NAC679B.715. Notification of reasons for adverse underwriting decision; summary of rights.

     1. Except as otherwise provided in subsection 4, if an adverse underwriting decision occurs, the insurance institution or agent responsible for the decision shall:

     (a) Provide the applicant, policyholder or natural person proposed for coverage with the specific reason or reasons for the adverse underwriting decision in writing or advise him or her that, upon submitting a request in writing, he or she may receive the specific reason or reasons in writing; and

     (b) Provide the applicant, policyholder or natural person proposed for coverage with a summary of the rights established under subsection 2 and NAC 679B.705 and 679B.710.

     2. Upon receiving a written request within 90 business days after notifying an applicant, policyholder or natural person proposed for coverage of an adverse underwriting decision, the insurance institution or agent shall furnish within 21 business days after the date of receiving the written request to the applicant, policyholder or natural person proposed for coverage:

     (a) In writing, the specific reason or reasons for the adverse underwriting decision if the information was not initially furnished in writing pursuant to paragraph (a) of subsection 1; and

     (b) The specific items of personal and privileged information that support those reasons, except that the insurance institution or agent:

          (1) Is not required to furnish specific items of privileged information if it has a reasonable suspicion, based upon specific information available for review by the Commissioner, that the applicant, policyholder or natural person proposed for coverage has engaged in criminal activity, fraud, material misrepresentation or material nondisclosure.

          (2) Has the option of disclosing information concerning specific items of medical record information supplied by a medical care institution or medical professional, including the names and addresses of the institutional sources of that information, to either the natural person about whom the information relates or to a medical professional designated by the natural person and licensed to provide medical care with respect to the condition to which the information relates.

     3. The obligations imposed by this section upon an insurance institution or agent may be satisfied by another insurance institution or agent authorized to act on its behalf.

     4. When an adverse underwriting decision results in an oral request or inquiry, the explanation of reasons and summary of rights required by subsection 1 may be given orally.

     (Added to NAC by Comm’r of Insurance, 10-4-88, eff. 1-1-89)