (11) and (12) of section 38a-469, shall not be 402
prohibited from refusing to insure or applying a preexisting condition 403 Raised Bill No. 5255
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limitation, to the extent permitted by law, to an individual who has been 404
diagnosed with a disease or condition based on medical information 405
other than genetic information and has exhibited symptoms of such 406
disease or condition. For the purposes of this subsection, "genetic 407
information" means the information about genes, gene products or 408
inherited characteristics that may derive from an individual or family 409
member. 410
(20) Any violation of sections 38a-465 to 38a-465q, inclusive. 411
(21) With respect to a managed care organization, as defined in 412
section 38a-478, failing to establish a confidentiality procedure for 413
medical record information, as required by section 38a-999. 414
(22) Any violation of sections 38a-591d to 38a-591f, inclusive. 415
(23) Any violation of section 38a-472j. 416
(24) Any violation of section 2 of this act. 417
This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2021 38a-1
Sec. 2 January 1, 2021 New section
Sec. 3 January 1, 2021 38a-816
Statement of Purpose:
To (1) prohibit certain insurers from discriminating against any
individual solely because such individual is a living organ donor, and
(2) provide that such discrimination constitutes a violation of the
Connecticut Unfair Insurance Practices Act.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
underlined.]