33-39-3. Definitions.

As used in this chapter:

‘‘Adverse underwriting decision’’ means:#

1. (A)

   Any of the following actions with respect to insurance transactions involving insurance coverage which is individually underwritten:#

   1. (i)

      A declination of insurance coverage;#

   2. (ii)

      A termination of insurance coverage;#

   3. (iii)

      Failure of an agent to apply for insurance coverage with a specific insurance institution which the agent represents and which is requested by an applicant;#

   4. (iv)

      In the case of property or casualty insurance coverage:#

      1. (I)

         Placement by an insurance institution or agent of a risk with a residual market mechanism or an unauthorized insurer; or#

      2. (II)

         The charging of a higher rate on the basis of information which differs from that which the applicant or policyholder furnished;#

   5. (v)

      In the case of a life, health, or disability insurance coverage, an offer to insure at higher than standard rates; or#

2. (B)

   Notwithstanding subparagraph (A) of this paragraph, the following actions shall not be considered adverse underwriting decisions but the insurance institution or agent responsible for their occurrence shall nevertheless provide the applicant or policyholder with the specific reason or reasons for their occurrence:#

   1. (i)

      The termination of an individual policy form on a class or state-wide basis;#

   2. (ii)

      A declination of insurance coverage solely because such coverage is not available on a class or state-wide basis;#

   3. (iii)

      The rescission of a policy; or#

   4. (iv)

      The accommodation of an insured by an agent who places insurance for such insured with any insurer, residual market mechanism, or unauthorized insurer which is satisfactory to such insured when such insured has been canceled, nonrenewed, declined, or otherwise unable to obtain coverage for any reason.#

‘‘Affiliate’’ or ‘‘affiliated’’ means a person that directly, or indirectly through one or more intermediaries, controls, is controlled by, or is under common control with another person.#

‘‘Agent’’ means any agent, broker, subagent, counselor, adjustor, solicitor, or service representative as defined in Code Sections 33-23-1 and 33-23-40.#

‘‘Applicant’’ means any person who seeks to contract for insurance coverage other than a person seeking insurance coverage that is not individually underwritten.#

‘‘Consumer report’’ means any written, oral, or other communication of information bearing on a natural person’s credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used in connection with an insurance transaction.#

‘‘Consumer reporting agency’’ means any person who:#

1. (A)

   Regularly engages, in whole or in part, in the practice of assembling or preparing consumer reports for a monetary fee;#

2. (B)

   Obtains information primarily from sources other than insurance institutions; and#

3. (C)

   Furnishes consumer reports to other persons.#

‘‘Control’’ including the term ‘‘controlled by’’ or ‘‘under common control with,’’ means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is the result of an official position with or corporate office held by the person.#

‘‘Declination of insurance coverage’’ means a denial, in whole or in part, by an insurance institution or agent of requested insurance coverage.#

‘‘Individual’’ means any natural person who:#

1. (A)

   In the case of property or casualty insurance, is a past, present, or proposed named insured or certificate holder;#

2. (B)

   In the case of life, health, or disability insurance, is a past, present, or proposed principal insured or certificate holder;#

3. (C)

   Is a past, present, or proposed policyowner;#

4. (D)

   Is a past or present applicant;#

5. (E)

   Is a past or present claimant; or#

6. (F)

   Derived, derives, or is proposed to derive insurance coverage under an insurance policy or certificate subject to this chapter.#

‘‘Institutional source’’ means any person or governmental entity that provides information about an individual to an agent, insurance institution, or insurance-support organization other than:#

1. (A)

   An agent;#

2. (B)

   The individual who is the subject of the information; or#

3. (C)

   A natural person acting in a personal capacity rather than in a business or professional capacity.#

‘‘Insurance institution’’ means any corporation, association, partnership, reciprocal exchange, interinsurer, Lloyd’s insurer, fraternal benefit society, or other person engaged in the business of insurance, including health care plans and health maintenance organizations as defined in Chapters 20 and 21 of this title. ‘‘Insurance institution’’ shall not include agents or insurance-support organizations.#

‘‘Insurance-support organization’’ means:#

1. (A)

   Any person who regularly engages, in whole or in part, in the practice of assembling or collecting information about natural persons for the primary purpose of providing the information to an insurance institution or agent for insurance transactions, including:#

   1. (i)

      The furnishing of consumer reports or investigative consumer reports to an insurance institution or agent for use in connection with an insurance transaction; or#

   2. (ii)

      The collection of personal information from insurance institutions, agents, or other insurance-support organizations for the purpose of detecting or preventing fraud, material misrepresentation, or material nondisclosure in connection with insurance underwriting or insurance claim activity.#

2. (B)

   Notwithstanding subparagraph (A) of this paragraph, the following persons shall not be considered ‘‘insurance-support organizations’’ for purposes of this chapter: agents, government institutions, insurance institutions, medical care institutions, and medical professionals.#

‘‘Insurance transaction’’ means any transaction involving insurance primarily for personal, family, or household needs rather than business or professional needs which entails:#

1. (A)

   The individual determination of an individual’s eligibility for an insurance coverage, benefit, or payment; or#

2. (B)

   The servicing of an insurance application, policy, contract, or certificate.#

‘‘Investigative consumer report’’ means a consumer report or portion thereof in which information about a natural person’s character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with the person’s neighbors, friends, associates, acquaintances, or others who may have knowledge concerning such items of information.#

‘‘Medical-care institution’’ means any facility or institution that is licensed to provide health care services to natural persons, including but not limited to: health maintenance organizations, home health agencies, hospitals, medical clinics, public health agencies, rehabilitation agencies, and skilled nursing facilities.#

‘‘Medical professional’’ means any person licensed or certified to provide health care services to natural persons, including but not limited to, a chiropractor, clinical dietitian, clinical psychologist, dentist, nurse, occupational therapist, optometrist, pharmacist, physical therapist, physician, podiatrist, psychiatric social worker, or speech therapist.#

‘‘Medical-record information’’ means personal information which:#

1. (A)

   Relates to an individual’s physical or mental condition, medical history, or medical treatment; and#

2. (B)

   Is obtained from a medical professional or medical-care institution, from the individual, or from the individual’s spouse, parent, or legal guardian.#

‘‘Person’’ means any natural person, corporation, association, partnership, or other legal entity.#

‘‘Personal information’’ means any individually identifiable information gathered in connection with an insurance transaction from which judgments can be made about an individual’s character, habits, avocations, finances, occupation, general reputation, credit, health, or any other personal characteristics. ‘‘Personal information’’ does not include an individual’s name, address, and age when no other underwriting information is gathered on that individual nor does it include any ‘‘privileged information.’’#

‘‘Policyholder’’ means any person who:#

1. (A)

   In the case of individual property or casualty insurance, is a present named insured;#

2. (B)

   In the case of individual life, health, or disability insurance, is a present policyholder; or#

3. (C)

   In the case of group insurance which is individually underwritten, is a present group certificate holder.#

‘‘Pretext interview’’ means an interview whereby a person, in an attempt to obtain information about a natural person, performs one or more of the following acts:#

1. (A)

   Pretends to be someone he or she is not;#

2. (B)

   Pretends to represent a person he or she is not in fact representing;#

3. (C)

   Misrepresents the true purpose of the interview; or#

4. (D)

   Refuses to identify himself or herself upon request.#

‘‘Privileged information’’ means any individually identifiable information that:#

1. (A)

   Relates to a claim for insurance benefits or a civil or criminal proceeding involving an individual; and#

2. (B)

   Is collected in connection with or in reasonable anticipation of a claim for insurance benefits or civil or criminal proceeding involving an individual;#

3. provided, however, that information otherwise meeting the requirements of this paragraph shall nevertheless be considered ‘‘personal information’’ under this chapter if it is disclosed in violation of Code Section 33-39-14.

‘‘Residual market mechanism’’ means an association, organization, or other entity defined or described in Code Sections 33-9-7, 33-9-8, and 33-9-10.#

‘‘Termination of insurance coverage’’ or ‘‘termination of an insurance policy’’ means either a cancellation or nonrenewal of an insurance policy, in whole or in part, for any reason other than the failure to pay a premium as required by the policy.#

‘‘Unauthorized insurer’’ means an insurance institution that has not been granted a certificate of authority by the Commissioner to transact the business of insurance in this state.#