Terms Used In Illinois Compiled Statutes 215 ILCS 5/1004

  • 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
  • Director: means the Director of Insurance. See Illinois Compiled Statutes 215 ILCS 5/1003
  • Fraud: Intentional deception resulting in injury to another.
  • 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
    
for an insurance coverage, benefit or payment, or
        (2) the servicing of an insurance application,
    
policy, contract or certificate. See Illinois Compiled Statutes 215 ILCS 5/1003
  • 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
  • Person: means any natural person, corporation, association, partnership or other legal entity. See Illinois Compiled Statutes 215 ILCS 5/1003
  • Pretext interview: means an interview whereby a person, in an attempt to obtain information about a natural person, performs one or more of the following acts:
            (1) pretends to be someone he or she is not,
            (2) pretends to represent a person he or she is not
    •     
    in fact representing,
            (3) misrepresents the true purpose of the interview,
        
    or
            (4) refuses to identify himself or herself upon
        
         No insurance institution, agent or insurance-support organization shall use or authorize the use of pretext interviews to obtain information in connection with an insurance transaction; provided, however, a pretext interview may be undertaken to obtain information from a person or institution that does not have a generally or statutorily recognized privileged relationship with the person about whom the information relates for the purpose of investigating a claim where, based upon specific information available for review by the Director, there is a reasonable basis for suspecting criminal activity, fraud, material misrepresentation or material nondisclosure in connection with the claim.
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