(a) When any law enforcement official or authority, any insurance department, state division of insurance fraud, or state or federal regulatory or licensing authority requests information from an insurer or insurance professional for the purpose of detecting, prosecuting or preventing insurance fraud, the insurer or insurance professional shall take all reasonable actions to provide the information requested, subject to any legal privilege protecting the information.
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Terms Used In Tennessee Code 56-53-109

  • Department: means the department of commerce and insurance. See Tennessee Code 56-1-102
  • Fraud: Intentional deception resulting in injury to another.
  • Insurance professional: means sales agents, managing general agents, brokers, producers, adjusters and third-party administrators. See Tennessee Code 56-53-101
  • Insurer: includes , but is not limited to, an insurance company, self-insurer, reinsurer, reciprocal exchange, interinsurer, risk retention group, Lloyd's insurer, fraternal benefit society, surety, medical service, health maintenance organization, dental, optometric or any other similar health service plan, and any other legal entity engaged or purportedly engaged in the business of insurance, including any person or entity that falls within the definition of "insurer" found within this title. See Tennessee Code 56-53-101
  • Person: means a natural person, company, corporation, unincorporated association, partnership, professional corporation, agency of government and any other entity. See Tennessee Code 56-53-101
  • Representative: when applied to those who represent a decedent, includes executors and administrators, unless the context implies heirs and distributees. See Tennessee Code 1-3-105
  • Restitution: The court-ordered payment of money by the defendant to the victim for damages caused by the criminal action.
  • State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
  • Subpoena: A command to a witness to appear and give testimony.
(b) Any insurer or insurance professional who has reasonable belief that an act violating § 56-53-102 or § 56-53-103 will be, is being, or has been committed shall furnish and disclose any information in the insurance professional’s possession concerning the act to the appropriate law enforcement official or authority, insurance department, state division of insurance fraud, or state or federal regulatory or licensing authority, subject to any legal privilege protecting the information. In no case shall the information be required by subpoena or otherwise to be given to the person alleged to have committed a violation, unless in possession of an insurer and that insurer used the information to deny a claim of the person, in whole or in part.
(c) All documents or other information submitted to or generated by a law enforcement, regulatory, licensing or other governmental agency pursuant to subsection (a) or (b) shall not be subject to disclosure pursuant to the public records laws, codified in title 10, chapter 7, and shall be confidential unless disclosed by the law enforcement, regulatory, licensing or other governmental agency at the agency’s sole discretion.
(d) Any person who has a reasonable belief that an act violating this chapter will be, is being, or has been committed, or any person who collects, reviews or analyzes information concerning insurance fraud may furnish and disclose any information in the person’s possession concerning the act to an authorized representative of an insurer who requests the information for the purpose of detecting, prosecuting or preventing insurance fraud.
(e) Failure to cooperate with a request for information from an appropriate local, state or federal governmental authority shall bar a person’s eligibility for restitution from any proceeds resulting from the governmental investigation and prosecution. This subsection (e) shall not be construed as limiting the ability of any governmental authority from imposing lawful civil discipline upon a person or entity that fails to cooperate with a request for information as delineated in this subsection (e).
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