An insurance institution, agent or insurance-support organization shall not disclose any personal or privileged information about an individual collected or received in connection with an insurance transaction unless the disclosure is: (A) with the written authorization of the individual, provided:
Terms Used In Illinois Compiled Statutes 215 ILCS 5/1014
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
Consumer reporting agency: means any person who: (1) regularly engages, in whole or in part, in the
practice of assembling or preparing consumer reports for a monetary fee,
(2) obtains information primarily from sources other
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 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
Insurance transaction: means any transaction involving insurance primarily for personal, family or household needs rather than business or professional needs which entails: (1) the determination of an individual's eligibility
Insurance-support organization: means : (1) 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:
(a) the furnishing of consumer reports or
investigative consumer reports to an insurance institution or agent for use in connection with an insurance transaction, or
(b) 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. 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
Personal information: includes an individual's name and address and "medical-record information" but does not include "privileged information". 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
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
Subpoena: A command to a witness to appear and give testimony.
(1) if such authorization is submitted by another insurance institution, agent or insurance-support organization, the authorization meets the requirements of Section 1007 of this Article, or (2) if such authorization is submitted by a person other than an insurance institution, agent or insurance-support organization, the authorization is: (a) dated, (b) signed by the individual, and (c) obtained one year or less prior to the date a disclosure is sought pursuant to this subsection; or (B) to a person other than an insurance institution, agent or insurance-support organization, provided such disclosure is reasonably necessary: (1) to enable such person to perform a business, professional or insurance function for the disclosing insurance institution, agent or insurance-support organization and such person agrees not to disclose the information further without the individual’s written authorization unless the further disclosure: (a) would otherwise be permitted by this Section if made by an insurance institution, agent, or insurance-support organization, or (b) is reasonably necessary for such person to perform its function for the disclosing insurance institution, agent, or insurance-support organization, or (2) to enable such person to provide information to the disclosing insurance institution, agent, or insurance-support organization for the purpose of: (a) determining an individual’s eligibility for an insurance benefit or payment, or (b) detecting or preventing criminal activity, fraud, material misrepresentation or material nondisclosure in connection with an insurance transaction; or (C) to an insurance institution, agent, insurance-support organization or self-insurer, provided the information disclosed is limited to that which is reasonably necessary: (1) to detect or prevent criminal activity, fraud, material misrepresentation or material nondisclosure in connection with insurance transactions, or (2) for either the disclosing or receiving insurance institution, agent or insurance-support organization to perform its function in connection with an insurance transaction involving the individual; or (D) to a medical care institution or medical professional for the purpose of: (1) verifying insurance coverage or benefits, (2) informing an individual of a medical problem of which the individual may not be aware, or (3) conducting an operations or services audit, provided only such information is disclosed as is reasonably necessary to accomplish the foregoing purposes; or (E) to an insurance regulatory authority; or (F) to a law enforcement or other governmental authority: (1) to protect the interests of the insurance institution, agent or insurance-support organization in preventing or prosecuting the perpetration of fraud upon it, or (2) if the insurance institution, agent or insurance-support organization reasonably believes that illegal activities have been conducted by the individual; or (G) otherwise permitted or required by law; or (H) in response to a facially valid administrative or judicial order, including a search warrant or subpoena; or (I) made for the purpose of conducting actuarial or research studies provided: (1) no individual may be identified in any actuarial or research report, (2) materials allowing the individual to be identified are returned or destroyed as soon as they are no longer needed, and (3) the actuarial or research organization agrees not to disclose the information unless the disclosure would otherwise be permitted by this Section if made by an insurance institution, agent or insurance-support organization; or (J) to a party or a representative of a party to a proposed or consummated sale, transfer, merger or consolidation of all or part of the business of the insurance institution, agent or insurance support organization, provided: (1) prior to the consummation of the sale, transfer, merger or consolidation only such information is disclosed as is reasonably necessary to enable the recipient to make business decisions about the purchase, transfer, merger or consolidation, and (2) the recipient agrees not to disclose the information unless the disclosure would otherwise be permitted by this Section if made by an insurance institution, agent or insurance-support organization; or (K) to a person whose only use of such information will be in connection with the marketing of a product or service, provided: (1) no medical-record information, privileged information, or personal information relating to an individual’s character, personal habits, mode of living or general reputation is disclosed, and no classification derived from such information is disclosed, (2) the individual has been given an opportunity to indicate that he or she does not want personal information disclosed for marketing purposes and has given no indication that he or she does not want the information disclosed, and (3) the person receiving such information agrees not to use it except in connection with the marketing of a product or service; or (L) to an affiliate whose only use of the information will be in connection with an audit of the insurance institution or agent or the marketing of an insurance product or service, provided the affiliate agrees not to disclose the information for any other purpose or to unaffiliated persons; or (M) by a consumer reporting agency, provided: the disclosure is to a person other than an insurance institution or agent; or (N) to a group policyholder for the purpose of reporting claims experience or conducting an audit of the insurance institution’s or agent’s operations or services, provided the information disclosed is reasonably necessary for the group policyholder to conduct the review or audit; or (O) to a professional peer review organization for the purpose of reviewing the service or conduct of a medical-care institution or medical professional; or (P) to a governmental authority for the purpose of determining the individual’s eligibility for health benefits for which the governmental authority may be liable; or (Q) to a certificateholder or policyholder for the purpose of providing information regarding the status of an insurance transaction; or (R) to a lienholder, mortgagee, assignee, lessee, or other person shown on the records of an insurance institution or agent as having a legal or beneficial interest in a policy of insurance; provided that information disclosed is limited to that which is reasonably necessary to permit such person to protect its interest in such policy.
