(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

insurance transactions involving insurance coverage which is individually underwritten:

coverage with a specific insurance institution which the agent represents and which is requested by an applicant,

insurance coverage:

agent of a risk with a residual market mechanism, an unauthorized insurer or an insurance institution which specializes in substandard risks, or

basis of information which differs from that which the applicant or policyholder furnished, or

	insurance coverage, an offer to insure at higher than standard rates. See Illinois Compiled Statutes 215 ILCS 5/1003 Agent: means an individual, firm, partnership, association or corporation who is involved in the solicitation, negotiation or binding of coverages for or on applications or policies of insurance, covering property or risks located in this State. See Illinois Compiled Statutes 215 ILCS 5/1003 Applicant: means any person who seeks to contract for insurance coverage other than a person seeking group insurance that is not individually underwritten. See Illinois Compiled Statutes 215 ILCS 5/1003 Director: means the Director of Insurance. See Illinois Compiled Statutes 215 ILCS 5/1003 Fraud: Intentional deception resulting in injury to another. Individual: means any natural person who:         (1) in the case of property or casualty insurance, is
a past, present or proposed named insured or certificateholder;
(2) in the case of life, health or disability
insurance, is a past, present or proposed principal insured or certificateholder;
(3) is a past, present or proposed policyowner;         (4) is a past or present applicant;         (5) is a past or present claimant; or         (6) derived, derives or is proposed to derive
insurance coverage under an insurance policy or certificate subject to this Article. See Illinois Compiled Statutes 215 ILCS 5/1003 Insurance institution: means any corporation, association, partnership, reciprocal exchange, inter-insurer, Lloyd's insurer, fraternal benefit society or other person engaged in the business of insurance, health maintenance organizations as defined in § 2 of the Health Maintenance Organization Act, voluntary health services plans as defined in § 2 of the Voluntary Health Services Plans Act, and dental service plans as defined in § 4 of the Dental Service Plan Act. See Illinois Compiled Statutes 215 ILCS 5/1003 Medical professional: means any person licensed or certified to provide health care services to natural persons, including but not limited to, a physician, dentist, nurse, optometrist, chiropractor, naprapath, pharmacist, physical or occupational therapist, psychiatric social worker, speech therapist, clinical dietitian or clinical psychologist. See Illinois Compiled Statutes 215 ILCS 5/1003 Medical-care institution: means any facility or institution that is licensed to provide health care services to natural persons, including but not limited to: hospitals, skilled nursing facilities, home-health agencies, medical clinics, rehabilitation agencies and public-health agencies and health-maintenance organizations. See Illinois Compiled Statutes 215 ILCS 5/1003 Medical-record information: means personal information which:         (1) relates to an individual's physical or mental      condition, medical history or medical treatment, and         (2) is obtained from a medical professional or      medical-care institution, from the individual, or from the individual's spouse, parent or legal guardian. See Illinois Compiled Statutes 215 ILCS 5/1003 Person: means any natural person, corporation, association, partnership or other legal entity. See Illinois Compiled Statutes 215 ILCS 5/1003 Policyholder: means any person who:         (1) in the case of individual property or casualty      insurance, is a present named insured;         (2) in the case of individual life, health or      disability insurance, is a present policyowner; or         (3) in the case of group insurance which is      individually underwritten, is a present group certificateholder. See Illinois Compiled Statutes 215 ILCS 5/1003 Privileged information: means any individually identifiable information that: (1) relates to a claim for insurance benefits or a civil or criminal proceeding involving an individual, and (2) is collected in connection with or in reasonable anticipation of a claim for insurance benefits or civil or criminal proceeding involving an individual; provided, however, information otherwise meeting the requirements of this subsection shall nevertheless be considered "personal information" under this Article if it is disclosed in violation of Section 1014 of this Article. See Illinois Compiled Statutes 215 ILCS 5/1003      (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.   Previous section Next section    Article XL Contents