§ 38.2-610. Notice of adverse underwriting decision; furnishing reasons fordecisions and sources of information.
A. In the event of an adverse underwriting decision, including those thatinvolve policies referred to in subdivision 1 of subsection E of § 38.2-2114and in subdivision 3 of subsection F of § 38.2-2212, the insuranceinstitution or agent responsible for the decision shall give a written noticein a form approved by the Commission that:
1. Either provides the applicant, policyholder, or individual proposed forcoverage with the specific reason or reasons for the adverse underwritingdecision in writing or advises such person that upon written request he mayreceive the specific reason or reasons in writing; and
2. Provides the applicant, policyholder, or individual proposed for coveragewith a summary of the rights established under subsection B of this sectionand §§ 38.2-608 and 38.2-609.
B. Upon receipt of a written request within ninety business days from thedate of the mailing of notice or other communication of an adverseunderwriting decision to an applicant, policyholder or individual proposedfor coverage, the insurance institution or agent shall furnish to such personwithin twenty-one business days from the date of receipt of the writtenrequest:
1. The specific reason or reasons for the adverse underwriting decision, inwriting, if that information was not initially furnished in writing pursuantto subdivision 1 of subsection A of this section;
2. The specific items of personal and privileged information that supportthose reasons, however:
a. The insurance institution or agent shall not be required to furnishspecific items of privileged information if it has a reasonable suspicion,based upon specific information available for review by the Commission, thatthe applicant, policyholder, or individual proposed for coverage has engagedin criminal activity, fraud, material misrepresentation, or materialnondisclosure; and
b. Specific items of medical-record information supplied by a medical-careinstitution or medical professional shall be disclosed either directly to theindividual about whom the information relates or to a medical professionaldesignated by the individual and licensed to provide medical care withrespect to the condition to which the information relates, whichever theinsurance institution or agent prefers; and
3. The names and addresses of the institutional sources that supplied thespecific items of information given pursuant to subdivision 2 of subsection Bof this section. However, the identity of any medical professional ormedical-care institution shall be disclosed either directly to the individualor to the designated medical professional, whichever the insuranceinstitution or agent prefers.
C. The obligations imposed by this section upon an insurance institution oragent may be satisfied by another insurance institution or agent authorizedto act on its behalf. However, the insurance institution or agent making anadverse underwriting decision shall remain responsible for compliance withthe obligations imposed by this section.
D. When an adverse underwriting decision results solely from an oral requestor inquiry, the explanation of reasons and summary of rights required bysubsection A of this section may be given orally.
§ 38.2-610. Notice of adverse underwriting decision; furnishing reasons fordecisions and sources of information.
A. In the event of an adverse underwriting decision, including those thatinvolve policies referred to in subdivision 1 of subsection E of § 38.2-2114and in subdivision 3 of subsection F of § 38.2-2212, the insuranceinstitution or agent responsible for the decision shall give a written noticein a form approved by the Commission that:
1. Either provides the applicant, policyholder, or individual proposed forcoverage with the specific reason or reasons for the adverse underwritingdecision in writing or advises such person that upon written request he mayreceive the specific reason or reasons in writing; and
2. Provides the applicant, policyholder, or individual proposed for coveragewith a summary of the rights established under subsection B of this sectionand §§ 38.2-608 and 38.2-609.
B. Upon receipt of a written request within ninety business days from thedate of the mailing of notice or other communication of an adverseunderwriting decision to an applicant, policyholder or individual proposedfor coverage, the insurance institution or agent shall furnish to such personwithin twenty-one business days from the date of receipt of the writtenrequest:
1. The specific reason or reasons for the adverse underwriting decision, inwriting, if that information was not initially furnished in writing pursuantto subdivision 1 of subsection A of this section;
2. The specific items of personal and privileged information that supportthose reasons, however:
a. The insurance institution or agent shall not be required to furnishspecific items of privileged information if it has a reasonable suspicion,based upon specific information available for review by the Commission, thatthe applicant, policyholder, or individual proposed for coverage has engagedin criminal activity, fraud, material misrepresentation, or materialnondisclosure; and
b. Specific items of medical-record information supplied by a medical-careinstitution or medical professional shall be disclosed either directly to theindividual about whom the information relates or to a medical professionaldesignated by the individual and licensed to provide medical care withrespect to the condition to which the information relates, whichever theinsurance institution or agent prefers; and
3. The names and addresses of the institutional sources that supplied thespecific items of information given pursuant to subdivision 2 of subsection Bof this section. However, the identity of any medical professional ormedical-care institution shall be disclosed either directly to the individualor to the designated medical professional, whichever the insuranceinstitution or agent prefers.
C. The obligations imposed by this section upon an insurance institution oragent may be satisfied by another insurance institution or agent authorizedto act on its behalf. However, the insurance institution or agent making anadverse underwriting decision shall remain responsible for compliance withthe obligations imposed by this section.
D. When an adverse underwriting decision results solely from an oral requestor inquiry, the explanation of reasons and summary of rights required bysubsection A of this section may be given orally.
§ 38.2-610. Notice of adverse underwriting decision; furnishing reasons fordecisions and sources of information.
A. In the event of an adverse underwriting decision, including those thatinvolve policies referred to in subdivision 1 of subsection E of § 38.2-2114and in subdivision 3 of subsection F of § 38.2-2212, the insuranceinstitution or agent responsible for the decision shall give a written noticein a form approved by the Commission that:
1. Either provides the applicant, policyholder, or individual proposed forcoverage with the specific reason or reasons for the adverse underwritingdecision in writing or advises such person that upon written request he mayreceive the specific reason or reasons in writing; and
2. Provides the applicant, policyholder, or individual proposed for coveragewith a summary of the rights established under subsection B of this sectionand §§ 38.2-608 and 38.2-609.
B. Upon receipt of a written request within ninety business days from thedate of the mailing of notice or other communication of an adverseunderwriting decision to an applicant, policyholder or individual proposedfor coverage, the insurance institution or agent shall furnish to such personwithin twenty-one business days from the date of receipt of the writtenrequest:
1. The specific reason or reasons for the adverse underwriting decision, inwriting, if that information was not initially furnished in writing pursuantto subdivision 1 of subsection A of this section;
2. The specific items of personal and privileged information that supportthose reasons, however:
a. The insurance institution or agent shall not be required to furnishspecific items of privileged information if it has a reasonable suspicion,based upon specific information available for review by the Commission, thatthe applicant, policyholder, or individual proposed for coverage has engagedin criminal activity, fraud, material misrepresentation, or materialnondisclosure; and
b. Specific items of medical-record information supplied by a medical-careinstitution or medical professional shall be disclosed either directly to theindividual about whom the information relates or to a medical professionaldesignated by the individual and licensed to provide medical care withrespect to the condition to which the information relates, whichever theinsurance institution or agent prefers; and
3. The names and addresses of the institutional sources that supplied thespecific items of information given pursuant to subdivision 2 of subsection Bof this section. However, the identity of any medical professional ormedical-care institution shall be disclosed either directly to the individualor to the designated medical professional, whichever the insuranceinstitution or agent prefers.
C. The obligations imposed by this section upon an insurance institution oragent may be satisfied by another insurance institution or agent authorizedto act on its behalf. However, the insurance institution or agent making anadverse underwriting decision shall remain responsible for compliance withthe obligations imposed by this section.
D. When an adverse underwriting decision results solely from an oral requestor inquiry, the explanation of reasons and summary of rights required bysubsection A of this section may be given orally.
