44-7406. Prohibited acts and practices; enumerated; immunity.
(1) The following acts or practices by an insurer are prohibited as unfairly discriminatory:
(a) Denying, refusing to issue, renew, or reissue, canceling, or otherwise terminating, restricting, or excluding coverage on or adding a premium differential to any policy on the basis of the applicant's or insured's abuse status;
(b) Excluding or limiting coverage for losses, denying benefits, or denying a claim incurred by an insured as a result of abuse on the basis of the insured's abuse status except as otherwise permitted or required by the laws of this state relating to acts of abuse committed by a life insurance beneficiary;
(c) Terminating group health coverage for a subject of abuse because coverage was originally issued in the name of the abuser and the abuser has divorced, separated from, or lost custody of the subject of abuse, or the abuser's coverage has terminated voluntarily or involuntarily;
(d) In the case of a property and casualty insurer, (i) denying or limiting payment for a covered loss or denying a covered claim incurred as a result of abuse by a person other than a coinsured or (ii) failing to pay losses arising out of abuse to an innocent first-party claimant to the extent of such claimant's legal interest in the covered property if the loss is caused by the intentional act of an insured or using other exclusions or limitations on coverage which the director has determined unreasonably restrict the ability of subjects of abuse to be indemnified for such losses. Subdivision (1)(d) of this section does not require payment in excess of the loss or policy limits. Nothing in subdivision (1)(d) of this section shall be construed to prohibit an insurer from applying reasonable standards of proof to claims under such subdivision;
(e) When the insurer has information in its possession that clearly indicates that the applicant, insured, or claimant is a subject of abuse, disclosing or transferring by a person employed by or contracting with the insurer of confidential abuse information for any purpose or to any person, except:
(i) To a subject of abuse or a person specifically designated in writing by the subject of abuse;
(ii) To a health care provider for the direct provision of health care services;
(iii) To a licensed physician identified and designated by the subject of abuse;
(iv) When ordered by the director or a court of competent jurisdiction or otherwise required by law;
(v) When necessary for a valid business purpose to transfer information that includes confidential abuse information, confidential abuse information may be disclosed only to the following persons:
(A) A reinsurer that seeks to indemnify or indemnifies all or any part of a policy covering a subject of abuse and that cannot underwrite or satisfy its obligations under the reinsurance agreement without such disclosure;
(B) A party to a proposed or consummated sale, transfer, merger, or consolidation of all or part of the business of the insurer;
(C) Medical or claims personnel contracting with the insurer, including parent or affiliate companies of the insurer that have service agreements with the insurer, only when necessary to process an application or perform the insurer's duties under the policy or to protect the safety or privacy of a subject of abuse; and
(D) With respect to address and telephone number, an entity with whom the insurer transacts business when the business cannot be transacted without the address and telephone number;
(vi) To an attorney who needs the information to represent the insurer effectively, if the insurer notifies the attorney of its obligations under the Unfair Discrimination Against Subjects of Abuse in Insurance Act and requests that the attorney exercise due diligence to protect the confidential abuse information consistent with the attorney's obligation to represent the insurer;
(vii) To the policy owner or assignee, in the course of delivery of the policy, if the policy contains information about the abuse status; and
(viii) To any other entity deemed appropriate by the director; and
(f) Requesting information about acts of abuse or abuse status, or making use of such information, however obtained, except:
(i) For the limited purpose of complying with legal obligations;
(ii) When verifying a person's claim to be a subject of abuse or to have sustained an abuse-related medical condition or incurred an abuse-related claim; or
(iii) When cooperating with a subject of abuse in seeking protection from abuse or facilitating the treatment of an abuse-related medical condition.
(2) Nothing in subdivision (1)(c) of this section prohibits the health carrier from requiring the subject of abuse to provide satisfactory evidence that he or she is a subject of abuse, from requiring the subject of abuse to pay the full premium for coverage under the health benefit plan from the date of termination of the group coverage forward, or from requiring as a condition of coverage that the subject of abuse reside or work within its service area, if the requirements are applied to all insureds of the health carrier. The subject of abuse shall make application for the continuation coverage required by subdivision (1)(c) of this section within sixty days after termination of the group coverage. Any continuation coverage required by subdivision (1)(c) of this section shall cease upon termination of the underlying group coverage. The health carrier may terminate the continuation coverage required by subdivision (1)(c) of this section after it has been in force for eighteen months, if the health carrier offers conversion to an equivalent individual plan. The continuation coverage required by subdivision (1)(c) of this section shall be satisfied by coverage required under 29 U.S.C. 1161 et seq. provided to a subject of abuse and is not intended to be in addition to coverage provided under 29 U.S.C. 1161 et seq.
(3) Subdivision (1)(e) of this section does not preclude a subject of abuse from obtaining his or her insurance records.
(4) A subject of abuse may provide evidence of abuse to a health carrier for the limited purpose of facilitating treatment of an abuse-related medical condition or demonstrating that a medical condition is abuse-related, and this section does not authorize the health carrier to disregard that information.
(5) This section does not prohibit a life insurer from declining to issue a life insurance policy if the applicant or prospective owner of the policy is or would be designated as a beneficiary of the policy, and if:
(a) The applicant or prospective owner of the policy lacks an insurable interest in the prospective insured;
(b) The applicant or prospective owner of the policy is known, on the basis of medical, police, or court records, to have committed an act of abuse against the prospective insured; or
(c) The insured or prospective insured is a subject of abuse, and that person, or a person who has assumed the care of that person if a minor or incapacitated, has objected to the issuance of the policy on the ground that the policy would be issued to or for the direct or indirect benefit of the abuser.
(6) This section does not prohibit a property and casualty insurer from denying a property claim when the damage or loss is the result of intentional conduct by a named insured who commits an act of abuse, except that the property and casualty insurer shall make payment on such a claim to an innocent coinsured subject of abuse to the extent of the innocent coinsured's interest in the property and within the limits of coverage when the damage or loss was proximately related to and in furtherance of abuse. A property and casualty insurer paying such a claim shall be subrogated to the rights of the innocent coinsured subject of abuse to recover for any damages paid by the insurance.
(7) This section does not prohibit an insurer from asking an applicant or insured about a medical condition or a claim or from using information thereby obtained to underwrite or to evaluate and carry out its rights and duties under the policy, even if the information is related to a medical condition or claim that the insurer knows or has reason to know is abuse-related, to the extent otherwise permitted under the act and other applicable law.
(8) An insurer shall not be held civilly or criminally liable for the death of or injury to an insured resulting from any action taken in a good faith effort to comply with the requirements of the act. However, this subsection does not prevent an action by the director to investigate or enforce a violation of the act or to assert any other claims authorized by law.
(9) An insurer shall not be liable for a violation of the act by a person who is a contractor with the insurer unless the insurer directed the act, practice, or omission that constitutes the violation.
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