28 | | - | ENGROSSED HOUSE |
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29 | | - | BILL NO. 2144 By: Kannady, Deck, Pae, |
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30 | | - | Schreiber, Rosecrants, |
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31 | | - | Provenzano, Moore, Harris, |
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32 | | - | Miller, Roe, Humphrey, |
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33 | | - | Ranson, Townley, Pfeiffer, |
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34 | | - | Caldwell (Chad), Cantrell, |
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35 | | - | Turner, Marti, George, and |
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36 | | - | Manger of the House |
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| 29 | + | HOUSE OF REPRESENTATIVES - FLOOR VERSION |
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| 30 | + | |
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| 31 | + | STATE OF OKLAHOMA |
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| 32 | + | |
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| 33 | + | 1st Session of the 60th Legislature (2025) |
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| 34 | + | |
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| 35 | + | HOUSE BILL 2144 By: Kannady and Deck of the |
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| 36 | + | House |
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45 | 46 | | |
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46 | 47 | | An Act relating to insurance; creating t he Insurance |
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47 | 48 | | Consumers Protection Act; providing definitions; |
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48 | 49 | | creating a statutory cause of acti on; clarifying |
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49 | 50 | | determination of reasonableness and necessity; |
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50 | 51 | | providing who may bring action; declaring certain |
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51 | 52 | | policy, contract, or plan provisions void; clari fying |
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52 | 53 | | there is no requirement to exhaust administrative |
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53 | 54 | | remedies; directing that claimants are e ntitled to |
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54 | 55 | | trial by jury; clarifying issues of bad faith are |
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55 | 56 | | question of fact; creating a statutory cause of |
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56 | 57 | | action against certain bad faith insurers; clarifyi ng |
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57 | 58 | | duty of good faith and fair dealing is nondelegable; |
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58 | 59 | | providing when a cause of action for bad faith shall |
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59 | 60 | | lie; providing for damages; permitting punitive |
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60 | 61 | | damages; providing categories; directing jury to base |
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61 | 62 | | award on certain factors; limiting certain pu nitive |
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62 | 63 | | damages; clarifying considerations and defenses; |
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63 | 64 | | clarifying that causes of actions in act do not limit |
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64 | 65 | | other actions; providing for codification; and |
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65 | 66 | | providing an effective date. |
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70 | 71 | | BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: |
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97 | 99 | | SECTION 1. NEW LAW A new section of law to be codified |
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98 | 100 | | in the Oklahoma Statut es as Section 1119 of Title 12, unless there |
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99 | 101 | | is created a duplication in numbering, reads as follows: |
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100 | 102 | | This act shall be known and may be cited as the "Insurance |
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101 | 103 | | Consumers Protection Act ". |
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102 | 104 | | SECTION 2. NEW LAW A new section of law to b e codified |
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103 | 105 | | in the Oklahoma Statutes as Section 1119.1 of Title 12, unless there |
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104 | 106 | | is created a duplication in numbering, reads as follows: |
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105 | 107 | | As used in the Insuranc e Consumers Protection Act: |
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106 | 108 | | 1. "Bad faith" means conduct of an insurer that violates its |
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107 | 109 | | duty or duties of good faith and fair dealing to a first -party |
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108 | 110 | | claimant or third-party beneficiary by acts including but not |
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109 | 111 | | limited to unreasonably or untimely refus ing to pay or tender the |
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110 | 112 | | proper benefits for a valid claim under the insurance policy. This |
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111 | 113 | | duty of good faith and fair dealing is contained in every insurance |
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112 | 114 | | contract and is a nondelegable duty; |
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113 | 115 | | 2. "First-party claimant" means an individual corporation , |
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114 | 116 | | association, partnership, or other legal entity asserting an |
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115 | 117 | | entitlement to benefits owed dire ctly to or on behalf of an insured |
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116 | 118 | | under an insurance policy. First-party claimants include a public |
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117 | 119 | | entity that has paid a claim for benefits dues to an insur er's |
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118 | 120 | | unreasonable delay or denial of the claim; |
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144 | 147 | | |
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145 | 148 | | 3. "Insurance" is a contract whereby one undert akes to |
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146 | 149 | | indemnify another or to pay a specified amount upon determinable |
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147 | 150 | | contingencies; |
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148 | 151 | | 4. "Insurer" means every person engaged in the business of |
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149 | 152 | | making, selling, or binding contracts of insurance or indemnity in |
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150 | 153 | | Oklahoma, except for independent insuranc e agents and captive |
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151 | 154 | | insurance agents that market for only one insurer. A nonprofit |
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152 | 155 | | hospital service and medical indemnity corporation is an insurer |
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153 | 156 | | within the meaning of this act. The term insurer does not include |
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154 | 157 | | burial associations; |
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155 | 158 | | 5. "Insured" means a person for whom the insurance policy is |
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156 | 159 | | written to protect; |
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157 | 160 | | 6. "Issued in this state" refers to every health and disability |
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158 | 161 | | policy, insurance contract, ins urance certificate, and insurance |
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159 | 162 | | agreement existing, offered, issued, delivered, or renewed in the |
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160 | 163 | | State of Oklahoma or providing health or disability benefits to a |
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161 | 164 | | resident or domiciliary of the State of Oklahoma and every employee |
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162 | 165 | | benefit plan covering a resident or domiciliary of the State of |
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163 | 166 | | Oklahoma, whether or not on behalf of an employer loca ted or |
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164 | 167 | | domiciled in Oklahoma, on or after January 1, 2005, notwithstanding |
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165 | 168 | | any contractual or statutory choice -of-law provision to the |
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166 | 169 | | contrary; |
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193 | 197 | | 7. "Person" means an individual, entity, company, insurer, |
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194 | 198 | | association, organization, society, reciprocal or i nter-insurance |
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195 | 199 | | exchange, partnership, syndicate, business trust, or corporation; |
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196 | 200 | | 8. "Prior authorization" or "pre-authorization" means the |
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197 | 201 | | review and approval by the insurer of treatment recommendations from |
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198 | 202 | | a health insurance policyholder 's physician or the review by the |
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199 | 203 | | insured's agent experienced in remedying the type of casualt y or |
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200 | 204 | | damage at issue; and |
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201 | 205 | | 9. "Third-party beneficiary" means a person that receiv es |
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202 | 206 | | benefits from a contract between two other parties, one of which is |
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203 | 207 | | an insurer, even though t hey are not a party to the contract . |
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204 | 208 | | SECTION 3. NEW LAW A new section of law to be codified |
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205 | 209 | | in the Oklahoma Statutes as Section 1119.2 of Title 12, unless there |
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206 | 210 | | is created a duplication in numbering, reads as follows: |
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207 | 211 | | A. There is hereby created a statutory cause of action for an |
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208 | 212 | | insured under an insurance po licy, as a first-party claimant, and |
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209 | 213 | | any third-party beneficiary to the contract o f insurance between the |
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210 | 214 | | insurer and insured, to maintain an action in district court or any |
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211 | 215 | | court of competent jurisdiction for the bad faith refusal of or |
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212 | 216 | | untimely pre-authorization of benefits, and for payment of such |
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213 | 217 | | benefits. |
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214 | 218 | | B. Provided, however, the recommended treatment for which pre - |
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215 | 219 | | authorization or payment of benefits is sought shall be rea sonable |
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216 | 220 | | and necessary for the person covered by the insurance policy. The |
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243 | 248 | | reasonableness and necessity of the recommended treatment shall be |
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244 | 249 | | determined by a jury. |
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245 | 250 | | C. Either the first-party claimant or third -party beneficiary |
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246 | 251 | | may prosecute a claim for bad faith created by this act. |
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247 | 252 | | D. An insurance policy, insurance contract, or plan that is |
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248 | 253 | | issued in this state shall not contain a provision purporting to |
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249 | 254 | | reserve discretion to the insurer, plan administrator, or claim |
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250 | 255 | | administrator to interpret the terms o f the policy, contract, or |
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251 | 256 | | plan or to determine eligibility for benefits. If an insurance |
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252 | 257 | | policy, contract, or plan contains such a provision, the provision |
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253 | 258 | | is void. |
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254 | 259 | | E. There is no requirement to exhaust any administrative |
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255 | 260 | | remedies with the Oklahoma Insu rance Department before filing an |
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256 | 261 | | action asserting a cause of action for bad faith in a district |
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257 | 262 | | court. |
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258 | 263 | | F. A claimant under this section is entitled to a trial by |
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259 | 264 | | jury. |
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260 | 265 | | G. The issue of bad faith is always a question of fact which |
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261 | 266 | | must be submitted to a j ury pursuant to Section 6 of Article 2 of |
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262 | 267 | | the Oklahoma Constitution. |
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263 | 268 | | SECTION 4. NEW LAW A new section of law to be codified |
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264 | 269 | | in the Oklahoma Statutes as Section 1119.3 of Title 12, unless there |
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265 | 270 | | is created a duplication in numbering, reads as follows: |
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291 | 297 | | |
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292 | 298 | | A. There is hereby created a statutory cause of action against |
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293 | 299 | | an insurer, except pursuant to an insurance policy providing for |
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294 | 300 | | statutory workers' compensation benefits under the Administrative |
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295 | 301 | | Workers' Compensation Act in Title 85A of t he Oklahoma Statutes or |
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296 | 302 | | the Workers' Compensation Code in Title 85 of the Okla homa Statutes, |
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297 | 303 | | if the action or actions of the insurer is in bad faith as defined |
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298 | 304 | | by this act. |
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299 | 305 | | B. There is no requirement to exhaust any administrative |
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300 | 306 | | remedies with the Oklahom a Insurance Department before filing an |
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301 | 307 | | action asserting a cause of action for bad faith in a district |
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302 | 308 | | court. |
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303 | 309 | | C. A claimant under this section is entitled to a trial by |
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304 | 310 | | jury. |
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305 | 311 | | D. The issue of bad faith is always a question of fact which |
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306 | 312 | | must be submitted to a jury. |
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307 | 313 | | E. The duty of good faith and fair dealing is contained in |
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308 | 314 | | every insurance contract and is a nondelegable duty. |
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309 | 315 | | SECTION 5. NEW LAW A new section of law to be codified |
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310 | 316 | | in the Oklahoma Statutes as Section 1119.4 of Title 12, unless there |
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311 | 317 | | is created a duplication in numbering, reads as follows: |
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312 | 318 | | A cause of action for bad faith created by this act shall lie |
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313 | 319 | | if: |
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314 | 320 | | 1. The insurer was required under the insurance policy to pay |
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315 | 321 | | the insured's claim; |
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342 | 349 | | 2. The insurer's refusal to pay the claim was unreasonable or |
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343 | 350 | | untimely under the circumstances related to the claim; |
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344 | 351 | | 3. The insurer had no reasonable basis for the refusal, or the |
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345 | 352 | | amount it offered to satisfy the claim was unreasonably low; or |
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346 | 353 | | 4. The violation by the insurer of its dut y of good faith and |
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347 | 354 | | fair dealing was the direct cause of the injury sustained by the |
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348 | 355 | | insured. |
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349 | 356 | | SECTION 6. NEW LAW A new section of law to be codified |
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350 | 357 | | in the Oklahoma Statutes as Section 1119.5 of Title 12, unless there |
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351 | 358 | | is created a duplication in numbering, reads as follows: |
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352 | 359 | | A. If the insurer violates its dut y or duties of good faith and |
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353 | 360 | | fair dealing, the amount of damages shall be fixed a s the amount of |
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354 | 361 | | money that will compensate a first -party claimant or third -party |
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355 | 362 | | beneficiary for any loss suffered as a result of the breach of the |
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356 | 363 | | duty of good faith and fair dealing. |
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357 | 364 | | B. In fixing the amount of damages, the jury may consider |
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358 | 365 | | financial losses, emotional distress, embarrassment, loss of |
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359 | 366 | | reputation, and mental pain and suffering. |
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360 | 367 | | C. The jury may award punitive damages for the sake of example |
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361 | 368 | | and by way of punishing the insurer based upon the following |
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362 | 369 | | factors, in accordance with Section 9.1 of Title 23 of the Oklahoma |
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363 | 370 | | Statutes: |
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364 | 371 | | 1. The profitability of the misconduct to the insurer; |
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365 | 372 | | 2. The duration of the misconduct and any concealment of it; |
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392 | 400 | | 3. The attitude and conduct of the insurer upon discovery of |
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393 | 401 | | the bad faith action; and |
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394 | 402 | | 4. The financial condition of the insurer. |
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395 | 403 | | D. Category I. Where the jury finds by clear and convincing |
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396 | 404 | | evidence that an insurer has recklessly disregarded its duty to deal |
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397 | 405 | | fairly and act in good faith with its insured; the jury, in a |
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398 | 406 | | separate proceeding conducted after the jury has made such finding |
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399 | 407 | | and awarded actual damages, may award punitive damages in a n amount |
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400 | 408 | | not to exceed the greater of: |
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401 | 409 | | 1. One Hundred Thousand Dollars ($100,000.00); or |
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402 | 410 | | 2. The amount of the actual damages awarded. |
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403 | 411 | | E. Category II. Where the jury finds by clear and convincing |
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404 | 412 | | evidence that: |
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405 | 413 | | 1. An insurer has acted intentionally and with malice towards |
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406 | 414 | | others; or |
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407 | 415 | | 2. An insurer has intentionally and with mali ce breached its |
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408 | 416 | | duty to deal fairly and act in good faith with its insured. |
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409 | 417 | | The jury, in a separate proceeding conducted after the jury has |
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410 | 418 | | made such finding and awarded actual d amages, may award punitive |
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411 | 419 | | damages in an amount not to exceed the greatest of: |
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412 | 420 | | a. Five Hundred Thousand Dollars ($500,000.00), |
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413 | 421 | | b. twice the amount of actual dam ages awarded, or |
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440 | 449 | | c. the increased financial benefit derived by the insurer |
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441 | 450 | | as a direct result of the conduct causing the injury |
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442 | 451 | | to the plaintiff and other persons or entities . |
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443 | 452 | | F. Category III. Where the jury finds by clear and convincing |
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444 | 453 | | evidence that: |
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445 | 454 | | 1. An insurer has acted intentionally and with malice towards |
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446 | 455 | | others; or |
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447 | 456 | | 2. An insurer has intentionally and with malice breached its |
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448 | 457 | | duty to deal fairly and act in good faith with its insured, and the |
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449 | 458 | | court finds, on the record and out of the presence of the jury, that |
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450 | 459 | | there is evidence beyond a reasonable doubt that the insurer acted |
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451 | 460 | | intentionally and with malice and engaged in conduct life - |
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452 | 461 | | threatening to humans, the jury, in a separate proceeding conducted |
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453 | 462 | | after the jury has made such finding and awarde d actual damages, may |
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454 | 463 | | award punitive damages in any amount the jury deems appropriate, |
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455 | 464 | | without regard to the limitations set forth in subsections B and C |
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456 | 465 | | of this section. Any award of punitive damages under this |
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457 | 466 | | subsection awarded in any manner other than as required in this |
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458 | 467 | | subsection shall be void and reversible error. |
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459 | 468 | | G. In determining the amoun t, if any, of punitive damages to be |
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460 | 469 | | awarded under either subsection B, C, or D of this section, the jury |
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461 | 470 | | shall make the award based upon the factors set forth in subsection |
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462 | 471 | | A of this section. |
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489 | 499 | | H. Any award of punitive damages under this section awarded in |
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490 | 500 | | any manner other than as required in this section shall be void and |
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491 | 501 | | reversible error. |
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492 | 502 | | SECTION 7. NEW LAW A new section of law to be cod ified |
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493 | 503 | | in the Oklahoma Statutes as Section 1119.6 of Title 12, unless there |
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494 | 504 | | is created a duplicat ion in numbering, reads as follows: |
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495 | 505 | | A cause of action for bad faith as provide d for by this act |
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496 | 506 | | requires analysis of the insurer 's action and not the interpreta tion |
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497 | 507 | | of any health insurance plan or how a health insurance plan relates |
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498 | 508 | | to the claim. Any insurance contract issued in this state that |
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499 | 509 | | offers health insurance benefits shall not contain a provision |
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500 | 510 | | purporting to reserve discretion to the insurer to inter pret the |
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501 | 511 | | terms of the contract . If an insurance contract contains such a |
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502 | 512 | | provision, the provisi on is void. The interpretation of a health |
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503 | 513 | | insurance plan shall not be a defe nse to a bad faith cause of |
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504 | 514 | | action. |
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505 | 515 | | SECTION 8. NEW LAW A n ew section of law to be codified |
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506 | 516 | | in the Oklahoma Statutes as Section 1119.7 of Title 12, unless there |
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507 | 517 | | is created a duplication in numbering, reads as follows: |
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508 | 518 | | The causes of actions authorized in this act are in addition to, |
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509 | 519 | | and do not limit or affect, othe r actions available by statute or |
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510 | 520 | | common law, now or in the future . The statutory causes of act ion |
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511 | 521 | | created by this act are in addition to the common law bad faith |
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512 | 522 | | causes of action and in no way limit remedies or rights established |
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513 | 523 | | |
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