(a) Any person who commits, or participates in, or permits its employees or its agents to commit any of the following acts with an intent to induce reliance, has committed an unlawful insurance act:

medical exam

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Terms Used In Tennessee Code 56-47-104

  • Insurance policy: means the written instrument in which are set forth the terms of any binder of coverage or contract of insurance, including a binder or contract issued by a state-assigned risk plan, or other forms of workers' compensation insurance. See Tennessee Code 56-47-102
  • Insurance professional: means sales agents, managing general agents, brokers, producers, adjusters and third party administrators. See Tennessee Code 56-47-102
  • Insurance transaction: means a transaction by, between or among an:
    (A) Insurer or a person who acts on behalf of an insurer. See Tennessee Code 56-47-102
  • Insurer: means any person purporting to engage in the business of insurance or authorized to do business in this state or subject to regulation by the state, who undertakes to indemnify another against loss, damage or liability arising from a contingent or unknown event related to causes arising under title 50, chapter 6. See Tennessee Code 56-47-102
  • Pattern or practice: means repeated, routine or generalized in nature, and not merely isolated or sporadic. See Tennessee Code 56-47-102
  • Person: means a natural person, company, corporation, unincorporated association, partnership, professional corporation, agency of government or any other entity. See Tennessee Code 56-47-102
  • Practitioner: means a licensee of this state authorized to practice medicine and surgery, psychology, chiropractic or law or any other licensee of state or person required to be licensed in this state whose services are compensated either in whole or in part, directly or indirectly, by insurance proceeds. See Tennessee Code 56-47-102
(1) Presents, causes to be presented or prepares with knowledge or belief that it will be presented, by or on behalf of an insured, insurer, claimant or applicant to an insurer or insurance professional in connection with an insurance transaction, any information that the person knows to contain false representations, or representations, the falsity of which the person has recklessly disregarded, as to any material fact, or that withholds or conceals a material fact, concerning any of the following:

(i) The application for, rating of or renewal of, any insurance policy;
(ii) A claim for payment or benefit pursuant to any insurance policy; or
(iii) Payments made in accordance with the terms of any insurance policy;
(2) Presents, causes to be presented, or prepares with knowledge or belief that it will be presented, to or by an insurer, insurance professional in connection with an insurance transaction, any information that the person knows to contain false representations, or representations, the falsity of which the person has recklessly disregarded, as to any material fact, or that withholds or conceals a material fact, concerning any of the following:

(i) The solicitation for sale of any insurance policy or purported insurance policy;
(ii) An application for certificate of authority; or
(iii) The financial condition of any insurer;
(3) Solicits or accepts new or renewal insurance risks by or for an insurer that the person knows was insolvent or the insolvency of which the person recklessly disregards;
(4) Presents, causes to be presented, or prepares with knowledge or belief that it will be presented, by or on behalf of an insured or insurer, or insurance professional or any other person to a claimant in connection with an insurance transaction, any information that the person knows to contain false representations, or representations, the falsity of which the person has recklessly disregarded, as to any material fact, or that withholds or conceals a material fact, concerning any of the following:

(i) A claim for payment for benefit pursuant to any insurance policy; or
(ii) Payments made in accordance with the terms of any insurance policy.
(b) It is unlawful for any person to commit, or to attempt to commit, or to aid, assist, abet or solicit another to commit, or to conspire to commit an unlawful insurance act.
(c) A practitioner violates this section only if the practitioner has been engaged in conduct that constitutes a pattern or practice of violation of this section.
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