2019 Connecticut General Statutes
Title 38a - Insurance
Chapter 705 - Connecticut Insurance Information and Privacy Protection Act
Section 38a-985 - (Formerly Sec. 38-510). Insurer to provide its reasons for adverse underwriting decisions.
(a) Subject to the provisions of sections 38a-307, 38a-323 and 38a-343, in the event of an adverse underwriting decision, the insurance institution or agent responsible for the decision shall: (1) Either provide the applicant, policyholder or individual proposed for coverage with the specific reason for the adverse underwriting decision in writing or advise such person that upon written request he may receive the specific reason in writing, and (2) provide the applicant, policyholder or individual proposed for coverage with a summary of the rights established under subsection (b) of this section and sections 38a-983 and 38a-984.
(b) Upon receipt of a written request within ninety business days from the date of the mailing of notice or other communication of an adverse underwriting decision to an applicant, policyholder or individual proposed for coverage, the insurance institution or agent shall furnish such person not later than twenty-one business days after the date of receipt of such written request: (1) The specific reason for the adverse underwriting decision, in writing, if such information was not initially furnished in writing pursuant to subdivision (1) of subsection (a) of this section; (2) the specific items of personal and privileged information that support those reasons, except that: (A) The insurance institution or agent shall not be required to furnish specific items of privileged information if it has a reasonable suspicion, based upon specific information available for review by the commissioner, that the applicant, policyholder or individual proposed for coverage has engaged in criminal activity, fraud, material misrepresentation or material nondisclosure, and (B) specific items of medical-record information supplied by a medical-care institution or medical professional shall be disclosed either directly to the individual to whom the information relates or to a medical professional designated by the individual and licensed to provide medical care with respect to the condition to which the information relates; and (3) the names and addresses of the institutional sources that supplied the specific items of information pursuant to subdivision (2) of subsection (b) of this section, except that the identity of any medical professional or medical-care institution shall be disclosed either directly to the individual or to the designated medical professional.
(c) The obligations imposed by this section upon an insurance institution or agent may be satisfied by another insurance institution or agent authorized to act on its behalf.
(d) When an adverse underwriting decision results solely from an oral request or inquiry, the explanation of reasons and summary of rights required by subsection (a) of this section may be given orally.
(e) The insurance institution or agent responsible for the occurrence of any action specified in subparagraph (B) of subdivision (1) of section 38a-976 that is not an adverse underwriting decision shall provide the applicant or policyholder with the specific reason for its occurrence.
(P.A. 81-368, S. 11, 25; P.A. 82-472, S. 122, 183; P.A. 85-156, S. 3; P.A. 14-235, S. 8; P.A. 17-15, S. 93.)
History: P.A. 82-472 made technical changes; P.A. 85-156 substituted reference to Sec. 38-185w for reference to Sec. 38-175i in Subsec. (a); Sec. 38-510 transferred to Sec. 38a-985 in 1991; P.A. 14-235 made technical changes in Subsec. (e); P.A. 17-15 made technical changes in Subsec. (b).
