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General Assembly Raised Bill No. 6387
January Session, 2021
LCO No. 2752
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING IN SURANCE DISCRIMINATION AGAINST
LIVING ORGAN DONORS.
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 Section 38a-1 of the general statutes is repealed and the 1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, 2022): 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. 6387
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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. 6387
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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. 6387
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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, 2022) (a) Notwithstanding any 92
provision of the general statutes, no insurer delivering, issuing for 93
delivery or amending a life insurance policy, long-term care insurance 94
policy or a policy providing disability income protection coverage in 95
this state on or after January 1, 2022, shall, for any such policy issued on 96
or after said date: 97
(1) Decline to provide coverage, or limit the coverage provided, for 98
an individual under such policy solely because the individual is a living 99
organ donor; 100
(2) Preclude an individual from donating all or part of an organ as a 101
condition to maintaining coverage under such policy; or 102 Raised Bill No. 6387
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(3) Otherwise engage in discrimination in offering, issuing for 103
delivery, amending or cancelling, or in setting the amount, price or 104
conditions of, coverage for an individual under such policy solely 105
because the individual is a living organ donor. 106
(b) Any violation of this section shall be deemed an unfair method of 107
competition and unfair and deceptive act or practice in the business of 108
insurance under section 38a-816 of the general statutes, as amended by 109
this act. 110
Sec. 3. Section 38a-816 of the general statutes is repealed and the 111
following is substituted in lieu thereof (Effective January 1, 2022): 112
The following are defined as unfair methods of competition and 113
unfair and deceptive acts or practices in the business of insurance: 114
(1) Misrepresentations and false advertising of insurance policies. 115
Making, issuing or circulating, or causing to be made, issued or 116
circulated, any estimate, illustration, circular or statement, sales 117
presentation, omission or comparison which: (A) Misrepresents the 118
benefits, advantages, conditions or terms of any insurance policy; (B) 119
misrepresents the dividends or share of the surplus to be received, on 120
any insurance policy; (C) makes any false or misleading statements as 121
to the dividends or share of surplus previously paid on any insurance 122
policy; (D) is misleading or is a misrepresentation as to the financial 123
condition of any person, or as to the legal reserve system upon which 124
any life insurer operates; (E) uses any name or title of any insurance 125
policy or class of insurance policies misrepresenting the true nature 126
thereof; (F) is a misrepresentation, including, but not limited to, an 127
intentional misquote of a premium rate, for the purpose of inducing or 128
tending to induce to the purchase, lapse, forfeiture, exchange, 129
conversion or surrender of any insurance policy; (G) is a 130
misrepresentation for the purpose of effecting a pledge or assignment of 131
or effecting a loan against any insurance policy; or (H) misrepresents 132
any insurance policy as being shares of stock. 133 Raised Bill No. 6387
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(2) False information and advertising generally. Making, publishing, 134
disseminating, circulating or placing before the public, or causing, 135
directly or indirectly, to be made, published, disseminated, circulated or 136
placed before the public, in a newspaper, magazine or other publication, 137
or in the form of a notice, circular, pamphlet, letter or poster, or over any 138
radio or television station, or in any other way, an advertisement, 139
announcement or statement containing any assertion, representation or 140
statement with respect to the business of insurance or with respect to 141
any person in the conduct of his insurance business, which is untrue, 142
deceptive or misleading. 143
(3) Defamation. Making, publishing, disseminating or circulating, 144
directly or indirectly, or aiding, abetting or encouraging the making, 145
publishing, disseminating or circulating of, any oral or written 146
statement or any pamphlet, circular, article or literature which is false 147
or maliciously critical of or derogatory to the financial condition of an 148
insurer, and which is calculated to injure any person engaged in the 149
business of insurance. 150
(4) Boycott, coercion and intimidation. Entering into any agreement 151
to commit, or by any concerted action committing, any act of boycott, 152
coercion or intimidation resulting in or tending to result in unreasonable 153
restraint of, or monopoly in, the business of insurance. 154
(5) False financial statements. Filing with any supervisory or other 155
public official, or making, publishing, disseminating, circulating or 156
delivering to any person, or placing before the public, or causing, 157
directly or indirectly, to be made, published, disseminated, circulated or 158
delivered to any person, or placed before the public, any false statement 159
of financial condition of an insurer with intent to deceive; or making any 160
false entry in any book, report or statement of any insurer with intent to 161
deceive any agent or examiner lawfully appointed to examine into its 162
condition or into any of its affairs, or any public official to whom such 163
insurer is required by law to report, or who has authority by law to 164
examine into its condition or into any of its affairs, or, with like intent, 165
wilfully omitting to make a true entry of any material fact pertaining to 166 Raised Bill No. 6387
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the business of such insurer in any book, report or statement of such 167
insurer. 168
(6) Unfair claim settlement practices. Committing or performing with 169
such frequency as to indicate a general business practice any of the 170
following: (A) Misrepresenting pertinent facts or insurance policy 171
provisions relating to coverages at issue; (B) failing to acknowledge and 172
act with reasonable promptness upon communications with respect to 173
claims arising under insurance policies; (C) failing to adopt and 174
implement reasonable standards for the prompt investigation of claims 175
arising under insurance policies; (D) refusing to pay claims without 176
conducting a reasonable investigation based upon all available 177
information; (E) failing to affirm or deny coverage of claims within a 178
reasonable time after proof of loss statements have been completed; (F) 179
not attempting in good faith to effectuate prompt, fair and equitable 180
settlements of claims in which liability has become reasonably clear; (G) 181
compelling insureds to institute litigation to recover amounts due under 182
an insurance policy by offering substantially less than the amounts 183
ultimately recovered in actions brought by such insureds; (H) 184
attempting to settle a claim for less than the amount to which a 185
reasonable man would have believed he was entitled by reference to 186
written or printed advertising material accompanying or made part of 187
an application; (I) attempting to settle claims on the basis of an 188
application which was altered without notice to, or knowledge or 189
consent of the insured; (J) making claims payments to insureds or 190
beneficiaries not accompanied by statements setting forth the coverage 191
under which the payments are being made; (K) making known to 192
insureds or claimants a policy of appealing from arbitration awards in 193
favor of insureds or claimants for the purpose of compelling them to 194
accept settlements or compromises less than the amount awarded in 195
arbitration; (L) delaying the investigation or payment of claims by 196
requiring an insured, claimant, or the physician of either to submit a 197
preliminary claim report and then requiring the subsequent submission 198
of formal proof of loss forms, both of which submissions contain 199
substantially the same information; (M) failing to promptly settle claims, 200 Raised Bill No. 6387
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where liability has become reasonably clear, under one portion of the 201
insurance policy coverage in order to influence settlements under other 202
portions of the insurance policy coverage; (N) failing to promptly 203
provide a reasonable explanation of the basis in the insurance policy in 204
relation to the facts or applicable law for denial of a claim or for the offer 205
of a compromise settlement; (O) using as a basis for cash settlement with 206
a first party automobile insurance claimant an amount which is less than 207
the amount which the insurer would pay if repairs were made unless 208
such amount is agreed to by the insured or provided for by the 209
insurance policy. 210
(7) Failure to maintain complaint handling procedures. Failure of any 211
person to maintain complete record of all the complaints which it has 212
received since the date of its last examination. This record shall indicate 213
the total number of complaints, their classification by line of insurance, 214
the nature of each complaint, the disposition of these complaints, and 215
the time it took to process each complaint. For purposes of this 216
subsection "complaint" means any written communication primarily 217
expressing a grievance. 218
(8) Misrepresentation in insurance applications. Making false or 219
fraudulent statements or representations on or relative to an application 220
for an insurance policy for the purpose of obtaining a fee, commission, 221
money or other benefit from any insurer, producer or individual. 222
(9) Any violation of any one of sections 38a-358, 38a-446, 38a-447, 38a-223
488, 38a-825, 38a-826, 38a-828 and 38a-829. None of the following 224
practices shall be considered discrimination within the meaning of 225
section 38a-446 or 38a-488 or a rebate within the meaning of section 38a-226
825: (A) Paying bonuses to policyholders or otherwise abating their 227
premiums in whole or in part out of surplus accumulated from 228
nonparticipating insurance, provided any such bonuses or abatement of 229
premiums shall be fair and equitable to policyholders and for the best 230
interests of the company and its policyholders; (B) in the case of policies 231
issued on the industrial debit plan, making allowance to policyholders 232
who have continuously for a specified period made premium payments 233 Raised Bill No. 6387
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directly to an office of the insurer in an amount which fairly represents 234
the saving in collection expense; (C) readjustment of the rate of premium 235
for a group insurance policy based on loss or expense experience, or 236
both, at the end of the first or any subsequent policy year, which may be 237
made retroactive for such policy year. 238
(10) Notwithstanding any provision of any policy of insurance, 239
certificate or service contract, whenever such insurance policy or 240
certificate or service contract provides for reimbursement for any 241
services which may be legally performed by any practitioner of the 242
healing arts licensed to practice in this state, reimbursement under such 243
insurance policy, certificate or service contract shall not be denied 244
because of race, color or creed nor shall any insurer make or permit any 245
unfair discrimination against particular individuals or persons so 246
licensed. 247
(11) Favored agent or insurer: Coercion of debtors. (A) No person 248
may (i) require, as a condition precedent to the lending of money or 249
extension of credit, or any renewal thereof, that the person to whom 250
such money or credit is extended or whose obligation the creditor is to 251
acquire or finance, negotiate any policy or contract of insurance through 252
a particular insurer or group of insurers or producer or group of 253
producers; (ii) unreasonably disapprove the insurance policy provided 254
by a borrower for the protection of the property securing the credit or 255
lien; (iii) require directly or indirectly that any borrower, mortgagor, 256
purchaser, insurer or producer pay a separate charge, in connection 257
with the handling of any insurance policy required as security for a loan 258
on real estate or pay a separate charge to substitute the insurance policy 259
of one insurer for that of another; or (iv) use or disclose information 260
resulting from a requirement that a borrower, mortgagor or purchaser 261
furnish insurance of any kind on real property being conveyed or used 262
as collateral security to a loan, when such information is to the 263
advantage of the mortgagee, vendor or lender, or is to the detriment of 264
the borrower, mortgagor, purchaser, insurer or the producer complying 265
with such a requirement. 266 Raised Bill No. 6387
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(B) (i) Subparagraph (A)(iii) of this subdivision shall not include the 267
interest which may be charged on premium loans or premium 268
advancements in accordance with the security instrument. (ii) For 269
purposes of subparagraph (A)(ii) of this subdivision, such disapproval 270
shall be deemed unreasonable if it is not based solely on reasonable 271
standards uniformly applied, relating to the extent of coverage required 272
and the financial soundness and the services of an insurer. Such 273
standards shall not discriminate against any particular type of insurer, 274
nor shall such standards call for the disapproval of an insurance policy 275
because such policy contains coverage in addition to that required. (iii) 276
The commissioner may investigate the affairs of any person to whom 277
this subdivision applies to determine whether such person has violated 278
this subdivision. If a violation of this subdivision is found, the person in 279
violation shall be subject to the same procedures and penalties as are 280
applicable to other provisions of section 38a-815, subsections (b) and (e) 281
of section 38a-817 and this section. (iv) For purposes of this section, 282
"person" includes any individual, corporation, limited liability 283
company, association, partnership or other legal entity. 284
(12) Refusing to insure, refusing to continue to insure or limiting the 285
amount, extent or kind of coverage available to an individual or 286
charging an individual a different rate for the same coverage because of 287
physical disability, mental or nervous condition as set forth in section 288
38a-488a or intellectual disability, except where the refusal, limitation or 289
rate differential is based on sound actuarial principles or is related to 290
actual or reasonably anticipated experience. 291
(13) Refusing to insure, refusing to continue to insure or limiting the 292
amount, extent or kind of coverage available to an individual or 293
charging an individual a different rate for the same coverage solely 294
because of blindness or partial blindness. For purposes of this 295
subdivision, "refusal to insure" includes the denial by an insurer of 296
disability insurance coverage on the grounds that the policy defines 297
"disability" as being presumed in the event that the insured is blind or 298
partially blind, except that an insurer may exclude from coverage any 299 Raised Bill No. 6387
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disability, consisting solely of blindness or partial blindness, when such 300
condition existed at the time the policy was issued. Any individual who 301
is blind or partially blind shall be subject to the same standards of sound 302
actuarial principles or actual or reasonably anticipated experience as are 303
sighted persons with respect to all other conditions, including the 304
underlying cause of the blindness or partial blindness. 305
(14) Refusing to insure, refusing to continue to insure or limiting the 306
amount, extent or kind of coverage available to an individual or 307
charging an individual a different rate for the same coverage because of 308
exposure to diethylstilbestrol through the female parent. 309
(15) (A) Failure by an insurer, or any other entity responsible for 310
providing payment to a health care provider pursuant to an insurance 311
policy, to pay accident and health claims, including, but not limited to, 312
claims for payment or reimbursement to health care providers, within 313
the time periods set forth in subparagraph (B) of this subdivision, unless 314
the Insurance Commissioner determines that a legitimate dispute exists 315
as to coverage, liability or damages or that the claimant has fraudulently 316
caused or contributed to the loss. Any insurer, or any other entity 317
responsible for providing payment to a health care provider pursuant 318
to an insurance policy, who fails to pay such a claim or request within 319
the time periods set forth in subparagraph (B) of this subdivision shall 320
pay the claimant or health care provider the amount of such claim plus 321
interest at the rate of fifteen per cent per annum, in addition to any other 322
penalties which may be imposed pursuant to sections 38a-11, 38a-25, 323
38a-41 to 38a-53, inclusive, 38a-57 to 38a-60, inclusive, 38a-62 to 38a-64, 324
inclusive, 38a-76, 38a-83, 38a-84, 38a-117 to 38a-124, inclusive, 38a-129 325
to 38a-140, inclusive, 38a-146 to 38a-155, inclusive, 38a-283, 38a-288 to 326
38a-290, inclusive, 38a-319, 38a-320, 38a-459, 38a-464, 38a-815 to 38a-819, 327
inclusive, 38a-824 to 38a-826, inclusive, and 38a-828 to 38a-830, 328
inclusive. Whenever the interest due a claimant or health care provider 329
pursuant to this section is less than one dollar, the insurer shall deposit 330
such amount in a separate interest-bearing account in which all such 331
amounts shall be deposited. At the end of each calendar year each such 332 Raised Bill No. 6387
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insurer shall donate such amount to The University of Connecticut 333
Health Center. 334
(B) Each insurer or other entity responsible for providing payment to 335
a health care provider pursuant to an insurance policy subject to this 336
section, shall pay claims not later than: 337
(i) For claims filed in paper format, sixty days after receipt by the 338
insurer of the claimant's proof of loss form or the health care provider's 339
request for payment filed in accordance with the insurer's practices or 340
procedures, except that when there is a deficiency in the information 341
needed for processing a claim, as determined in accordance with section 342
38a-477, the insurer shall (I) send written notice to the claimant or health 343
care provider, as the case may be, of all alleged deficiencies in 344
information needed for processing a claim not later than thirty days 345
after the insurer receives a claim for payment or reimbursement under 346
the contract, and (II) pay claims for payment or reimbursement under 347
the contract not later than thirty days after the insurer receives the 348
information requested; and 349
(ii) For claims filed in electronic format, twenty days after receipt by 350
the insurer of the claimant's proof of loss form or the health care 351
provider's request for payment filed in accordance with the insurer's 352
practices or procedures, except that when there is a deficiency in the 353
information needed for processing a claim, as determined in accordance 354
with section 38a-477, the insurer shall (I) notify the claimant or health 355
care provider, as the case may be, of all alleged deficiencies in 356
information needed for processing a claim not later than ten days after 357
the insurer receives a claim for payment or reimbursement under the 358
contract, and (II) pay claims for payment or reimbursement under the 359
contract not later than ten days after the insurer receives the information 360
requested. 361
(C) As used in this subdivision, "health care provider" means a person 362
licensed to provide health care services under chapter 368d, chapter 363
368v, chapters 370 to 373, inclusive, 375 to 383c, inclusive, 384a to 384c, 364 Raised Bill No. 6387
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inclusive, or chapter 400j. 365
(16) Failure to pay, as part of any claim for a damaged motor vehicle 366
under any automobile insurance policy where the vehicle has been 367
declared to be a constructive total loss, an amount equal to the sum of 368
(A) the settlement amount on such vehicle plus, whenever the insurer 369
takes title to such vehicle, (B) an amount determined by multiplying 370
such settlement amount by a percentage equivalent to the current sales 371
tax rate established in section 12-408. For purposes of this subdivision, 372
"constructive total loss" means the cost to repair or salvage damaged 373
property, or the cost to both repair and salvage such property, equals or 374
exceeds the total value of the property at the time of the loss. 375
(17) Any violation of section 42-260, by an extended warranty 376
provider subject to the provisions of said section, including, but not 377
limited to: (A) Failure to include all statements required in subsections 378
(c) and (f) of section 42-260 in an issued extended warranty; (B) offering 379
an extended warranty without being (i) insured under an adequate 380
extended warranty reimbursement insurance policy or (ii) able to 381
demonstrate that reserves for claims contained in the provider's 382
financial statements are not in excess of one-half the provider's audited 383
net worth; (C) failure to submit a copy of an issued extended warranty 384
form or a copy of such provider's extended warranty reimbursement 385
policy form to the Insurance Commissioner. 386
(18) With respect to an insurance company, hospital service 387
corporation, health care center or fraternal benefit society providing 388
individual or group health insurance coverage of the types specified in 389
subdivisions (1), (2), (4), (6), (10), (11) and (12) of section 38a-469, 390
refusing to insure, refusing to continue to insure or limiting the amount, 391
extent or kind of coverage available to an individual or charging an 392
individual a different rate for the same coverage because such 393
individual has been a victim of family violence. 394
(19) With respect to an insurance company, hospital service 395
corporation, health care center or fraternal benefit society providing 396 Raised Bill No. 6387
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individual or group health insurance coverage of the types specified in 397
subdivisions (1), (2), (3), (4), (6), (9), (10), (11) and (12) of section 38a-469, 398
refusing to insure, refusing to continue to insure or limiting the amount, 399
extent or kind of coverage available to an individual or charging an 400
individual a different rate for the same coverage because of genetic 401
information. Genetic information indicating a predisposition to a 402
disease or condition shall not be deemed a preexisting condition in the 403
absence of a diagnosis of such disease or condition that is based on other 404
medical information. An insurance company, hospital service 405
corporation, health care center or fraternal benefit society providing 406
individual health coverage of the types specified in subdivisions (1), (2), 407
(3), (4), (6), (9), (10), (11) and (12) of section 38a-469, shall not be 408
prohibited from refusing to insure or applying a preexisting condition 409
limitation, to the extent permitted by law, to an individual who has been 410
diagnosed with a disease or condition based on medical information 411
other than genetic information and has exhibited symptoms of such 412
disease or condition. For the purposes of this subsection, "genetic 413
information" means the information about genes, gene products or 414
inherited characteristics that may derive from an individual or family 415
member. 416
(20) Any violation of sections 38a-465 to 38a-465q, inclusive. 417
(21) With respect to a managed care organization, as defined in 418
section 38a-478, failing to establish a confidentiality procedure for 419
medical record information, as required by section 38a-999. 420
(22) Any violation of sections 38a-591d to 38a-591f, inclusive. 421
(23) Any violation of section 38a-472j. 422
(24) Any violation of section 2 of this act. 423
This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2022 38a-1 Raised Bill No. 6387
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Sec. 2 January 1, 2022 New section
Sec. 3 January 1, 2022 38a-816
INS Joint Favorable