Arizona Laws 20-2113. Disclosure limitations and conditions
An insurance institution, insurance producer 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:
Terms Used In Arizona Laws 20-2113
- Consumer reporting agency: means any person who does any of the following:
(a) Regularly engages, in whole or in part, in the practice of assembling or preparing consumer reports for a monetary fee. See Arizona Laws 20-2102
- Fraud: Intentional deception resulting in injury to another.
- including: means not limited to and is not a term of exclusion. See Arizona Laws 1-215
- Individual: means any natural person who:
(a) In the case of property or casualty insurance, is a past, present or proposed named insured or certificate holder. See Arizona Laws 20-2102
- Insurance institution: means any corporation, association, partnership, reciprocal insurer, inter-insurer, Lloyd's association, fraternal benefit society or other person engaged in the business of insurance, including health care service organizations and hospital, medical, dental and optometric service corporations as defined in this title. See Arizona Laws 20-2102
- Insurance producer: means an insurance producer as defined in section 20-281. See Arizona Laws 20-2102
- Insurance support organization: means :
(a) 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 insurance producer for insurance transactions, including the furnishing of consumer reports or investigative consumer reports to an insurance institution or insurance producer for use in connection with an insurance transaction or the collection of personal information from insurance institutions, insurance producers 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 Arizona Laws 20-2102
- Insurance transaction: means any transaction that involves insurance primarily for personal, family or household needs rather than business or professional needs and that entails the determination of an individual's eligibility for an insurance coverage, benefit or payment or the servicing of an insurance application, policy, contract or certificate, including transfers of business. See Arizona Laws 20-2102
- Medical care institution: means any facility or institution that is licensed to provide health care services to natural persons including:
(a) Health care service organizations. See Arizona Laws 20-2102
- Medical professional: means any person licensed or certified to provide health care services to natural persons, including a chiropractor, clinical dietitian, clinical psychologist, dentist, nurse, occupational therapist, optometrist, pharmacist, physical therapist, physician, podiatrist, psychiatric social worker or speech therapist. See Arizona Laws 20-2102
- Medical record information: means personal information that relates to an individual's physical or mental condition, medical history or medical treatment and that is obtained from a medical professional or medical care institution, the individual or the individual's spouse, parent or legal guardian. See Arizona Laws 20-2102
- Person: includes a corporation, company, partnership, firm, association or society, as well as a natural person. See Arizona Laws 1-215
- Personal information: means any individually identifiable information gathered in connection with an insurance transaction and from which judgments can be made about an individual's character, habits, avocations, finances, occupation, general reputation, credit, health or any other personal characteristics. See Arizona Laws 20-2102
- Policyholder: means any person who:
(a) In the case of individual property or casualty insurance, is a present named insured. See Arizona Laws 20-2102
- Privileged information: means any individually identifiable information that relates to a claim for insurance benefits or a civil or criminal proceeding involving an individual and that is collected in connection with or in reasonable anticipation of a claim for insurance benefits or a civil or criminal proceeding involving an individual, except that information otherwise meeting the requirements of this paragraph is considered personal information under this chapter if it is disclosed in violation of section 20-2113. See Arizona Laws 20-2102
- Subpoena: A command to a witness to appear and give testimony.
1. With the written authorization of the individual except that:
(a) If the authorization is submitted by another insurance institution, insurance producer or insurance support organization, the authorization shall meet the requirements prescribed in section 20-2106.
(b) If the authorization is submitted by a person other than an insurance institution, insurance producer or insurance support organization, the authorization shall be dated, signed by the individual and obtained one year or less before the date a disclosure is sought pursuant to this section.
2. To a person other than an insurance institution, insurance producer or insurance support organization, if the disclosure is reasonably necessary:
(a) To enable the person to perform a business, professional or insurance function for the disclosing insurance institution, insurance producer or insurance support organization and the person agrees not to disclose the information further without the individual’s written authorization unless the further disclosure either:
(i) Would otherwise be permitted by this section if made by an insurance institution, insurance producer or insurance support organization.
(ii) Is reasonably necessary for the person to perform the individual’s function for the disclosing insurance institution, insurance producer or insurance support organization.
(b) To enable the person to provide information to the disclosing insurance institution, insurance producer or insurance support organization for the purpose of determining an individual’s eligibility for an insurance benefit or payment or detecting or preventing criminal activity, fraud, material misrepresentation or material nondisclosure in connection with an insurance transaction.
3. To an insurance institution, insurance producer, insurance support organization or self-insurer if the information disclosed is limited to that which is reasonably necessary either:
(a) To detect or prevent criminal activity, fraud, material misrepresentation or material nondisclosure in connection with insurance transactions.
(b) For the disclosing or receiving insurance institution, insurance producer or insurance support organization to perform its function in connection with an insurance transaction involving the individual.
4. To a medical care institution or medical professional for the purpose of verifying insurance coverage or benefits, informing an individual of a medical problem of which the individual may not be aware or conducting an operations or service audit, if only the information that is reasonably necessary to accomplish the purposes prescribed by this paragraph is disclosed.
5. To an insurance regulatory authority.
6. To a law enforcement or other governmental authority to protect the interests of the insurance institution, insurance producer or insurance support organization in preventing or prosecuting the perpetration of fraud upon it, or if the insurance institution, insurance producer or insurance support organization reasonably believes that illegal activities have been conducted by the individual.
7. Otherwise permitted or required by law.
8. In response to a valid administrative or judicial order, including a search warrant or subpoena.
9. Made for the purpose of conducting actuarial or research studies, except that no individual may be identified in any actuarial or research report, materials allowing the individual to be identified shall be returned or destroyed as soon as they are no longer needed and the actuarial or research organization shall agree not to disclose the information unless the disclosure would otherwise be permitted by this section if made by an insurance institution, insurance producer or insurance support organization.
10. 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, insurance producer or insurance support organization, except that before the consummation of the sale, transfer, merger or consolidation only the information is disclosed that is reasonably necessary to enable the recipient to make business decisions about the purchase, transfer, merger or consolidation and the recipient agrees not to disclose the information unless the disclosure would otherwise be permitted by this section if made by an insurance institution, insurance producer or insurance support organization.
11. To a person whose only use of the information will be in connection with the marketing of a product or service if:
(a) 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 the information is disclosed.
(b) The individual has been given an opportunity to indicate that the individual does not want personal information disclosed for marketing purposes and has given no indication that the individual does not want the information disclosed.
(c) The person receiving the information agrees not to use it except in connection with the marketing of a product or service.
12. To an affiliate whose only use of the information will be in connection with an audit of the insurance institution or insurance producer or the marketing of an insurance or financial product or service, if the affiliate agrees not to disclose the information for any other purpose or to an unaffiliated person, except that no medical record information may be disclosed for marketing purposes without the individual’s written consent.
13. By a consumer reporting agency if the disclosure is to a person other than an insurance institution or insurance producer.
14. To a group insurance policyholder for the purpose of reporting claims experience or conducting an audit of the insurance institution’s or insurance producer’s operations or services if the information disclosed is reasonably necessary for the recipient to conduct the review or audit.
15. To a professional peer review organization for the purpose of reviewing the service or conduct of a medical care institution or medical professional.
16. To a governmental authority for the purpose of determining the individual’s eligibility for health benefits for which the governmental authority may be liable.
17. To a certificate holder or policyholder for the purpose of providing information regarding the status of an insurance transaction.