2006 New York Code - Information To Be Furnished Insureds; Aggrieved Person.

 
    §  2319.  Information  to be furnished insureds; aggrieved person. (a)
  Every insurer and rate service organization shall  within  a  reasonable
  time  after  receiving  written  request therefor, and upon payment of a
  reasonable charge, furnish to any insured affected by a rate made by it,
  or to the  authorized  representative  of  the  insured,  all  pertinent
  information as to the rate.
    (b)  Except  as  provided  in  subsection  (c)  of this section, every
  insurer or rate service organization shall  provide  within  this  state
  reasonable  means whereby any person aggrieved by the application of its
  rating  system  may  be  heard,  in   person   or   by   an   authorized
  representative,  on  written  request to review the manner in which such
  rating system has been applied in connection with the insurance afforded
  or offered. If the insurer or rate service organization fails  to  grant
  or  reject  the request within thirty days, applicant may proceed in the
  same manner as if the application had been rejected. Any party  affected
  by the action of the insurer or rate service organization on the request
  may within thirty days after written notice of such action appeal to the
  superintendent,  who,  after  a hearing held upon not less than ten days
  written notice to the appellant and  to  the  insurer  or  rate  service
  organization, may affirm, modify or reverse such action.
    (c)  (1)  Subject  to  the  regulations  of  the superintendent, every
  workers' compensation rate  service  organization  shall  establish  and
  implement  procedures  for  the  review  of  its determination to make a
  rating classification, relating  to  insurance  authorized  pursuant  to
  paragraph  fifteen of subsection (a) of section one thousand one hundred
  thirteen of this chapter, which has been filed with and approved by  the
  superintendent.  Such  procedures  for review shall (A) ensure that such
  organization shall, within a reasonable period of time  after  receiving
  written  request  therefor,  furnish  any  insured  affected by a rating
  classification  made  by  the  organization,  or   to   the   authorized
  representative  of  the  insured,  any  information  pertaining  to  the
  insured's file and any information,  upon  request,  pertaining  to  the
  application  of the classification, and (B) require an insured aggrieved
  by such determination to submit a written  request  for  review  of  the
  rating  classification. The failure of such rate service organization to
  respond in writing to a  written  request  submitted  pursuant  to  this
  subsection  within  sixty days, shall authorize the applicant for review
  to proceed as though the classification challenged  was  disapproved  by
  the rate service organization. If the workers' compensation rate service
  organization   cannot,   within   such   sixty  day  period,  make  such
  determination or advise the insured that an inspection, audit  or  study
  is  required,  the  organization  shall  submit a written request to the
  superintendent, within the sixty day  period,  requesting  a  reasonable
  extension of the time period in which to make such determination.
    (2)  Any insured adversely affected by a review, completed pursuant to
  paragraph one of this subsection, may, within thirty days  of  receiving
  written  notice  of  the  results  of  the review, appeal such review in
  writing to the superintendent. Such appeal shall specify the grounds  to
  be  relied  upon  by  the  appellant.  The  superintendent  shall make a
  determination and notify the insured within sixty days of receipt of the
  request for an appeal as to whether he or she finds that the application
  is made in good faith, that the applicant would be so aggrieved  if  his
  grounds are established, and that such grounds otherwise justify holding
  such a hearing. If the superintendent determines that such criteria have
  been  met  by  the  insured's application, then the superintendent shall
  hold a hearing on such matter  within  sixty  days  of  receipt  of  the
  request  for an appeal, but upon no less than ten days written notice to
  the parties of the hearing. The superintendent  may  affirm,  modify  or
  reverse the review of the rate service organization.
    (3) Any determination by the superintendent, pursuant to paragraph two
  of   this   subsection,   shall   be   reviewable  pursuant  to  article
  seventy-eight of the civil practice law and rules.