Sec. 38a-477b. Postclaims underwriting prohibited unless approval granted. Application for approval of rescission, cancellation or limitation. Decision. Appeals. Regulations.
Sec. 38a-477b. Postclaims underwriting prohibited unless approval granted.
Application for approval of rescission, cancellation or limitation. Decision. Appeals. Regulations. (a) Unless approval is granted pursuant to subsection (b) of this
section, no insurer or health care center may rescind, cancel or limit any policy of insurance, contract, evidence of coverage or certificate that provides coverage of the type
specified in subdivisions (1), (2), (4), (6), (10), (11) and (12) of section 38a-469 on the
basis of written information submitted on, with or omitted from an insurance application
by the insured if the insurer or health care center failed to complete medical underwriting
and resolve all reasonable medical questions related to the written information submitted
on, with or omitted from the insurance application before issuing the policy, contract,
evidence of coverage or certificate. No insurer or health care center may rescind, cancel
or limit any such policy, contract, evidence of coverage or certificate more than two
years after the effective date of the policy, contract, evidence of coverage or certificate.
(b) An insurer or health care center shall apply for approval of such rescission,
cancellation or limitation by submitting such written information to the Insurance Commissioner on an application in such form as the commissioner prescribes. Such insurer
or health care center shall provide a copy of the application for such approval to the
insured or the insured's representative. Not later than seven business days after receipt
of the application for such approval, the insured or the insured's representative shall
have an opportunity to review such application and respond and submit relevant information to the commissioner with respect to such application. Not later than fifteen business
days after the submission of information by the insured or the insured's representative,
the commissioner shall issue a written decision on such application. The commissioner
may approve such rescission, cancellation or limitation if the commissioner finds that
(1) the written information submitted on or with the insurance application was false at
the time such application was made and the insured or such insured's representative
knew or should have known of the falsity therein, and such submission materially affects
the risk or the hazard assumed by the insurer or health care center, or (2) the information
omitted from the insurance application was knowingly omitted by the insured or such
insured's representative, or the insured or such insured's representative should have
known of such omission, and such omission materially affects the risk or the hazard
assumed by the insurer or health care center. Such decision shall be mailed to the insured,
the insured's representative, if any, and the insurer or health care center.
(c) Notwithstanding the provisions of chapter 54, any insurer or insured aggrieved
by any decision by the commissioner under subsection (b) of this section may, within
thirty days after notice of the commissioner's decision is mailed to such insurer and
insured, take an appeal therefrom to the superior court for the judicial district of Hartford,
which shall be accompanied by a citation to the commissioner to appear before said
court. Such citation shall be signed by the same authority, and such appeal shall be
returnable at the same time and served and returned in the same manner, as is required
in case of a summons in a civil action. Said court may grant such relief as may be
equitable.
(d) The Insurance Commissioner may adopt regulations, in accordance with chapter
54, to implement the provisions of this section.
(P.A. 07-113, S. 1.)