56-43-106 - Policies Certificates of coverage Forms Rates Schedule of compensation paid.
56-43-106. Policies Certificates of coverage Forms Rates Schedule of compensation paid.
(a) (1) Each contractual obligation for legal insurance shall be evidenced by a policy or master policy. Legal insurance may be written on an individual, group, blanket or franchise basis. Each person insured under a group policy must be issued a certificate of coverage. No legal insurance policy or certificate of any kind may be issued or delivered in this state unless and until a copy of the form of the policy or certificate has been filed with the commissioner and approved.
(2) The forms must meet the following requirements:
(A) Policies must contain a detailed list and description of the legal services promised or the legal matters for which expenses are to be reimbursed and the amount of reimbursement;
(B) Policies and certificates must indicate prominently the name of the insurer and the full address of its principal place of business; and
(C) Certificates issued under group policies may summarize the terms of the master contract but must contain a full and clear statement of the benefits provided.
(3) The commissioner may disapprove a form if it is found that it:
(A) Does not meet the requirements of subdivision (a)(2);
(B) Is unfair, unfairly discriminatory, misleading, obscure or encourages misrepresentation or misunderstanding of the contract, including cases where the form:
(i) Provides coverage or benefits that are too restricted to achieve the purposes for which the policy is designed;
(ii) Fails to attain a reasonable degree of readability, simplicity and conciseness; or
(iii) Is misleading, deceptive or obscure because of its physical aspects, such as format, typography, style, color, material or organization;
(C) Provides coverage or benefits or contains other provisions that would endanger the financial soundness of the insurer; or
(D) Is contrary to law.
(b) (1) Rate filing or rate review requirements shall be the same as those for personal risk insurance in chapter 5, part 3 of this title.
(2) The rates must meet the following requirements:
(A) They must be established and justified in accordance with generally accepted insurance principles, including, but not limited to, the experience or judgment of the insurer making the rate filing or actuarial computations;
(B) They may not be excessive, inadequate or unfairly discriminatory. Rates are not unfairly discriminatory because they are averaged broadly among persons insured under group, franchise or blanket policies; and
(C) The commissioner may by written order suspend or modify the requirement of filing for any risk, group or class of risk, the rates for which cannot practically be filed before they are used.
(c) If the commissioner determines that any form reviewed under subsection (a) and any schedule of rates reviewed under subsection (b) complies with the requirements of this section, the commissioner shall approve, within thirty (30) days, which may be extended for an additional thirty (30) days by notice in writing to the person making the filing prior to the expiration of the first thirty (30) days. If disapproving a filing, the commissioner shall notify the person making it in writing specifying the reasons for the disapproval. A hearing shall be granted within thirty (30) days after a request in writing by any person aggrieved by the decision of the commissioner. If the commissioner does not disapprove a form or schedule of rates within thirty (30) days of the filing or an extension of the form or schedule, it shall be deemed approved. The commissioner may, after notice and hearing, disapprove any rate that has been previously approved or deemed approved.
(d) Any schedule of compensation paid either directly to lawyers or to beneficiaries as reimbursement of costs incurred for covered legal services shall be filed with the commissioner within thirty (30) days after its use.
(e) The commissioner may require the submission of whatever relevant information is reasonably necessary in determining whether to approve or disapprove a filing made pursuant to subsection (a), (b) or (d).
[Acts 1989, ch. 423, § 5.]