(215 ILCS 5/1011) (from Ch. 73, par. 1065.711)
Sec. 1011.
Reasons for Adverse Underwriting Decisions.
(A) In the event
of an adverse underwriting decision the insurance institution or agent responsible
for the decision shall:
(1) either provide the applicant, policyholder or individual proposed
for coverage with the specific reason or reasons for the adverse underwriting
decision in writing or advise such person that upon written request he or
she may receive the specific reason or reasons in writing, and
(2) provide the applicant, policyholder or individual proposed for coverage
with a summary of the rights established under subsection (B) and Sections
1009 and 1010 of this Article.
(B) Upon receipt of a written request within 90 business days from the
date of the mailing of notice or other communication of an adverse underwriting
decision to an applicant, policyholder or individual proposed for coverage,
the insurance institution or agent shall furnish to such person within 21
business days from the date of receipt of such written request:
(1) the specific reason or reasons for the adverse underwriting decision,
in writing, if such information was not initially furnished in writing pursuant
to paragraph (1) of subsection (A);
(2) the specific items of personal and privileged information that
support those reasons; provided, however:
(a) the insurance institution or agent shall not be required to furnish
specific items of privileged information if it has reasonable suspicion,
based upon specific information available for review by the Director, that
the applicant, policyholder
or individual proposed for coverage has engaged in criminal activity,
fraud, material misrepresentation
or material nondisclosure, and
(b) specific items of medical-record information supplied by a medical-care
institution or medical professional shall be disclosed either directly to
the individual about whom the information relates or to a medical professional
designated by the individual and licensed to provide medical care with respect
to the condition to which the information relates, whichever the insurance
institution or agent prefers; and
(3) the names and addresses of the institutional sources that supplied
the specific items of information pursuant to paragraph (2) of
subsection (B); provided, however, that the identity of any medical professional
or medical-care institution shall be disclosed either directly to the individual
or to the
designated medical professional, whichever the insurance institution or agent prefers.
(C) The obligations imposed by this Section upon an insurance institution
or agent may be satisfied by another insurance institution or agent authorized
to act on its behalf.
(D) When an adverse underwriting decision results solely from an oral
request or inquiry, the explanation of reasons and summary of rights required
by subsection (A) may be given orally.
(Source: P.A. 82-108.)
|