Maine Revised Statutes Title 24-A Sec. 2212 – Reasons for adverse underwriting decisions
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1. Notice to consumer. In the event of an adverse underwriting decision, the carrier or producer responsible for the decision shall:
A. Comply with the federal Fair Credit Reporting Act, 15 United States Code § 1681m if the decision is based in whole or in part on any information contained in a consumer report; [PL 2013, c. 588, Pt. D, §6 (AMD).]
B. Either provide the consumer with the specific reason or reasons for the adverse underwriting decision in writing or advise the consumer that upon written request the consumer may receive the specific reason or reasons in writing; and [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]
C. Provide the consumer with a summary of the rights established under subsection 2 and sections 2210 and 2211. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]
[PL 2013, c. 588, Pt. D, §6 (AMD).]
Terms Used In Maine Revised Statutes Title 24-A Sec. 2212
- Adverse underwriting decision: means any of the following actions with respect to consumer insurance transactions involving insurance coverage that is individually underwritten:
A. See Maine Revised Statutes Title 24-A Sec. 2204carrier: means :
A. See Maine Revised Statutes Title 24-A Sec. 2204Confidential investigative information: means any information that:
A. See Maine Revised Statutes Title 24-A Sec. 2204consumer: means any individual who resides or obtains insurance in this State and:
A. See Maine Revised Statutes Title 24-A Sec. 2204Fair Credit Reporting Act: A federal law, established in 1971 and revised in 1997, that gives consumers the right to see their credit records and correct any mistakes. Source: OCC Fraud: Intentional deception resulting in injury to another. Health care: includes prescribing, dispensing, furnishing or providing to a patient drugs, biologicals, medical devices, health care equipment and supplies or hospice services and the banking of blood, sperm, organs or any other tissue. See Maine Revised Statutes Title 24-A Sec. 2204 Health care practitioner: means a person licensed in this State to provide or otherwise lawfully providing health care, and includes a partnership or corporation made up of health care practitioners, or an officer, employee, agent or contractor of a health care practitioner acting in the course and scope of employment, agency or contract related to or supportive of the provision of health care to an individual. See Maine Revised Statutes Title 24-A Sec. 2204 Health care provider: means a health care practitioner or health care facility. See Maine Revised Statutes Title 24-A Sec. 2204 in writing: include printing and other modes of making legible words. See Maine Revised Statutes Title 1 Sec. 72 Personal information: includes but is not limited to an individual's name and address and health care information. See Maine Revised Statutes Title 24-A Sec. 2204 United States: includes territories and the District of Columbia. See Maine Revised Statutes Title 1 Sec. 72
2. Request for explanation. If a consumer makes a written request for explanation of an adverse underwriting decision within 90 days after receiving written notice of the decision, the carrier or producer shall furnish to the consumer within 21 days after receiving the request:
A. The specific reason or reasons for the adverse underwriting decision, in writing, if such information was not initially furnished in writing pursuant to subsection 1, paragraph A or B; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]
B. The specific items of personal information that support those reasons, except that:
(1) The carrier or producer is not required to furnish confidential investigative information if it has a reasonable suspicion, based upon specific information available for review by the superintendent, that the consumer has engaged in criminal activity, fraud, material misrepresentation or material nondisclosure; and
(2) In lieu of disclosure directly to the consumer, the carrier or producer may elect to disclose health care information to a person designated by the consumer who is licensed to provide health care with respect to the condition to which the information relates; and [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]
C. The names and addresses of the institutional sources that supplied the specific items of information pursuant to paragraph B, except that the carrier may elect to disclose the identity of any health care provider to the consumer’s designated health care practitioner. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]
[PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]
3. Satisfaction by other carrier, producer or administrator. The obligations imposed by this section upon a carrier or producer may be satisfied by another carrier, producer or administrator authorized to act on its behalf.
[PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]
SECTION HISTORY
PL 1997, c. 677, §3 (NEW). PL 1997, c. 677, §5 (AFF). PL 2013, c. 588, Pt. D, §6 (AMD).