Tenn. Code Ann. § 56-7-2203 — TN Code / Title 56 / Chapter 7 / Section 56-7-2203
Part definitions
Status: in_force

As used in this part, unless the context otherwise requires: (1) "Actuarial certification" means a written statement by a member of the American Academy of Actuaries or other individual acceptable to the commissioner that a small employer carrier is in compliance with § 56-7-2207 , based upon the person's examination, including a review of the appropriate records and of the actuarial assumptions and methods used by the small employer carrier in establishing premium rates for applicable health benefit plans; (2) "Base premium rate" means, for each class of business as to a rating period, the lowest premium rate charged or that could have been charged under a rating system for that class of business, by the small employer carrier to small employers with similar case characteristics for health benefit plans with the same or similar coverage; (3) "Board" means the board of directors of the pool; (4) "Carrier" means any person that provides one (1) or more health benefit plans in this state, including a licensed insurance company, a prepaid hospital or medical service plan, a health maintenance organization (HMO) and a multiple employer welfare arrangement (MEWA); (5) "Case characteristics" means demographic or other objective characteristics of a small employer, as determined by a small employer carrier, that are considered by the small employer carrier in the determination of premium rates for the small employer, but does not mean claim experience, health status and duration of coverage since issue; (6) "Class of business" means all or a distinct grouping of small employers as shown on the records of a small employer carrier; (7) "Dependent" means the spouse or child of an eligible employee, subject to applicable terms of the health care plan covering the employee; (8) "Eligible employee" means an employee who works for a small employer on a full-time basis, with a normal work week of thirty (30) or more hours, including a sole proprietor, a partner or a partnership, or an independent contractor, if included as an employee under a health care plan of a small employer. "Eligible employee" does not include employees who work on a part-time, temporary, or substitute basis; (9) (A) "Health benefit plan" means: (i) Any accident and health insurance policy or certificate; (ii) Nonprofit hospital or medical service corporation contract; (iii) Health, hospital or medical service corporation plan contract; (iv) HMO subscriber contract; (v) Plan provided by a MEWA; or (vi) Plan provided by another benefit arrangement, to the extent permitted by Employee Retirement Income Security Act (ERISA) ( 29 U.S.C. § 1001 et seq.), subject to § 56-7-2206 . (B) "Health benefit plan" does not mean: (i) Accident only, specified disease only, fixed indemnity, credit or disability insurance; (ii) Coverage or medicare services pursuant to contracts with the federal government; (iii) Medicare supplement or long-term care insurance; (iv) Dental only or vision only insurance; (v) Coverage issued as a supplement to liability insurance; (vi) Insurance arising out of a workers' compensation or similar law; (vii) Automobile medical payment insurance; or (viii) Insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability insurance policy or equivalent self-insurance; (10) "Health group cooperative" or "cooperative" means a private purchasing cooperative composed of small employers formed under this part; (11) "Impaired insurer" has the same meaning as in § 56-12-203 ; (12) "Index rate" means, for each class of business as to a rating period for small employers with similar case characteristics, the arithmetic average of the applicable base premium rate and the corresponding highest premium rate; (13) "Late enrollee" means an eligible employee or dependent who requests enrollment in a health benefit plan of a small employer following the initial enrollment period provided under the terms of the health benefit plan; provided, that the initial enrollment period shall be a period of at least thirty (30) days. However, an eligible employee or dependent shall not be considered a late enrollee if: (A) The individual: (i) Was covered under another employer health benefit plan at the time the individual was eligible to enroll; (ii) Stated, at the time of the initial enrollment, that coverage under another employer health benefit plan was the reason for declining enrollment; (iii) Has lost coverage under another employer health benefit plan as a result of termination of employment, the termination of the other plan's coverage, death of a spouse or divorce; and (iv) Requests enrollment within thirty (30) days after termination of coverage provided under another employer health benefit plan; (B) The individual is employed by an employer that offers multiple health benefit plans and the individual elects a different plan during an open enrollment period; or (C) A court has ordered coverage be provided for a spouse or minor child under a covered employee's health benefit plan, and request for enrollment is made within thirty (30) days after issuance of the court order; (14) "New business premium rate" means, for each class of business as to a rating period, the lowest premium rate charged, offered or that could have been charged by a small employer carrier to small employers with similar case characteristics for newly issued health benefit plans with the same or similar coverage; (15) "Preexisting conditions provision" means a policy provision that limits or excludes coverage for charges or expenses incurred during a specified period following the insured's effective date of coverage, for a condition that, during a specified period immediately preceding the effective date of coverage, had manifested itself in a manner that would cause an ordinarily prudent person to seek diagnosis, care or treatment, or for which medical advice, diagnosis, care or treatment was recommended or received as to that condition or as to pregnancy existing on the effective date of coverage; (16) "Premium" includes insurance premiums or other fees charged for a health benefit plan, including the costs of benefits paid or reimbursements made to or on behalf of persons covered by the plan; (17) "Rating period" means the calendar period for which premium rates established by a small employer carrier are assumed to be in effect, as determined by the small employer carrier; (18) "Small employer" means any person actively engaged in business that, on at least fifty percent (50%) of its working days during the preceding year, employed no fewer than three (3) eligible employees and no more than twenty-five (25) eligible employees, the majority of whom are employed within this state; provided, however, that for purposes of participating in a health group cooperative, a "small employer" includes any person that, during the preceding year, employed no less than two (2) and no more than fifty (50) eligible employees and otherwise qualifies as a small employer pursuant to this subdivision (18). "Small employer" includes companies that are affiliated companies, as defined in § 56-13-102 , or that are eligible to file a combined tax return under the Internal Revenue Code ( 26 U.S.C. § 1 et seq.). Except as otherwise provided, the provisions of this part that apply to a small employer shall continue to apply until the plan anniversary following the date the employer no longer meets the requirements of this section; and (19) "Small employer carrier" means any carrier that offers health benefit plans covering eligible employees of one (1) or more small employers. Acts 1992, ch. 808, § 3; 2008, ch. 1036, §§ 1, 2; 2011, ch. 344, § 1.
As used in this part, unless the context otherwise requires:
(1) "Actuarial certification" means a written statement by a member of the American Academy of Actuaries or other individual acceptable to the commissioner that a small employer carrier is in compliance with § 56-7-2207 , based upon the person's examination, including a review of the appropriate records and of the actuarial assumptions and methods used by the small employer carrier in establishing premium rates for applicable health benefit plans;
(2) "Base premium rate" means, for each class of business as to a rating period, the lowest premium rate charged or that could have been charged under a rating system for that class of business, by the small employer carrier to small employers with similar case characteristics for health benefit plans with the same or similar coverage;
(3) "Board" means the board of directors of the pool;
(4) "Carrier" means any person that provides one (1) or more health benefit plans in this state, including a licensed insurance company, a prepaid hospital or medical service plan, a health maintenance organization (HMO) and a multiple employer welfare arrangement (MEWA);
(5) "Case characteristics" means demographic or other objective characteristics of a small employer, as determined by a small employer carrier, that are considered by the small employer carrier in the determination of premium rates for the small employer, but does not mean claim experience, health status and duration of coverage since issue;
(6) "Class of business" means all or a distinct grouping of small employers as shown on the records of a small employer carrier;
(7) "Dependent" means the spouse or child of an eligible employee, subject to applicable terms of the health care plan covering the employee;
(8) "Eligible employee" means an employee who works for a small employer on a full-time basis, with a normal work week of thirty (30) or more hours, including a sole proprietor, a partner or a partnership, or an independent contractor, if included as an employee under a health care plan of a small employer. "Eligible employee" does not include employees who work on a part-time, temporary, or substitute basis;
(9) (A) "Health benefit plan" means: (i) Any accident and health insurance policy or certificate; (ii) Nonprofit hospital or medical service corporation contract; (iii) Health, hospital or medical service corporation plan contract; (iv) HMO subscriber contract; (v) Plan provided by a MEWA; or (vi) Plan provided by another benefit arrangement, to the extent permitted by Employee Retirement Income Security Act (ERISA) ( 29 U.S.C. § 1001 et seq.), subject to § 56-7-2206 . (B) "Health benefit plan" does not mean: (i) Accident only, specified disease only, fixed indemnity, credit or disability insurance; (ii) Coverage or medicare services pursuant to contracts with the federal government; (iii) Medicare supplement or long-term care insurance; (iv) Dental only or vision only insurance; (v) Coverage issued as a supplement to liability insurance; (vi) Insurance arising out of a workers' compensation or similar law; (vii) Automobile medical payment insurance; or (viii) Insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability insurance policy or equivalent self-insurance;
(A) "Health benefit plan" means: (i) Any accident and health insurance policy or certificate; (ii) Nonprofit hospital or medical service corporation contract; (iii) Health, hospital or medical service corporation plan contract; (iv) HMO subscriber contract; (v) Plan provided by a MEWA; or (vi) Plan provided by another benefit arrangement, to the extent permitted by Employee Retirement Income Security Act (ERISA) ( 29 U.S.C. § 1001 et seq.), subject to § 56-7-2206 .
(i) Any accident and health insurance policy or certificate;
(ii) Nonprofit hospital or medical service corporation contract;
(iii) Health, hospital or medical service corporation plan contract;
(iv) HMO subscriber contract;
(v) Plan provided by a MEWA; or
(vi) Plan provided by another benefit arrangement, to the extent permitted by Employee Retirement Income Security Act (ERISA) ( 29 U.S.C. § 1001 et seq.), subject to § 56-7-2206 .
(B) "Health benefit plan" does not mean: (i) Accident only, specified disease only, fixed indemnity, credit or disability insurance; (ii) Coverage or medicare services pursuant to contracts with the federal government; (iii) Medicare supplement or long-term care insurance; (iv) Dental only or vision only insurance; (v) Coverage issued as a supplement to liability insurance; (vi) Insurance arising out of a workers' compensation or similar law; (vii) Automobile medical payment insurance; or (viii) Insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability insurance policy or equivalent self-insurance;
(i) Accident only, specified disease only, fixed indemnity, credit or disability insurance;
(ii) Coverage or medicare services pursuant to contracts with the federal government;
(iii) Medicare supplement or long-term care insurance;
(iv) Dental only or vision only insurance;
(v) Coverage issued as a supplement to liability insurance;
(vi) Insurance arising out of a workers' compensation or similar law;
(vii) Automobile medical payment insurance; or
(viii) Insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability insurance policy or equivalent self-insurance;
(10) "Health group cooperative" or "cooperative" means a private purchasing cooperative composed of small employers formed under this part;
(11) "Impaired insurer" has the same meaning as in § 56-12-203 ;
(12) "Index rate" means, for each class of business as to a rating period for small employers with similar case characteristics, the arithmetic average of the applicable base premium rate and the corresponding highest premium rate;
(13) "Late enrollee" means an eligible employee or dependent who requests enrollment in a health benefit plan of a small employer following the initial enrollment period provided under the terms of the health benefit plan; provided, that the initial enrollment period shall be a period of at least thirty (30) days. However, an eligible employee or dependent shall not be considered a late enrollee if: (A) The individual: (i) Was covered under another employer health benefit plan at the time the individual was eligible to enroll; (ii) Stated, at the time of the initial enrollment, that coverage under another employer health benefit plan was the reason for declining enrollment; (iii) Has lost coverage under another employer health benefit plan as a result of termination of employment, the termination of the other plan's coverage, death of a spouse or divorce; and (iv) Requests enrollment within thirty (30) days after termination of coverage provided under another employer health benefit plan; (B) The individual is employed by an employer that offers multiple health benefit plans and the individual elects a different plan during an open enrollment period; or (C) A court has ordered coverage be provided for a spouse or minor child under a covered employee's health benefit plan, and request for enrollment is made within thirty (30) days after issuance of the court order;
(A) The individual: (i) Was covered under another employer health benefit plan at the time the individual was eligible to enroll; (ii) Stated, at the time of the initial enrollment, that coverage under another employer health benefit plan was the reason for declining enrollment; (iii) Has lost coverage under another employer health benefit plan as a result of termination of employment, the termination of the other plan's coverage, death of a spouse or divorce; and (iv) Requests enrollment within thirty (30) days after termination of coverage provided under another employer health benefit plan;
(i) Was covered under another employer health benefit plan at the time the individual was eligible to enroll;
(ii) Stated, at the time of the initial enrollment, that coverage under another employer health benefit plan was the reason for declining enrollment;
(iii) Has lost coverage under another employer health benefit plan as a result of termination of employment, the termination of the other plan's coverage, death of a spouse or divorce; and
(iv) Requests enrollment within thirty (30) days after termination of coverage provided under another employer health benefit plan;
(B) The individual is employed by an employer that offers multiple health benefit plans and the individual elects a different plan during an open enrollment period; or
(C) A court has ordered coverage be provided for a spouse or minor child under a covered employee's health benefit plan, and request for enrollment is made within thirty (30) days after issuance of the court order;
(14) "New business premium rate" means, for each class of business as to a rating period, the lowest premium rate charged, offered or that could have been charged by a small employer carrier to small employers with similar case characteristics for newly issued health benefit plans with the same or similar coverage;
(15) "Preexisting conditions provision" means a policy provision that limits or excludes coverage for charges or expenses incurred during a specified period following the insured's effective date of coverage, for a condition that, during a specified period immediately preceding the effective date of coverage, had manifested itself in a manner that would cause an ordinarily prudent person to seek diagnosis, care or treatment, or for which medical advice, diagnosis, care or treatment was recommended or received as to that condition or as to pregnancy existing on the effective date of coverage;
(16) "Premium" includes insurance premiums or other fees charged for a health benefit plan, including the costs of benefits paid or reimbursements made to or on behalf of persons covered by the plan;
(17) "Rating period" means the calendar period for which premium rates established by a small employer carrier are assumed to be in effect, as determined by the small employer carrier;
(18) "Small employer" means any person actively engaged in business that, on at least fifty percent (50%) of its working days during the preceding year, employed no fewer than three (3) eligible employees and no more than twenty-five (25) eligible employees, the majority of whom are employed within this state; provided, however, that for purposes of participating in a health group cooperative, a "small employer" includes any person that, during the preceding year, employed no less than two (2) and no more than fifty (50) eligible employees and otherwise qualifies as a small employer pursuant to this subdivision (18). "Small employer" includes companies that are affiliated companies, as defined in § 56-13-102 , or that are eligible to file a combined tax return under the Internal Revenue Code ( 26 U.S.C. § 1 et seq.). Except as otherwise provided, the provisions of this part that apply to a small employer shall continue to apply until the plan anniversary following the date the employer no longer meets the requirements of this section; and
(19) "Small employer carrier" means any carrier that offers health benefit plans covering eligible employees of one (1) or more small employers.
Acts 1992, ch. 808, § 3; 2008, ch. 1036, §§ 1, 2; 2011, ch. 344, § 1.
Tenn. Code Ann. § 56-11-116 — TN Code / Title 56 / Chapter 11 / Section 56-11-116
Supervisory colleges
Status: in_force

(a) Power of Commissioner. With respect to any insurer or health maintenance organization registered under § 56-11-105 , and in accordance with subsection (c), the commissioner shall also have the power to participate in a supervisory college for any domestic insurer or health maintenance organization that is part of an insurance holding company system with international operations in order to determine compliance by the insurer or health maintenance organization with this title. The powers of the commissioner with respect to supervisory colleges include, but are not limited to, the following: (1) Initiating the establishment of a supervisory college; (2) Clarifying the membership and participation of other supervisors in the supervisory college; (3) Clarifying the functions of the supervisory college and the role of other regulators, including the establishment of a group-wide supervisor; (4) Coordinating the ongoing activities of the supervisory college, including planning meetings, supervisory activities, and processes for information sharing; and (5) Establishing a crisis management plan. (b) Expenses. (1) Each registered insurer or health maintenance organization subject to this section shall be liable for and shall pay the reasonable expenses of the commissioner's participation in a supervisory college in accordance with subsection (c), including reasonable travel expenses. (2) For purposes of this section, a supervisory college may be convened as either a temporary or permanent forum for communication and cooperation between the regulators charged with the supervision of the insurer or health maintenance organization or its affiliates, and the commissioner may establish a regular assessment to the insurer or health maintenance organization for the payment of these expenses. (c) Supervisory College. In order to assess the business strategy, financial position, legal and regulatory position, risk exposure, risk management and governance processes, and as part of the examination of individual insurers in accordance with § 56-11-107 , the commissioner may participate in a supervisory college with other regulators charged with supervision of the insurer or health maintenance organization or its affiliates, including other state, federal and international regulatory agencies. The commissioner may enter into agreements in accordance with § 56-11-108(c) providing the basis for cooperation between the commissioner and the other regulatory agencies, and the activities of the supervisory college. Nothing in this section shall delegate to the supervisory college the authority of the commissioner to regulate or supervise the insurer or its affiliates within its jurisdiction. (d) Group-Wide Supervision of Internationally Active Insurance Groups. (1) (A) The commissioner is authorized to act as the group-wide supervisor for any internationally active insurance group in accordance with this section. However, the commissioner may also acknowledge that another regulatory official shall serve as the group-wide supervisor if the internationally active insurance group: (i) Does not have substantial insurance operations in the United States; (ii) Has substantial insurance operations in the United States, but not in this state; or (iii) Has substantial insurance operations in the United States and this state, but the commissioner has determined pursuant to the factors set forth in subdivisions (d)(2) and (6) that the other regulatory official is the appropriate group-wide supervisor. (B) An insurance holding company system that does not otherwise qualify as an internationally active insurance group may request that the commissioner make a determination or acknowledgment as to a group-wide supervisor pursuant to this section. (2) (A) In cooperation with other state, federal, and international regulatory agencies, the commissioner shall identify a single group-wide supervisor for an internationally active insurance group. The commissioner may determine that the commissioner is the appropriate group-wide supervisor for an internationally active insurance group that conducts substantial insurance operations concentrated in this state, or the commissioner may acknowledge that a regulatory official from another jurisdiction is the appropriate group-wide supervisor for the internationally active insurance group. The commissioner shall consider the following factors when making a determination or acknowledgement under this subsection (d): (i) The place of domicile of the insurers within the internationally active insurance group that hold the largest share of the group's written premiums, assets, or liabilities; (ii) The place of domicile of the top-tiered insurer or insurers in the insurance holding company system of the internationally active insurance group; (iii) The location of the executive offices or largest operational offices of the internationally active insurance group; (iv) Whether another regulatory official is acting or is seeking to act as the group-wide supervisor under a regulatory system that the commissioner determines to be: (a) Substantially similar to the system of regulation provided under the laws of this state; or (b) Otherwise sufficient in terms of providing for group-wide supervision, enterprise risk analysis, and cooperation with other regulatory officials; and (v) Whether another regulatory official acting or seeking to act as the group-wide supervisor provides the commissioner with reasonably reciprocal recognition and cooperation. (B) However, a regulatory official identified under this section as the group-wide supervisor may determine that it is appropriate to acknowledge another supervisor to serve as the group-wide supervisor. The acknowledgement of the group-wide supervisor must be made after consideration of the factors listed in subdivisions (d)(2)(A)(i)-(v), and must be made in cooperation with and subject to the acknowledgement of other regulatory officials involved with the supervision of members of the internationally active insurance group, and in consultation with the internationally active insurance group. (3) Notwithstanding any other law, when another regulatory official is acting as the group-wide supervisor of an internationally active insurance group, the commissioner shall acknowledge that regulatory official as the group-wide supervisor. However, the commissioner shall make a determination or acknowledgement as to the appropriate group-wide supervisor for the internationally active insurance group pursuant to subdivision (d)(2) if a material change in the internationally active insurance group results in: (A) The internationally active insurance group's insurers domiciled in this state holding the largest share of the group's premiums, assets, or liabilities; or (B) This state being the place of domicile of the top-tiered insurer or insurers in the insurance holding company system of the internationally active insurance group. (4) Pursuant to § 56-11-107 , the commissioner is authorized to collect from any insurer registered pursuant to § 56-11-105 all information necessary to determine whether the commissioner may act as the group-wide supervisor of an internationally active insurance group or if the commissioner may acknowledge another regulatory official to act as the group-wide supervisor. Prior to issuing a determination that an internationally active insurance group is subject to group-wide supervision by the commissioner, the commissioner shall notify the insurer registered pursuant to § 56-11-105 and the ultimate controlling person within the internationally active insurance group. The internationally active insurance group has not less than thirty (30) days to provide the commissioner with additional information pertinent to the pending determination. The commissioner shall publish on the website of the department the identity of internationally active insurance groups that the commissioner has determined are subject to group-wide supervision by the commissioner. (5) If the commissioner is the group-wide supervisor for an internationally active insurance group, the commissioner is authorized to: (A) Assess the enterprise risks within the internationally active insurance group to ensure that: (i) The material financial condition and liquidity risks to the members of the internationally active insurance group that are engaged in the business of insurance are identified by management; and (ii) Reasonable and effective mitigation measures are in place; (B) Request, from any member of an internationally active insurance group subject to the commissioner's supervision, information necessary and appropriate to assess enterprise risk, including, but not limited to, information about the members of the internationally active insurance group regarding: (i) Governance, risk assessment, and management; (ii) Capital adequacy; and (iii) Material intercompany transactions; (C) Coordinate and, through the authority of the regulatory officials of the jurisdictions where members of the internationally active insurance group are domiciled, compel development and implementation of reasonable measures designed to ensure that the internationally active insurance group is able to timely recognize and mitigate enterprise risks to members of the internationally active insurance group that are engaged in the business of insurance; (D) Communicate with other state, federal, or international regulatory agencies for members within the internationally active insurance group and share relevant information subject to the confidentiality provisions of § 56-11-108 , through supervisory colleges as set forth in this section, or otherwise; (E) Enter into agreements with or obtain documentation from any insurer registered under § 56-11-105 , any member of the internationally active insurance group, and any other state, federal, or international regulatory agencies for members of the internationally active insurance group, providing the basis for or otherwise clarifying the commissioner's role as group-wide supervisor, including provisions for resolving disputes with other regulatory officials. The agreements or documentation do not serve as evidence in any proceeding that any insurer or person with an insurance holding company system not domiciled or incorporated in this state is doing business in this state or is otherwise subject to jurisdiction in this state; and (F) Engage in other group-wide supervision activities consistent with the authority and purposes enumerated in this section and considered necessary by the commissioner. (6) If the commissioner acknowledges that another regulatory official from a jurisdiction that is not accredited by the National Association of Insurance Commissioners is the group-wide supervisor, the commissioner is authorized to reasonably cooperate, through supervisory colleges or otherwise, with group-wide supervision undertaken by the group-wide supervisor if: (A) The commissioner's cooperation complies with the laws of this state; and (B) The regulatory official acknowledged as the group-wide supervisor also recognizes and cooperates with the commissioner's activities as a group-wide supervisor for other internationally active insurance groups where applicable. Where such recognition and cooperation is not reasonably reciprocal, the commissioner is authorized to refuse recognition and cooperation. (7) The commissioner is authorized to enter into agreements with or obtain documentation from any insurer registered under § 56-11-105 , any affiliate of the insurer, and other state, federal, or international regulatory agencies for members of the internationally active insurance group that provide the basis for or otherwise clarify a regulatory official's role as group-wide supervisor. (8) The commissioner may promulgate rules necessary for the administration of this section. All rules must be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. (9) A registered insurer subject to this section is liable for and shall pay the reasonable expenses of the commissioner's participation in the administration of this section, including the engagement of attorneys, actuaries, and any other professionals, and all reasonable travel expenses. Amended by 2018 Tenn. Acts, ch. 873,s 16, eff. 5/3/2018. Amended by 2016 Tenn. Acts, ch. 735,s 5, eff. 4/7/2016. Acts 2014, ch. 583, § 25.
(a) Power of Commissioner. With respect to any insurer or health maintenance organization registered under § 56-11-105 , and in accordance with subsection (c), the commissioner shall also have the power to participate in a supervisory college for any domestic insurer or health maintenance organization that is part of an insurance holding company system with international operations in order to determine compliance by the insurer or health maintenance organization with this title. The powers of the commissioner with respect to supervisory colleges include, but are not limited to, the following: (1) Initiating the establishment of a supervisory college; (2) Clarifying the membership and participation of other supervisors in the supervisory college; (3) Clarifying the functions of the supervisory college and the role of other regulators, including the establishment of a group-wide supervisor; (4) Coordinating the ongoing activities of the supervisory college, including planning meetings, supervisory activities, and processes for information sharing; and (5) Establishing a crisis management plan.
(1) Initiating the establishment of a supervisory college;
(2) Clarifying the membership and participation of other supervisors in the supervisory college;
(3) Clarifying the functions of the supervisory college and the role of other regulators, including the establishment of a group-wide supervisor;
(4) Coordinating the ongoing activities of the supervisory college, including planning meetings, supervisory activities, and processes for information sharing; and
(5) Establishing a crisis management plan.
(b) Expenses. (1) Each registered insurer or health maintenance organization subject to this section shall be liable for and shall pay the reasonable expenses of the commissioner's participation in a supervisory college in accordance with subsection (c), including reasonable travel expenses. (2) For purposes of this section, a supervisory college may be convened as either a temporary or permanent forum for communication and cooperation between the regulators charged with the supervision of the insurer or health maintenance organization or its affiliates, and the commissioner may establish a regular assessment to the insurer or health maintenance organization for the payment of these expenses.
(1) Each registered insurer or health maintenance organization subject to this section shall be liable for and shall pay the reasonable expenses of the commissioner's participation in a supervisory college in accordance with subsection (c), including reasonable travel expenses.
(2) For purposes of this section, a supervisory college may be convened as either a temporary or permanent forum for communication and cooperation between the regulators charged with the supervision of the insurer or health maintenance organization or its affiliates, and the commissioner may establish a regular assessment to the insurer or health maintenance organization for the payment of these expenses.
(c) Supervisory College. In order to assess the business strategy, financial position, legal and regulatory position, risk exposure, risk management and governance processes, and as part of the examination of individual insurers in accordance with § 56-11-107 , the commissioner may participate in a supervisory college with other regulators charged with supervision of the insurer or health maintenance organization or its affiliates, including other state, federal and international regulatory agencies. The commissioner may enter into agreements in accordance with § 56-11-108(c) providing the basis for cooperation between the commissioner and the other regulatory agencies, and the activities of the supervisory college. Nothing in this section shall delegate to the supervisory college the authority of the commissioner to regulate or supervise the insurer or its affiliates within its jurisdiction.
(d) Group-Wide Supervision of Internationally Active Insurance Groups. (1) (A) The commissioner is authorized to act as the group-wide supervisor for any internationally active insurance group in accordance with this section. However, the commissioner may also acknowledge that another regulatory official shall serve as the group-wide supervisor if the internationally active insurance group: (i) Does not have substantial insurance operations in the United States; (ii) Has substantial insurance operations in the United States, but not in this state; or (iii) Has substantial insurance operations in the United States and this state, but the commissioner has determined pursuant to the factors set forth in subdivisions (d)(2) and (6) that the other regulatory official is the appropriate group-wide supervisor. (B) An insurance holding company system that does not otherwise qualify as an internationally active insurance group may request that the commissioner make a determination or acknowledgment as to a group-wide supervisor pursuant to this section. (2) (A) In cooperation with other state, federal, and international regulatory agencies, the commissioner shall identify a single group-wide supervisor for an internationally active insurance group. The commissioner may determine that the commissioner is the appropriate group-wide supervisor for an internationally active insurance group that conducts substantial insurance operations concentrated in this state, or the commissioner may acknowledge that a regulatory official from another jurisdiction is the appropriate group-wide supervisor for the internationally active insurance group. The commissioner shall consider the following factors when making a determination or acknowledgement under this subsection (d): (i) The place of domicile of the insurers within the internationally active insurance group that hold the largest share of the group's written premiums, assets, or liabilities; (ii) The place of domicile of the top-tiered insurer or insurers in the insurance holding company system of the internationally active insurance group; (iii) The location of the executive offices or largest operational offices of the internationally active insurance group; (iv) Whether another regulatory official is acting or is seeking to act as the group-wide supervisor under a regulatory system that the commissioner determines to be: (a) Substantially similar to the system of regulation provided under the laws of this state; or (b) Otherwise sufficient in terms of providing for group-wide supervision, enterprise risk analysis, and cooperation with other regulatory officials; and (v) Whether another regulatory official acting or seeking to act as the group-wide supervisor provides the commissioner with reasonably reciprocal recognition and cooperation. (B) However, a regulatory official identified under this section as the group-wide supervisor may determine that it is appropriate to acknowledge another supervisor to serve as the group-wide supervisor. The acknowledgement of the group-wide supervisor must be made after consideration of the factors listed in subdivisions (d)(2)(A)(i)-(v), and must be made in cooperation with and subject to the acknowledgement of other regulatory officials involved with the supervision of members of the internationally active insurance group, and in consultation with the internationally active insurance group. (3) Notwithstanding any other law, when another regulatory official is acting as the group-wide supervisor of an internationally active insurance group, the commissioner shall acknowledge that regulatory official as the group-wide supervisor. However, the commissioner shall make a determination or acknowledgement as to the appropriate group-wide supervisor for the internationally active insurance group pursuant to subdivision (d)(2) if a material change in the internationally active insurance group results in: (A) The internationally active insurance group's insurers domiciled in this state holding the largest share of the group's premiums, assets, or liabilities; or (B) This state being the place of domicile of the top-tiered insurer or insurers in the insurance holding company system of the internationally active insurance group. (4) Pursuant to § 56-11-107 , the commissioner is authorized to collect from any insurer registered pursuant to § 56-11-105 all information necessary to determine whether the commissioner may act as the group-wide supervisor of an internationally active insurance group or if the commissioner may acknowledge another regulatory official to act as the group-wide supervisor. Prior to issuing a determination that an internationally active insurance group is subject to group-wide supervision by the commissioner, the commissioner shall notify the insurer registered pursuant to § 56-11-105 and the ultimate controlling person within the internationally active insurance group. The internationally active insurance group has not less than thirty (30) days to provide the commissioner with additional information pertinent to the pending determination. The commissioner shall publish on the website of the department the identity of internationally active insurance groups that the commissioner has determined are subject to group-wide supervision by the commissioner. (5) If the commissioner is the group-wide supervisor for an internationally active insurance group, the commissioner is authorized to: (A) Assess the enterprise risks within the internationally active insurance group to ensure that: (i) The material financial condition and liquidity risks to the members of the internationally active insurance group that are engaged in the business of insurance are identified by management; and (ii) Reasonable and effective mitigation measures are in place; (B) Request, from any member of an internationally active insurance group subject to the commissioner's supervision, information necessary and appropriate to assess enterprise risk, including, but not limited to, information about the members of the internationally active insurance group regarding: (i) Governance, risk assessment, and management; (ii) Capital adequacy; and (iii) Material intercompany transactions; (C) Coordinate and, through the authority of the regulatory officials of the jurisdictions where members of the internationally active insurance group are domiciled, compel development and implementation of reasonable measures designed to ensure that the internationally active insurance group is able to timely recognize and mitigate enterprise risks to members of the internationally active insurance group that are engaged in the business of insurance; (D) Communicate with other state, federal, or international regulatory agencies for members within the internationally active insurance group and share relevant information subject to the confidentiality provisions of § 56-11-108 , through supervisory colleges as set forth in this section, or otherwise; (E) Enter into agreements with or obtain documentation from any insurer registered under § 56-11-105 , any member of the internationally active insurance group, and any other state, federal, or international regulatory agencies for members of the internationally active insurance group, providing the basis for or otherwise clarifying the commissioner's role as group-wide supervisor, including provisions for resolving disputes with other regulatory officials. The agreements or documentation do not serve as evidence in any proceeding that any insurer or person with an insurance holding company system not domiciled or incorporated in this state is doing business in this state or is otherwise subject to jurisdiction in this state; and (F) Engage in other group-wide supervision activities consistent with the authority and purposes enumerated in this section and considered necessary by the commissioner. (6) If the commissioner acknowledges that another regulatory official from a jurisdiction that is not accredited by the National Association of Insurance Commissioners is the group-wide supervisor, the commissioner is authorized to reasonably cooperate, through supervisory colleges or otherwise, with group-wide supervision undertaken by the group-wide supervisor if: (A) The commissioner's cooperation complies with the laws of this state; and (B) The regulatory official acknowledged as the group-wide supervisor also recognizes and cooperates with the commissioner's activities as a group-wide supervisor for other internationally active insurance groups where applicable. Where such recognition and cooperation is not reasonably reciprocal, the commissioner is authorized to refuse recognition and cooperation. (7) The commissioner is authorized to enter into agreements with or obtain documentation from any insurer registered under § 56-11-105 , any affiliate of the insurer, and other state, federal, or international regulatory agencies for members of the internationally active insurance group that provide the basis for or otherwise clarify a regulatory official's role as group-wide supervisor. (8) The commissioner may promulgate rules necessary for the administration of this section. All rules must be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. (9) A registered insurer subject to this section is liable for and shall pay the reasonable expenses of the commissioner's participation in the administration of this section, including the engagement of attorneys, actuaries, and any other professionals, and all reasonable travel expenses.
(1) (A) The commissioner is authorized to act as the group-wide supervisor for any internationally active insurance group in accordance with this section. However, the commissioner may also acknowledge that another regulatory official shall serve as the group-wide supervisor if the internationally active insurance group: (i) Does not have substantial insurance operations in the United States; (ii) Has substantial insurance operations in the United States, but not in this state; or (iii) Has substantial insurance operations in the United States and this state, but the commissioner has determined pursuant to the factors set forth in subdivisions (d)(2) and (6) that the other regulatory official is the appropriate group-wide supervisor. (B) An insurance holding company system that does not otherwise qualify as an internationally active insurance group may request that the commissioner make a determination or acknowledgment as to a group-wide supervisor pursuant to this section.
(A) The commissioner is authorized to act as the group-wide supervisor for any internationally active insurance group in accordance with this section. However, the commissioner may also acknowledge that another regulatory official shall serve as the group-wide supervisor if the internationally active insurance group: (i) Does not have substantial insurance operations in the United States; (ii) Has substantial insurance operations in the United States, but not in this state; or (iii) Has substantial insurance operations in the United States and this state, but the commissioner has determined pursuant to the factors set forth in subdivisions (d)(2) and (6) that the other regulatory official is the appropriate group-wide supervisor.
(i) Does not have substantial insurance operations in the United States;
(ii) Has substantial insurance operations in the United States, but not in this state; or
(iii) Has substantial insurance operations in the United States and this state, but the commissioner has determined pursuant to the factors set forth in subdivisions (d)(2) and (6) that the other regulatory official is the appropriate group-wide supervisor.
(B) An insurance holding company system that does not otherwise qualify as an internationally active insurance group may request that the commissioner make a determination or acknowledgment as to a group-wide supervisor pursuant to this section.
(2) (A) In cooperation with other state, federal, and international regulatory agencies, the commissioner shall identify a single group-wide supervisor for an internationally active insurance group. The commissioner may determine that the commissioner is the appropriate group-wide supervisor for an internationally active insurance group that conducts substantial insurance operations concentrated in this state, or the commissioner may acknowledge that a regulatory official from another jurisdiction is the appropriate group-wide supervisor for the internationally active insurance group. The commissioner shall consider the following factors when making a determination or acknowledgement under this subsection (d): (i) The place of domicile of the insurers within the internationally active insurance group that hold the largest share of the group's written premiums, assets, or liabilities; (ii) The place of domicile of the top-tiered insurer or insurers in the insurance holding company system of the internationally active insurance group; (iii) The location of the executive offices or largest operational offices of the internationally active insurance group; (iv) Whether another regulatory official is acting or is seeking to act as the group-wide supervisor under a regulatory system that the commissioner determines to be: (a) Substantially similar to the system of regulation provided under the laws of this state; or (b) Otherwise sufficient in terms of providing for group-wide supervision, enterprise risk analysis, and cooperation with other regulatory officials; and (v) Whether another regulatory official acting or seeking to act as the group-wide supervisor provides the commissioner with reasonably reciprocal recognition and cooperation. (B) However, a regulatory official identified under this section as the group-wide supervisor may determine that it is appropriate to acknowledge another supervisor to serve as the group-wide supervisor. The acknowledgement of the group-wide supervisor must be made after consideration of the factors listed in subdivisions (d)(2)(A)(i)-(v), and must be made in cooperation with and subject to the acknowledgement of other regulatory officials involved with the supervision of members of the internationally active insurance group, and in consultation with the internationally active insurance group.
(A) In cooperation with other state, federal, and international regulatory agencies, the commissioner shall identify a single group-wide supervisor for an internationally active insurance group. The commissioner may determine that the commissioner is the appropriate group-wide supervisor for an internationally active insurance group that conducts substantial insurance operations concentrated in this state, or the commissioner may acknowledge that a regulatory official from another jurisdiction is the appropriate group-wide supervisor for the internationally active insurance group. The commissioner shall consider the following factors when making a determination or acknowledgement under this subsection (d): (i) The place of domicile of the insurers within the internationally active insurance group that hold the largest share of the group's written premiums, assets, or liabilities; (ii) The place of domicile of the top-tiered insurer or insurers in the insurance holding company system of the internationally active insurance group; (iii) The location of the executive offices or largest operational offices of the internationally active insurance group; (iv) Whether another regulatory official is acting or is seeking to act as the group-wide supervisor under a regulatory system that the commissioner determines to be: (a) Substantially similar to the system of regulation provided under the laws of this state; or (b) Otherwise sufficient in terms of providing for group-wide supervision, enterprise risk analysis, and cooperation with other regulatory officials; and (v) Whether another regulatory official acting or seeking to act as the group-wide supervisor provides the commissioner with reasonably reciprocal recognition and cooperation.
(i) The place of domicile of the insurers within the internationally active insurance group that hold the largest share of the group's written premiums, assets, or liabilities;
(ii) The place of domicile of the top-tiered insurer or insurers in the insurance holding company system of the internationally active insurance group;
(iii) The location of the executive offices or largest operational offices of the internationally active insurance group;
(iv) Whether another regulatory official is acting or is seeking to act as the group-wide supervisor under a regulatory system that the commissioner determines to be: (a) Substantially similar to the system of regulation provided under the laws of this state; or (b) Otherwise sufficient in terms of providing for group-wide supervision, enterprise risk analysis, and cooperation with other regulatory officials; and
(a) Substantially similar to the system of regulation provided under the laws of this state; or
(b) Otherwise sufficient in terms of providing for group-wide supervision, enterprise risk analysis, and cooperation with other regulatory officials; and
(v) Whether another regulatory official acting or seeking to act as the group-wide supervisor provides the commissioner with reasonably reciprocal recognition and cooperation.
(B) However, a regulatory official identified under this section as the group-wide supervisor may determine that it is appropriate to acknowledge another supervisor to serve as the group-wide supervisor. The acknowledgement of the group-wide supervisor must be made after consideration of the factors listed in subdivisions (d)(2)(A)(i)-(v), and must be made in cooperation with and subject to the acknowledgement of other regulatory officials involved with the supervision of members of the internationally active insurance group, and in consultation with the internationally active insurance group.
(3) Notwithstanding any other law, when another regulatory official is acting as the group-wide supervisor of an internationally active insurance group, the commissioner shall acknowledge that regulatory official as the group-wide supervisor. However, the commissioner shall make a determination or acknowledgement as to the appropriate group-wide supervisor for the internationally active insurance group pursuant to subdivision (d)(2) if a material change in the internationally active insurance group results in: (A) The internationally active insurance group's insurers domiciled in this state holding the largest share of the group's premiums, assets, or liabilities; or (B) This state being the place of domicile of the top-tiered insurer or insurers in the insurance holding company system of the internationally active insurance group.
(A) The internationally active insurance group's insurers domiciled in this state holding the largest share of the group's premiums, assets, or liabilities; or
(B) This state being the place of domicile of the top-tiered insurer or insurers in the insurance holding company system of the internationally active insurance group.
(4) Pursuant to § 56-11-107 , the commissioner is authorized to collect from any insurer registered pursuant to § 56-11-105 all information necessary to determine whether the commissioner may act as the group-wide supervisor of an internationally active insurance group or if the commissioner may acknowledge another regulatory official to act as the group-wide supervisor. Prior to issuing a determination that an internationally active insurance group is subject to group-wide supervision by the commissioner, the commissioner shall notify the insurer registered pursuant to § 56-11-105 and the ultimate controlling person within the internationally active insurance group. The internationally active insurance group has not less than thirty (30) days to provide the commissioner with additional information pertinent to the pending determination. The commissioner shall publish on the website of the department the identity of internationally active insurance groups that the commissioner has determined are subject to group-wide supervision by the commissioner.
(5) If the commissioner is the group-wide supervisor for an internationally active insurance group, the commissioner is authorized to: (A) Assess the enterprise risks within the internationally active insurance group to ensure that: (i) The material financial condition and liquidity risks to the members of the internationally active insurance group that are engaged in the business of insurance are identified by management; and (ii) Reasonable and effective mitigation measures are in place; (B) Request, from any member of an internationally active insurance group subject to the commissioner's supervision, information necessary and appropriate to assess enterprise risk, including, but not limited to, information about the members of the internationally active insurance group regarding: (i) Governance, risk assessment, and management; (ii) Capital adequacy; and (iii) Material intercompany transactions; (C) Coordinate and, through the authority of the regulatory officials of the jurisdictions where members of the internationally active insurance group are domiciled, compel development and implementation of reasonable measures designed to ensure that the internationally active insurance group is able to timely recognize and mitigate enterprise risks to members of the internationally active insurance group that are engaged in the business of insurance; (D) Communicate with other state, federal, or international regulatory agencies for members within the internationally active insurance group and share relevant information subject to the confidentiality provisions of § 56-11-108 , through supervisory colleges as set forth in this section, or otherwise; (E) Enter into agreements with or obtain documentation from any insurer registered under § 56-11-105 , any member of the internationally active insurance group, and any other state, federal, or international regulatory agencies for members of the internationally active insurance group, providing the basis for or otherwise clarifying the commissioner's role as group-wide supervisor, including provisions for resolving disputes with other regulatory officials. The agreements or documentation do not serve as evidence in any proceeding that any insurer or person with an insurance holding company system not domiciled or incorporated in this state is doing business in this state or is otherwise subject to jurisdiction in this state; and (F) Engage in other group-wide supervision activities consistent with the authority and purposes enumerated in this section and considered necessary by the commissioner.
(A) Assess the enterprise risks within the internationally active insurance group to ensure that: (i) The material financial condition and liquidity risks to the members of the internationally active insurance group that are engaged in the business of insurance are identified by management; and (ii) Reasonable and effective mitigation measures are in place;
(i) The material financial condition and liquidity risks to the members of the internationally active insurance group that are engaged in the business of insurance are identified by management; and
(ii) Reasonable and effective mitigation measures are in place;
(B) Request, from any member of an internationally active insurance group subject to the commissioner's supervision, information necessary and appropriate to assess enterprise risk, including, but not limited to, information about the members of the internationally active insurance group regarding: (i) Governance, risk assessment, and management; (ii) Capital adequacy; and (iii) Material intercompany transactions;
(i) Governance, risk assessment, and management;
(ii) Capital adequacy; and
(iii) Material intercompany transactions;
(C) Coordinate and, through the authority of the regulatory officials of the jurisdictions where members of the internationally active insurance group are domiciled, compel development and implementation of reasonable measures designed to ensure that the internationally active insurance group is able to timely recognize and mitigate enterprise risks to members of the internationally active insurance group that are engaged in the business of insurance;
(D) Communicate with other state, federal, or international regulatory agencies for members within the internationally active insurance group and share relevant information subject to the confidentiality provisions of § 56-11-108 , through supervisory colleges as set forth in this section, or otherwise;
(E) Enter into agreements with or obtain documentation from any insurer registered under § 56-11-105 , any member of the internationally active insurance group, and any other state, federal, or international regulatory agencies for members of the internationally active insurance group, providing the basis for or otherwise clarifying the commissioner's role as group-wide supervisor, including provisions for resolving disputes with other regulatory officials. The agreements or documentation do not serve as evidence in any proceeding that any insurer or person with an insurance holding company system not domiciled or incorporated in this state is doing business in this state or is otherwise subject to jurisdiction in this state; and
(F) Engage in other group-wide supervision activities consistent with the authority and purposes enumerated in this section and considered necessary by the commissioner.
(6) If the commissioner acknowledges that another regulatory official from a jurisdiction that is not accredited by the National Association of Insurance Commissioners is the group-wide supervisor, the commissioner is authorized to reasonably cooperate, through supervisory colleges or otherwise, with group-wide supervision undertaken by the group-wide supervisor if: (A) The commissioner's cooperation complies with the laws of this state; and (B) The regulatory official acknowledged as the group-wide supervisor also recognizes and cooperates with the commissioner's activities as a group-wide supervisor for other internationally active insurance groups where applicable. Where such recognition and cooperation is not reasonably reciprocal, the commissioner is authorized to refuse recognition and cooperation.
(A) The commissioner's cooperation complies with the laws of this state; and
(B) The regulatory official acknowledged as the group-wide supervisor also recognizes and cooperates with the commissioner's activities as a group-wide supervisor for other internationally active insurance groups where applicable. Where such recognition and cooperation is not reasonably reciprocal, the commissioner is authorized to refuse recognition and cooperation.
(7) The commissioner is authorized to enter into agreements with or obtain documentation from any insurer registered under § 56-11-105 , any affiliate of the insurer, and other state, federal, or international regulatory agencies for members of the internationally active insurance group that provide the basis for or otherwise clarify a regulatory official's role as group-wide supervisor.
(8) The commissioner may promulgate rules necessary for the administration of this section. All rules must be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(9) A registered insurer subject to this section is liable for and shall pay the reasonable expenses of the commissioner's participation in the administration of this section, including the engagement of attorneys, actuaries, and any other professionals, and all reasonable travel expenses.
Amended by 2018 Tenn. Acts, ch. 873,s 16, eff. 5/3/2018.
Amended by 2016 Tenn. Acts, ch. 735,s 5, eff. 4/7/2016.
Acts 2014, ch. 583, § 25.
Tenn. Code Ann. § 56-7-3404 — TN Code / Title 56 / Chapter 7 / Section 56-7-3404
Semiannual comparison of in-force policies, annuities, and account owners against death master file - Applicability of requirement - Actions by insurer upon learning of possible death - Disclosure of information to persons assisting in location of beneficiaries - Disposition of benefits
Status: in_force

(a) (1) To the extent that an insurer's records of its in-force policies, annuities, and account owners are available electronically, an insurer shall perform a comparison of such in-force policies, annuities, and account owners against a death master file, on a semi-annual basis, to identify potential death master file matches. To the extent that an insurer's records of its in-force policies, annuities, and account owners are not available electronically, an insurer shall perform a comparison of such in-force policies, annuities, and account owners against a death master file, on a semi-annual basis, to identify potential death master file matches, using the records most easily accessible by the insurer. (2) This section shall not apply to policies or annuities for which the insurer has received premiums from outside the policy value, by check, bank draft, payroll deduction, or any other similar method of active premium payment, within the eighteen (18) months immediately preceding the death master file comparison. (3) An insurer may comply with the requirements of this section by using the full death master file once and thereafter using the death master file update files for future comparisons. (4) An insurer that has not engaged in asymmetric conduct prior to July 1, 2015, shall not be required to comply with the requirements of this section with respect to any policies, annuities or retained asset accounts issued or delivered prior to July 1, 2015; provided, however, that an insurer, regardless of whether it has engaged in asymmetric conduct, shall comply with the requirements of this section for all policies, annuities, or retained asset accounts issued after July 1, 2015. (5) The comparison required by this section shall not be applicable to group life insurance policies for which the insurer does not perform record keeping services. (b) If an insurer learns of the possible death of a person, through a DMF match or otherwise, then the insurer shall within ninety (90) days complete a good faith effort, which shall be documented by the insurer, to: (1) Confirm the death of such person against other available records and information; (2) Review its records to determine whether such deceased person had purchased any other products with the insurer; (3) Determine whether benefits may be due in accordance with any applicable policy, annuity, or retained asset account; (4) Locate the beneficiary or beneficiaries; and (5) Provide the appropriate claims forms or instructions to the beneficiary to make a claim, and notify the beneficiary of the actions necessary to submit a valid claim. (c) Except as prohibited by law, an insurer may disclose only the minimum necessary identifying personal information about such an insured, annuitant, account owner or beneficiary to a person who the insurer reasonably believes may be able to assist the insurer in locating the beneficiary or a person otherwise entitled to payment of the claims proceeds. (d) In the event an insurer is unable to confirm the death of a person following a DMF match, an insurer may determine that no further good faith efforts, as described in subsection (b), are required of it with respect to such policy, annuity or retained asset account. (e) An insurer or its service provider shall not charge any beneficiary or other person who may be entitled to benefits any fees or costs associated with a DMF search or the verification of a DMF match conducted pursuant to this section. (f) The benefits from life insurance policies, annuities or retained asset accounts, plus any applicable accrued contractual interest, shall first be payable to the beneficiaries or account owners as provided for in such policies, annuities or retained asset accounts, and in the event said beneficiaries or account owners cannot be found, shall escheat to the state as unclaimed property under title 66, chapter 29, part 1. (g) The commissioner may exempt an insurer from the DMF comparisons required under subsection (a) if the insurer demonstrates to the commissioner's satisfaction that compliance would result in hardship to the insurer. (h) Nothing in this section limits an insurer from requiring a valid death certificate as part of any claims validation process or otherwise requiring compliance with the terms and conditions of the policy or annuity relative to filing and payment of claims. Amended by 2017 Tenn. Acts, ch. 457, s 3, eff. 7/1/2017. Added by 2014 Tenn. Acts, ch. 974,s 1, eff. 7/1/2015.
(a) (1) To the extent that an insurer's records of its in-force policies, annuities, and account owners are available electronically, an insurer shall perform a comparison of such in-force policies, annuities, and account owners against a death master file, on a semi-annual basis, to identify potential death master file matches. To the extent that an insurer's records of its in-force policies, annuities, and account owners are not available electronically, an insurer shall perform a comparison of such in-force policies, annuities, and account owners against a death master file, on a semi-annual basis, to identify potential death master file matches, using the records most easily accessible by the insurer. (2) This section shall not apply to policies or annuities for which the insurer has received premiums from outside the policy value, by check, bank draft, payroll deduction, or any other similar method of active premium payment, within the eighteen (18) months immediately preceding the death master file comparison. (3) An insurer may comply with the requirements of this section by using the full death master file once and thereafter using the death master file update files for future comparisons. (4) An insurer that has not engaged in asymmetric conduct prior to July 1, 2015, shall not be required to comply with the requirements of this section with respect to any policies, annuities or retained asset accounts issued or delivered prior to July 1, 2015; provided, however, that an insurer, regardless of whether it has engaged in asymmetric conduct, shall comply with the requirements of this section for all policies, annuities, or retained asset accounts issued after July 1, 2015. (5) The comparison required by this section shall not be applicable to group life insurance policies for which the insurer does not perform record keeping services.
(1) To the extent that an insurer's records of its in-force policies, annuities, and account owners are available electronically, an insurer shall perform a comparison of such in-force policies, annuities, and account owners against a death master file, on a semi-annual basis, to identify potential death master file matches. To the extent that an insurer's records of its in-force policies, annuities, and account owners are not available electronically, an insurer shall perform a comparison of such in-force policies, annuities, and account owners against a death master file, on a semi-annual basis, to identify potential death master file matches, using the records most easily accessible by the insurer.
(2) This section shall not apply to policies or annuities for which the insurer has received premiums from outside the policy value, by check, bank draft, payroll deduction, or any other similar method of active premium payment, within the eighteen (18) months immediately preceding the death master file comparison.
(3) An insurer may comply with the requirements of this section by using the full death master file once and thereafter using the death master file update files for future comparisons.
(4) An insurer that has not engaged in asymmetric conduct prior to July 1, 2015, shall not be required to comply with the requirements of this section with respect to any policies, annuities or retained asset accounts issued or delivered prior to July 1, 2015; provided, however, that an insurer, regardless of whether it has engaged in asymmetric conduct, shall comply with the requirements of this section for all policies, annuities, or retained asset accounts issued after July 1, 2015.
(5) The comparison required by this section shall not be applicable to group life insurance policies for which the insurer does not perform record keeping services.
(b) If an insurer learns of the possible death of a person, through a DMF match or otherwise, then the insurer shall within ninety (90) days complete a good faith effort, which shall be documented by the insurer, to: (1) Confirm the death of such person against other available records and information; (2) Review its records to determine whether such deceased person had purchased any other products with the insurer; (3) Determine whether benefits may be due in accordance with any applicable policy, annuity, or retained asset account; (4) Locate the beneficiary or beneficiaries; and (5) Provide the appropriate claims forms or instructions to the beneficiary to make a claim, and notify the beneficiary of the actions necessary to submit a valid claim.
(1) Confirm the death of such person against other available records and information;
(2) Review its records to determine whether such deceased person had purchased any other products with the insurer;
(3) Determine whether benefits may be due in accordance with any applicable policy, annuity, or retained asset account;
(4) Locate the beneficiary or beneficiaries; and
(5) Provide the appropriate claims forms or instructions to the beneficiary to make a claim, and notify the beneficiary of the actions necessary to submit a valid claim.
(c) Except as prohibited by law, an insurer may disclose only the minimum necessary identifying personal information about such an insured, annuitant, account owner or beneficiary to a person who the insurer reasonably believes may be able to assist the insurer in locating the beneficiary or a person otherwise entitled to payment of the claims proceeds.
(d) In the event an insurer is unable to confirm the death of a person following a DMF match, an insurer may determine that no further good faith efforts, as described in subsection (b), are required of it with respect to such policy, annuity or retained asset account.
(e) An insurer or its service provider shall not charge any beneficiary or other person who may be entitled to benefits any fees or costs associated with a DMF search or the verification of a DMF match conducted pursuant to this section.
(f) The benefits from life insurance policies, annuities or retained asset accounts, plus any applicable accrued contractual interest, shall first be payable to the beneficiaries or account owners as provided for in such policies, annuities or retained asset accounts, and in the event said beneficiaries or account owners cannot be found, shall escheat to the state as unclaimed property under title 66, chapter 29, part 1.
(g) The commissioner may exempt an insurer from the DMF comparisons required under subsection (a) if the insurer demonstrates to the commissioner's satisfaction that compliance would result in hardship to the insurer.
(h) Nothing in this section limits an insurer from requiring a valid death certificate as part of any claims validation process or otherwise requiring compliance with the terms and conditions of the policy or annuity relative to filing and payment of claims.
Amended by 2017 Tenn. Acts, ch. 457, s 3, eff. 7/1/2017.
Added by 2014 Tenn. Acts, ch. 974,s 1, eff. 7/1/2015.
Tenn. Code Ann. § 56-7-2365 — TN Code / Title 56 / Chapter 7 / Section 56-7-2365
Health insurance coverage related to clinical trials
Status: in_force

(a) As used in this section, unless the context otherwise requires: (1) "Health benefit plan" means any hospital or medical expense policy, health, hospital or medical service corporation contract, a policy or agreement entered into by a health insurer or health maintenance organization contract offered by an employer, but does not include individually underwritten health insurance policies, or policies or certificates covering only accident, credit, dental, disability income, long-term care, hospital indemnity, medicare supplement as defined in § 1882(g)(1) of the Social Security Act ( 42 U.S.C. § 1395ss(g)(1) ), specified disease, vision care, other limited benefit health insurance, coverage issued as a supplement to liability insurance, workers' compensation insurance, automobile medical payment insurance or insurance that is statutorily required to be contained in any liability insurance policy or equivalent self insurance; (2) "Health insurer" means any entity offering a health benefit plan; and (3) "Routine patient care costs" means the costs associated with the provision of health care services, including drugs, medical devices, and services that would otherwise be covered under the plan or contract, if those drugs, medical devices, and services were not provided in connection with an approved clinical trial program, including health care services that are: (A) Typically provided absent a clinical trial; (B) Required solely for the provision of the drug, medical device or service; (C) Required for the clinically appropriate monitoring of the drug, medical device, or service; (D) Provided for the prevention of complication arising from the provision of the drug, medical device, or service; and (E) Needed for the reasonable and necessary care arising from the provision of the drug, medical device, or service, including the diagnosis or treatment of the complications. (b) The subject of the trial must evaluate a drug, medical device or service that falls within a medicare benefit category and is not statutorily excluded from coverage. For purposes of this section, "routine patient care costs" does not include the costs associated with the provision of any of the following: (1) Drugs, medical devices, and services that have not been approved by the federal food and drug administration and that are associated with the clinical trial; (2) Services other than health care services, such as travel, housing, companion expenses, and other nonclinical expenses, that an enrollee may require as a result of the treatment being provided for purposes of the clinical trial; (3) Drugs, medical devices, and services that are provided solely to satisfy data collection and analysis needs, and that are not used in the clinical management of the patient; (4) Health care services that, except for the fact that they are being provided in a clinical trial, are otherwise specifically excluded from coverage under the enrollee's health plan; (5) Health care services customarily provided by the research sponsors free of charge for any enrollee in the trial; or (6) Drugs, medical devices, and services provided solely to determine trial eligibility. (c) For an enrollee diagnosed with cancer and accepted into a Phase I, Phase II, Phase III, or Phase IV clinical trial for cancer, every health benefit plan that is issued, amended, delivered, or renewed in this state, shall provide coverage for all routine patient care costs related to the clinical trials, if the enrollee's treating physician, who is providing covered health care services to the enrollee under the enrollee's health benefit plan contract, recommends participation in the clinical trial after determining that participation in the clinical trial has a meaningful potential benefit to the enrollee. For purposes of this section, the clinical trial's endpoints shall not be defined exclusively to test toxicity, but shall have a therapeutic intent. (d) The treatment shall be provided in a clinical trial that either: (1) Involves a drug that is exempt, under federal regulations, from new drug application; or (2) Is approved by one of the following: (A) One (1) of the national institutes of health; (B) The federal food and drug administration, in the form of an investigational new drug application; (C) The federal department of defense; or (D) The federal veteran's administration. (e) In the case of health care services provided by a participating provider, the payment rate shall be at the network negotiated rate, based on the member's plan design. In the case of a nonparticipating provider, the payment shall be at the rate that the member's plan would otherwise pay to a nonparticipating provider for the same services, less any applicable copayments and deductibles. (f) The provision of services, when required by this section, shall not, in itself, give rise to liability on the part of the health care service plan. (g) Nothing in this section shall be construed to limit, prohibit, or modify an enrollee's right to the independent review process available, or to the independent medical review system. (h) Nothing in this section shall be construed to otherwise limit or modify any existing requirements under this chapter, or to prevent application of copayment or deductible provisions in a plan. (i) Copayments and deductibles applied to services delivered in a clinical trial shall be the same as those applied to the same services, if not delivered in a clinical trial. (j) This section shall not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, medicare supplement, CHAMPUS supplement, long-term care, individually underwritten policies, or disability income insurance; provided, that, for specified disease and hospital indemnity insurance, coverage for benefits under this section shall apply, but only to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy. Nothing in this section shall be construed as imposing a new benefit mandate on specified disease, individually underwritten, or hospital indemnity insurance. (k) Nothing in this section shall be construed to require payment of costs associated with clinical trials that are not routine patient care costs, and that would not otherwise be covered by the health benefit plan, including, but not limited to, costs for services incurred that are related to or the result of the clinical trial. (l) This section does not require the payment of any patient care costs, routine or otherwise, that are billed by the provider to conduct the clinical trial. (m) Any entity seeking payment under this section must, at the time payment is sought, notify the health insurer in writing that the patient receiving the services for which payment is sought is the subject of a clinical trial. The notification shall include the patient's health insurance membership identification number. Failure to comply with this subsection (m) by the provider conducting the clinical trial shall relieve the health benefit plan and its enrollee from any obligation to reimburse the provider. (n) Notwithstanding any law to the contrary, any entity associated with the provision of medical services, as a part of a clinical trial pursuant to this part, shall, upon receipt of applicable payment by the health benefit plan, hold harmless, and relieve the enrollee involved, from any liability for services rendered by the provider, except for applicable copayment or coinsurance. (o) Nothing in this section shall be construed or interpreted as applying to the TennCare program under Title XIX of the Social Security Act ( 42 U.S.C. § 1396 et seq.), or any successor to the TennCare program administered pursuant to the federal medicaid laws. Health insurance entities that contract directly with the TennCare bureau, in the provision of services for TennCare recipients, are specifically excluded from this section, only for the products and services made by the health insurance entities on behalf of the bureau of TennCare. Acts 2005, ch. 424, § 1.
(a) As used in this section, unless the context otherwise requires: (1) "Health benefit plan" means any hospital or medical expense policy, health, hospital or medical service corporation contract, a policy or agreement entered into by a health insurer or health maintenance organization contract offered by an employer, but does not include individually underwritten health insurance policies, or policies or certificates covering only accident, credit, dental, disability income, long-term care, hospital indemnity, medicare supplement as defined in § 1882(g)(1) of the Social Security Act ( 42 U.S.C. § 1395ss(g)(1) ), specified disease, vision care, other limited benefit health insurance, coverage issued as a supplement to liability insurance, workers' compensation insurance, automobile medical payment insurance or insurance that is statutorily required to be contained in any liability insurance policy or equivalent self insurance; (2) "Health insurer" means any entity offering a health benefit plan; and (3) "Routine patient care costs" means the costs associated with the provision of health care services, including drugs, medical devices, and services that would otherwise be covered under the plan or contract, if those drugs, medical devices, and services were not provided in connection with an approved clinical trial program, including health care services that are: (A) Typically provided absent a clinical trial; (B) Required solely for the provision of the drug, medical device or service; (C) Required for the clinically appropriate monitoring of the drug, medical device, or service; (D) Provided for the prevention of complication arising from the provision of the drug, medical device, or service; and (E) Needed for the reasonable and necessary care arising from the provision of the drug, medical device, or service, including the diagnosis or treatment of the complications.
(1) "Health benefit plan" means any hospital or medical expense policy, health, hospital or medical service corporation contract, a policy or agreement entered into by a health insurer or health maintenance organization contract offered by an employer, but does not include individually underwritten health insurance policies, or policies or certificates covering only accident, credit, dental, disability income, long-term care, hospital indemnity, medicare supplement as defined in § 1882(g)(1) of the Social Security Act ( 42 U.S.C. § 1395ss(g)(1) ), specified disease, vision care, other limited benefit health insurance, coverage issued as a supplement to liability insurance, workers' compensation insurance, automobile medical payment insurance or insurance that is statutorily required to be contained in any liability insurance policy or equivalent self insurance;
(2) "Health insurer" means any entity offering a health benefit plan; and
(3) "Routine patient care costs" means the costs associated with the provision of health care services, including drugs, medical devices, and services that would otherwise be covered under the plan or contract, if those drugs, medical devices, and services were not provided in connection with an approved clinical trial program, including health care services that are: (A) Typically provided absent a clinical trial; (B) Required solely for the provision of the drug, medical device or service; (C) Required for the clinically appropriate monitoring of the drug, medical device, or service; (D) Provided for the prevention of complication arising from the provision of the drug, medical device, or service; and (E) Needed for the reasonable and necessary care arising from the provision of the drug, medical device, or service, including the diagnosis or treatment of the complications.
(A) Typically provided absent a clinical trial;
(B) Required solely for the provision of the drug, medical device or service;
(C) Required for the clinically appropriate monitoring of the drug, medical device, or service;
(D) Provided for the prevention of complication arising from the provision of the drug, medical device, or service; and
(E) Needed for the reasonable and necessary care arising from the provision of the drug, medical device, or service, including the diagnosis or treatment of the complications.
(b) The subject of the trial must evaluate a drug, medical device or service that falls within a medicare benefit category and is not statutorily excluded from coverage. For purposes of this section, "routine patient care costs" does not include the costs associated with the provision of any of the following: (1) Drugs, medical devices, and services that have not been approved by the federal food and drug administration and that are associated with the clinical trial; (2) Services other than health care services, such as travel, housing, companion expenses, and other nonclinical expenses, that an enrollee may require as a result of the treatment being provided for purposes of the clinical trial; (3) Drugs, medical devices, and services that are provided solely to satisfy data collection and analysis needs, and that are not used in the clinical management of the patient; (4) Health care services that, except for the fact that they are being provided in a clinical trial, are otherwise specifically excluded from coverage under the enrollee's health plan; (5) Health care services customarily provided by the research sponsors free of charge for any enrollee in the trial; or (6) Drugs, medical devices, and services provided solely to determine trial eligibility.
(1) Drugs, medical devices, and services that have not been approved by the federal food and drug administration and that are associated with the clinical trial;
(2) Services other than health care services, such as travel, housing, companion expenses, and other nonclinical expenses, that an enrollee may require as a result of the treatment being provided for purposes of the clinical trial;
(3) Drugs, medical devices, and services that are provided solely to satisfy data collection and analysis needs, and that are not used in the clinical management of the patient;
(4) Health care services that, except for the fact that they are being provided in a clinical trial, are otherwise specifically excluded from coverage under the enrollee's health plan;
(5) Health care services customarily provided by the research sponsors free of charge for any enrollee in the trial; or
(6) Drugs, medical devices, and services provided solely to determine trial eligibility.
(c) For an enrollee diagnosed with cancer and accepted into a Phase I, Phase II, Phase III, or Phase IV clinical trial for cancer, every health benefit plan that is issued, amended, delivered, or renewed in this state, shall provide coverage for all routine patient care costs related to the clinical trials, if the enrollee's treating physician, who is providing covered health care services to the enrollee under the enrollee's health benefit plan contract, recommends participation in the clinical trial after determining that participation in the clinical trial has a meaningful potential benefit to the enrollee. For purposes of this section, the clinical trial's endpoints shall not be defined exclusively to test toxicity, but shall have a therapeutic intent.
(d) The treatment shall be provided in a clinical trial that either: (1) Involves a drug that is exempt, under federal regulations, from new drug application; or (2) Is approved by one of the following: (A) One (1) of the national institutes of health; (B) The federal food and drug administration, in the form of an investigational new drug application; (C) The federal department of defense; or (D) The federal veteran's administration.
(1) Involves a drug that is exempt, under federal regulations, from new drug application; or
(2) Is approved by one of the following: (A) One (1) of the national institutes of health; (B) The federal food and drug administration, in the form of an investigational new drug application; (C) The federal department of defense; or (D) The federal veteran's administration.
(A) One (1) of the national institutes of health;
(B) The federal food and drug administration, in the form of an investigational new drug application;
(C) The federal department of defense; or
(D) The federal veteran's administration.
(e) In the case of health care services provided by a participating provider, the payment rate shall be at the network negotiated rate, based on the member's plan design. In the case of a nonparticipating provider, the payment shall be at the rate that the member's plan would otherwise pay to a nonparticipating provider for the same services, less any applicable copayments and deductibles.
(f) The provision of services, when required by this section, shall not, in itself, give rise to liability on the part of the health care service plan.
(g) Nothing in this section shall be construed to limit, prohibit, or modify an enrollee's right to the independent review process available, or to the independent medical review system.
(h) Nothing in this section shall be construed to otherwise limit or modify any existing requirements under this chapter, or to prevent application of copayment or deductible provisions in a plan.
(i) Copayments and deductibles applied to services delivered in a clinical trial shall be the same as those applied to the same services, if not delivered in a clinical trial.
(j) This section shall not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, medicare supplement, CHAMPUS supplement, long-term care, individually underwritten policies, or disability income insurance; provided, that, for specified disease and hospital indemnity insurance, coverage for benefits under this section shall apply, but only to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy. Nothing in this section shall be construed as imposing a new benefit mandate on specified disease, individually underwritten, or hospital indemnity insurance.
(k) Nothing in this section shall be construed to require payment of costs associated with clinical trials that are not routine patient care costs, and that would not otherwise be covered by the health benefit plan, including, but not limited to, costs for services incurred that are related to or the result of the clinical trial.
(l) This section does not require the payment of any patient care costs, routine or otherwise, that are billed by the provider to conduct the clinical trial.
(m) Any entity seeking payment under this section must, at the time payment is sought, notify the health insurer in writing that the patient receiving the services for which payment is sought is the subject of a clinical trial. The notification shall include the patient's health insurance membership identification number. Failure to comply with this subsection (m) by the provider conducting the clinical trial shall relieve the health benefit plan and its enrollee from any obligation to reimburse the provider.
(n) Notwithstanding any law to the contrary, any entity associated with the provision of medical services, as a part of a clinical trial pursuant to this part, shall, upon receipt of applicable payment by the health benefit plan, hold harmless, and relieve the enrollee involved, from any liability for services rendered by the provider, except for applicable copayment or coinsurance.
(o) Nothing in this section shall be construed or interpreted as applying to the TennCare program under Title XIX of the Social Security Act ( 42 U.S.C. § 1396 et seq.), or any successor to the TennCare program administered pursuant to the federal medicaid laws. Health insurance entities that contract directly with the TennCare bureau, in the provision of services for TennCare recipients, are specifically excluded from this section, only for the products and services made by the health insurance entities on behalf of the bureau of TennCare.
Acts 2005, ch. 424, § 1.
Tenn. Code Ann. § 56-2-903 — TN Code / Title 56 / Chapter 2 / Section 56-2-903
Part definitions
Status: in_force

As used in this part: (1) "Commissioner" means the commissioner of commerce and insurance; (2) "Corporate governance annual disclosure" or "CGAD" means a confidential report filed by the insurer or insurance group in accordance with this part; (3) "Department" means the department of commerce and insurance; (4) "Insurance group" means those insurers and affiliates included within an insurance holding company system as defined in § 56-11-101 ; (5) "Insurer" has the same meaning as "insurance company" in § 56-1-102 , except that "insurer" does not include agencies, authorities, or instrumentalities of the United States, its possessions and territories, the Commonwealth of Puerto Rico, the District of Columbia, or a state or political subdivision of a state; (6) "NAIC" means the National Association of Insurance Commissioners; and (7) "ORSA summary report" means the report filed in accordance with chapter 11, part 2 of this title. Added by 2018 Tenn. Acts, ch. 873,s 8, eff. 1/1/2019.
As used in this part:
(1) "Commissioner" means the commissioner of commerce and insurance;
(2) "Corporate governance annual disclosure" or "CGAD" means a confidential report filed by the insurer or insurance group in accordance with this part;
(3) "Department" means the department of commerce and insurance;
(4) "Insurance group" means those insurers and affiliates included within an insurance holding company system as defined in § 56-11-101 ;
(5) "Insurer" has the same meaning as "insurance company" in § 56-1-102 , except that "insurer" does not include agencies, authorities, or instrumentalities of the United States, its possessions and territories, the Commonwealth of Puerto Rico, the District of Columbia, or a state or political subdivision of a state;
(6) "NAIC" means the National Association of Insurance Commissioners; and
(7) "ORSA summary report" means the report filed in accordance with chapter 11, part 2 of this title.
Added by 2018 Tenn. Acts, ch. 873,s 8, eff. 1/1/2019.
Tenn. Code Ann. § 56-7-1201 — TN Code / Title 56 / Chapter 7 / Section 56-7-1201
Requirements and types of coverage - Presumptions - Limitations of liability
Status: in_force

(a) Every automobile liability insurance policy delivered, issued for delivery or renewed in this state, covering liability arising out of the ownership, maintenance, or use of any motor vehicle designed for use primarily on public roads and registered or principally garaged in this state, shall include uninsured motorist coverage, subject to provisions filed with and approved by the commissioner, for the protection of persons insured under the policy who are legally entitled to recover compensatory damages from owners or operators of uninsured motor vehicles because of bodily injury, sickness or disease, including death, resulting from injury, sickness or disease. (1) The limits of the uninsured motorist coverage shall be equal to the bodily injury liability limits stated in the policy. (2) However, any named insured may reject in writing the uninsured motorist coverage completely or select lower limits of the coverage but not less than the minimum coverage limits in § 55-12-107 . Any document signed by the named insured or legal representative that initially rejects the coverage or selects lower limits shall be binding upon every insured to whom the policy applies, and shall be conclusively presumed to become a part of the policy or contract when issued or delivered, regardless of whether physically attached to the policy or contract. Unless the named insured subsequently requests the coverage in writing, the rejected coverage need not be included in or supplemental to any continuation, renewal, reinstatement, or replacement of the policy, or the transfer of vehicles insured under the policy, where the named insured had rejected the coverage in connection with a policy previously issued by the same insurer; provided, that whenever a new application is submitted in connection with any renewal, reinstatement or replacement transaction, this section shall apply in the same manner as when a new policy is being issued. (3) No uninsured or underinsured motorist coverage need be provided in this state by an excess or umbrella policy of insurance. (b) (1) With respect to bodily injury to an insured, at a time when the insured is not occupying any motor vehicle, the insurance on the vehicle under which the injured party is an insured with the highest limits of uninsured motorist coverage shall apply, and no other uninsured motorist coverage shall apply. In no instance shall uninsured motorist coverage from more than one (1) policy be available as primary coverage, nor shall the injured party be an occupant of more than one (1) vehicle at one (1) time. (2) With respect to bodily injury to an insured while occupying a motor vehicle owned by the insured, only the limits of uninsured motorist coverage on the vehicle in which the insured was an occupant shall apply. The limits of uninsured motorist coverage shall not be increased because of multiple motor vehicles whether covered under a single policy or multiple policies, and in no event shall the total amount of recovery from all policies and bonds, including any amount recovered under the insured's uninsured motorist coverage, exceed the limits of the insured's uninsured motorist coverage. (3) With respect to bodily injury to an insured while occupying an automobile not owned by the insured, the following priorities of recovery under uninsured motorist coverage apply: (A) The uninsured motorist coverage on the vehicle in which the insured was an occupant shall be the primary uninsured motorist coverage; (B) If uninsured motorist coverage on the vehicle in which the insured was an occupant is exhausted due to the extent of compensatory damages, then the uninsured motorist coverage provided by a policy under which the insured is a named insured shall be applicable as excess coverage to the policy described in subdivision (b)(1); provided, that if the insured is covered as a named insured under more than one (1) policy, then only the policy with the highest limits of uninsured motorist coverage shall apply; (C) If the uninsured motorist coverage provided under the policies described in subdivisions (b)(3)(A) and (B), if applicable, is exhausted due to the extent of compensatory damages, then the uninsured motorist coverage provided by a policy under which the insured is covered other than as a named insured shall be applicable as excess coverage to the policies listed in subdivisions (b)(3)(A) and (B); provided, that if the insured is covered by more than one (1) such policy, then only the policy with the highest limits of uninsured motorist coverage shall apply; and (D) In no instance shall the insured be entitled to receive total benefits from all policies listed in subdivisions (b)(3)(A)-(C) in an amount greater than the limits of the policy providing the highest limits of uninsured motorist coverage. (c) (1) Every insured purchasing uninsured motorist bodily injury coverage shall be provided an opportunity to include uninsured motorist property damage coverage, subject to provisions filed with and approved by the commissioner, applicable to losses in excess of two hundred dollars ($200). However, the deductible of two hundred dollars ($200) shall not apply if: (A) The vehicle involved in the accident is insured by the same insurer for both collision and uninsured motorist property damage coverage; and (B) The operator of the other vehicle has been positively identified and is solely at fault. (2) No insurer shall be required to offer limits of property damage coverage greater in amount than the property damage liability limits purchased by the insured. After the uninsured motorist property damage coverage has been made available to an insured one (1) time and has been rejected in writing, it need not again be made available in any continuation, renewal, reinstatement, or replacement of the policy, or the transfer of vehicles insured under the policy, unless the insured makes a written request for the coverage; provided, that whenever a new application is submitted in connection with any renewal, reinstatement, or replacement transaction, this section shall apply in the same manner as when a new policy is being issued. As used in this section, "property damage" means damage to either the insured vehicle or property owned by an insured while in the insured vehicle. (d) The limit of liability for an insurer providing uninsured motorist coverage under this section is the amount of that coverage as specified in the policy less the sum of the limits collectible under all liability and/or primary uninsured motorist insurance policies, bonds, and securities applicable to the bodily injury or death of the insured. With regard to a claim against a governmental unit, political subdivision or agency thereof, the limitations of liability established under applicable law shall be considered as limits collectible under a liability insurance policy. (e) If the owner or operator of any motor vehicle that causes bodily injury or property damage to the insured is unknown, the insured shall have no right to recover under the uninsured motorist provision unless: (1) (A) Actual physical contact has occurred between the motor vehicle owned or operated by the unknown person and the person or property of the insured; or (B) The existence of the unknown motorist is established by clear and convincing evidence, other than any evidence provided by occupants in the insured vehicle; (2) The insured or someone in the insured's behalf has reported the accident to the appropriate law enforcement agency within a reasonable time after its occurrence; and (3) The insured was not negligent in failing to determine the identity of the other vehicle and the owner or operator of the other vehicle at the time of the accident. (f) No insurer shall increase the automobile insurance rate or premium of an insured with uninsured motorist coverage nor cancel the coverage due solely to the payment of any claim under uninsured motorist coverage. (g) Failure of the motorist from whom the insured is legally entitled to recover damages to file the appropriate forms required by the department of safety pursuant to the Financial Responsibility Law, compiled in title 55, chapter 12, within ninety (90) days of the accident date shall create a rebuttable presumption that the motorist was uninsured at the time of the accident. After the ninety (90) days and upon paying a fee as set by the department, the commissioner shall issue a certified affidavit indicating whether the forms have been filed. (h) An insurer's proof of compliance with this section may be accomplished by the capture of the named insured's signature or initials, or that of the insured's legal representative, by means of electronic imaging. However, this subsection (h) shall not be construed to authorize utilization of an electronic image of the signature or initials for any purpose other than demonstrating insurer compliance with the requirements of this section. In accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, the commissioner shall promulgate rules prescribing fines and/or other disciplinary actions to be imposed for insurer misuse of an electronic image of the signature or initials. Acts 1967, ch. 371, § 1; 1974, ch. 697, § 1; 1977, ch. 359, § 1; impl. am. Acts 1977, ch. 446, §§ 7, 39; Acts 1978, ch. 710, § 1; T.C.A., § 56-1148; Acts 1981, ch. 291, § 2; 1982, ch. 835, § 1; 1984, ch. 654, § 1; 1986, ch. 493, §§ 1, 2; 1986, ch. 667, § 1; 1988, ch. 605, § 1; 1989, ch. 313, § 1; 1993, ch. 112, § 1; 1993, ch. 137, § 1; 1996, ch. 711, § 1; 1996, ch. 825, § 1; 1999, ch. 196, § 1.
(a) Every automobile liability insurance policy delivered, issued for delivery or renewed in this state, covering liability arising out of the ownership, maintenance, or use of any motor vehicle designed for use primarily on public roads and registered or principally garaged in this state, shall include uninsured motorist coverage, subject to provisions filed with and approved by the commissioner, for the protection of persons insured under the policy who are legally entitled to recover compensatory damages from owners or operators of uninsured motor vehicles because of bodily injury, sickness or disease, including death, resulting from injury, sickness or disease. (1) The limits of the uninsured motorist coverage shall be equal to the bodily injury liability limits stated in the policy. (2) However, any named insured may reject in writing the uninsured motorist coverage completely or select lower limits of the coverage but not less than the minimum coverage limits in § 55-12-107 . Any document signed by the named insured or legal representative that initially rejects the coverage or selects lower limits shall be binding upon every insured to whom the policy applies, and shall be conclusively presumed to become a part of the policy or contract when issued or delivered, regardless of whether physically attached to the policy or contract. Unless the named insured subsequently requests the coverage in writing, the rejected coverage need not be included in or supplemental to any continuation, renewal, reinstatement, or replacement of the policy, or the transfer of vehicles insured under the policy, where the named insured had rejected the coverage in connection with a policy previously issued by the same insurer; provided, that whenever a new application is submitted in connection with any renewal, reinstatement or replacement transaction, this section shall apply in the same manner as when a new policy is being issued. (3) No uninsured or underinsured motorist coverage need be provided in this state by an excess or umbrella policy of insurance.
(1) The limits of the uninsured motorist coverage shall be equal to the bodily injury liability limits stated in the policy.
(2) However, any named insured may reject in writing the uninsured motorist coverage completely or select lower limits of the coverage but not less than the minimum coverage limits in § 55-12-107 . Any document signed by the named insured or legal representative that initially rejects the coverage or selects lower limits shall be binding upon every insured to whom the policy applies, and shall be conclusively presumed to become a part of the policy or contract when issued or delivered, regardless of whether physically attached to the policy or contract. Unless the named insured subsequently requests the coverage in writing, the rejected coverage need not be included in or supplemental to any continuation, renewal, reinstatement, or replacement of the policy, or the transfer of vehicles insured under the policy, where the named insured had rejected the coverage in connection with a policy previously issued by the same insurer; provided, that whenever a new application is submitted in connection with any renewal, reinstatement or replacement transaction, this section shall apply in the same manner as when a new policy is being issued.
(3) No uninsured or underinsured motorist coverage need be provided in this state by an excess or umbrella policy of insurance.
(b) (1) With respect to bodily injury to an insured, at a time when the insured is not occupying any motor vehicle, the insurance on the vehicle under which the injured party is an insured with the highest limits of uninsured motorist coverage shall apply, and no other uninsured motorist coverage shall apply. In no instance shall uninsured motorist coverage from more than one (1) policy be available as primary coverage, nor shall the injured party be an occupant of more than one (1) vehicle at one (1) time. (2) With respect to bodily injury to an insured while occupying a motor vehicle owned by the insured, only the limits of uninsured motorist coverage on the vehicle in which the insured was an occupant shall apply. The limits of uninsured motorist coverage shall not be increased because of multiple motor vehicles whether covered under a single policy or multiple policies, and in no event shall the total amount of recovery from all policies and bonds, including any amount recovered under the insured's uninsured motorist coverage, exceed the limits of the insured's uninsured motorist coverage. (3) With respect to bodily injury to an insured while occupying an automobile not owned by the insured, the following priorities of recovery under uninsured motorist coverage apply: (A) The uninsured motorist coverage on the vehicle in which the insured was an occupant shall be the primary uninsured motorist coverage; (B) If uninsured motorist coverage on the vehicle in which the insured was an occupant is exhausted due to the extent of compensatory damages, then the uninsured motorist coverage provided by a policy under which the insured is a named insured shall be applicable as excess coverage to the policy described in subdivision (b)(1); provided, that if the insured is covered as a named insured under more than one (1) policy, then only the policy with the highest limits of uninsured motorist coverage shall apply; (C) If the uninsured motorist coverage provided under the policies described in subdivisions (b)(3)(A) and (B), if applicable, is exhausted due to the extent of compensatory damages, then the uninsured motorist coverage provided by a policy under which the insured is covered other than as a named insured shall be applicable as excess coverage to the policies listed in subdivisions (b)(3)(A) and (B); provided, that if the insured is covered by more than one (1) such policy, then only the policy with the highest limits of uninsured motorist coverage shall apply; and (D) In no instance shall the insured be entitled to receive total benefits from all policies listed in subdivisions (b)(3)(A)-(C) in an amount greater than the limits of the policy providing the highest limits of uninsured motorist coverage.
(1) With respect to bodily injury to an insured, at a time when the insured is not occupying any motor vehicle, the insurance on the vehicle under which the injured party is an insured with the highest limits of uninsured motorist coverage shall apply, and no other uninsured motorist coverage shall apply. In no instance shall uninsured motorist coverage from more than one (1) policy be available as primary coverage, nor shall the injured party be an occupant of more than one (1) vehicle at one (1) time.
(2) With respect to bodily injury to an insured while occupying a motor vehicle owned by the insured, only the limits of uninsured motorist coverage on the vehicle in which the insured was an occupant shall apply. The limits of uninsured motorist coverage shall not be increased because of multiple motor vehicles whether covered under a single policy or multiple policies, and in no event shall the total amount of recovery from all policies and bonds, including any amount recovered under the insured's uninsured motorist coverage, exceed the limits of the insured's uninsured motorist coverage.
(3) With respect to bodily injury to an insured while occupying an automobile not owned by the insured, the following priorities of recovery under uninsured motorist coverage apply: (A) The uninsured motorist coverage on the vehicle in which the insured was an occupant shall be the primary uninsured motorist coverage; (B) If uninsured motorist coverage on the vehicle in which the insured was an occupant is exhausted due to the extent of compensatory damages, then the uninsured motorist coverage provided by a policy under which the insured is a named insured shall be applicable as excess coverage to the policy described in subdivision (b)(1); provided, that if the insured is covered as a named insured under more than one (1) policy, then only the policy with the highest limits of uninsured motorist coverage shall apply; (C) If the uninsured motorist coverage provided under the policies described in subdivisions (b)(3)(A) and (B), if applicable, is exhausted due to the extent of compensatory damages, then the uninsured motorist coverage provided by a policy under which the insured is covered other than as a named insured shall be applicable as excess coverage to the policies listed in subdivisions (b)(3)(A) and (B); provided, that if the insured is covered by more than one (1) such policy, then only the policy with the highest limits of uninsured motorist coverage shall apply; and (D) In no instance shall the insured be entitled to receive total benefits from all policies listed in subdivisions (b)(3)(A)-(C) in an amount greater than the limits of the policy providing the highest limits of uninsured motorist coverage.
(A) The uninsured motorist coverage on the vehicle in which the insured was an occupant shall be the primary uninsured motorist coverage;
(B) If uninsured motorist coverage on the vehicle in which the insured was an occupant is exhausted due to the extent of compensatory damages, then the uninsured motorist coverage provided by a policy under which the insured is a named insured shall be applicable as excess coverage to the policy described in subdivision (b)(1); provided, that if the insured is covered as a named insured under more than one (1) policy, then only the policy with the highest limits of uninsured motorist coverage shall apply;
(C) If the uninsured motorist coverage provided under the policies described in subdivisions (b)(3)(A) and (B), if applicable, is exhausted due to the extent of compensatory damages, then the uninsured motorist coverage provided by a policy under which the insured is covered other than as a named insured shall be applicable as excess coverage to the policies listed in subdivisions (b)(3)(A) and (B); provided, that if the insured is covered by more than one (1) such policy, then only the policy with the highest limits of uninsured motorist coverage shall apply; and
(D) In no instance shall the insured be entitled to receive total benefits from all policies listed in subdivisions (b)(3)(A)-(C) in an amount greater than the limits of the policy providing the highest limits of uninsured motorist coverage.
(c) (1) Every insured purchasing uninsured motorist bodily injury coverage shall be provided an opportunity to include uninsured motorist property damage coverage, subject to provisions filed with and approved by the commissioner, applicable to losses in excess of two hundred dollars ($200). However, the deductible of two hundred dollars ($200) shall not apply if: (A) The vehicle involved in the accident is insured by the same insurer for both collision and uninsured motorist property damage coverage; and (B) The operator of the other vehicle has been positively identified and is solely at fault. (2) No insurer shall be required to offer limits of property damage coverage greater in amount than the property damage liability limits purchased by the insured. After the uninsured motorist property damage coverage has been made available to an insured one (1) time and has been rejected in writing, it need not again be made available in any continuation, renewal, reinstatement, or replacement of the policy, or the transfer of vehicles insured under the policy, unless the insured makes a written request for the coverage; provided, that whenever a new application is submitted in connection with any renewal, reinstatement, or replacement transaction, this section shall apply in the same manner as when a new policy is being issued. As used in this section, "property damage" means damage to either the insured vehicle or property owned by an insured while in the insured vehicle.
(1) Every insured purchasing uninsured motorist bodily injury coverage shall be provided an opportunity to include uninsured motorist property damage coverage, subject to provisions filed with and approved by the commissioner, applicable to losses in excess of two hundred dollars ($200). However, the deductible of two hundred dollars ($200) shall not apply if: (A) The vehicle involved in the accident is insured by the same insurer for both collision and uninsured motorist property damage coverage; and (B) The operator of the other vehicle has been positively identified and is solely at fault.
(A) The vehicle involved in the accident is insured by the same insurer for both collision and uninsured motorist property damage coverage; and
(B) The operator of the other vehicle has been positively identified and is solely at fault.
(2) No insurer shall be required to offer limits of property damage coverage greater in amount than the property damage liability limits purchased by the insured. After the uninsured motorist property damage coverage has been made available to an insured one (1) time and has been rejected in writing, it need not again be made available in any continuation, renewal, reinstatement, or replacement of the policy, or the transfer of vehicles insured under the policy, unless the insured makes a written request for the coverage; provided, that whenever a new application is submitted in connection with any renewal, reinstatement, or replacement transaction, this section shall apply in the same manner as when a new policy is being issued. As used in this section, "property damage" means damage to either the insured vehicle or property owned by an insured while in the insured vehicle.
(d) The limit of liability for an insurer providing uninsured motorist coverage under this section is the amount of that coverage as specified in the policy less the sum of the limits collectible under all liability and/or primary uninsured motorist insurance policies, bonds, and securities applicable to the bodily injury or death of the insured. With regard to a claim against a governmental unit, political subdivision or agency thereof, the limitations of liability established under applicable law shall be considered as limits collectible under a liability insurance policy.
(e) If the owner or operator of any motor vehicle that causes bodily injury or property damage to the insured is unknown, the insured shall have no right to recover under the uninsured motorist provision unless: (1) (A) Actual physical contact has occurred between the motor vehicle owned or operated by the unknown person and the person or property of the insured; or (B) The existence of the unknown motorist is established by clear and convincing evidence, other than any evidence provided by occupants in the insured vehicle; (2) The insured or someone in the insured's behalf has reported the accident to the appropriate law enforcement agency within a reasonable time after its occurrence; and (3) The insured was not negligent in failing to determine the identity of the other vehicle and the owner or operator of the other vehicle at the time of the accident.
(1) (A) Actual physical contact has occurred between the motor vehicle owned or operated by the unknown person and the person or property of the insured; or (B) The existence of the unknown motorist is established by clear and convincing evidence, other than any evidence provided by occupants in the insured vehicle;
(A) Actual physical contact has occurred between the motor vehicle owned or operated by the unknown person and the person or property of the insured; or
(B) The existence of the unknown motorist is established by clear and convincing evidence, other than any evidence provided by occupants in the insured vehicle;
(2) The insured or someone in the insured's behalf has reported the accident to the appropriate law enforcement agency within a reasonable time after its occurrence; and
(3) The insured was not negligent in failing to determine the identity of the other vehicle and the owner or operator of the other vehicle at the time of the accident.
(f) No insurer shall increase the automobile insurance rate or premium of an insured with uninsured motorist coverage nor cancel the coverage due solely to the payment of any claim under uninsured motorist coverage.
(g) Failure of the motorist from whom the insured is legally entitled to recover damages to file the appropriate forms required by the department of safety pursuant to the Financial Responsibility Law, compiled in title 55, chapter 12, within ninety (90) days of the accident date shall create a rebuttable presumption that the motorist was uninsured at the time of the accident. After the ninety (90) days and upon paying a fee as set by the department, the commissioner shall issue a certified affidavit indicating whether the forms have been filed.
(h) An insurer's proof of compliance with this section may be accomplished by the capture of the named insured's signature or initials, or that of the insured's legal representative, by means of electronic imaging. However, this subsection (h) shall not be construed to authorize utilization of an electronic image of the signature or initials for any purpose other than demonstrating insurer compliance with the requirements of this section. In accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, the commissioner shall promulgate rules prescribing fines and/or other disciplinary actions to be imposed for insurer misuse of an electronic image of the signature or initials.
Acts 1967, ch. 371, § 1; 1974, ch. 697, § 1; 1977, ch. 359, § 1; impl. am. Acts 1977, ch. 446, §§ 7, 39; Acts 1978, ch. 710, § 1; T.C.A., § 56-1148; Acts 1981, ch. 291, § 2; 1982, ch. 835, § 1; 1984, ch. 654, § 1; 1986, ch. 493, §§ 1, 2; 1986, ch. 667, § 1; 1988, ch. 605, § 1; 1989, ch. 313, § 1; 1993, ch. 112, § 1; 1993, ch. 137, § 1; 1996, ch. 711, § 1; 1996, ch. 825, § 1; 1999, ch. 196, § 1.
Tenn. Code Ann. § 56-59-102 — TN Code / Title 56 / Chapter 59 / Section 56-59-102
Chapter definitions
Status: in_force

The following definitions are for purposes of this chapter and are not intended to provide actual terms required in GAP waivers: (1) "Administrator" means a person, other than an insurer or creditor, that performs administrative or operational functions pursuant to the GAP waiver program; (2) "Borrower" means a debtor, retail buyer or lessee under a finance agreement; (3) "Commissioner" means the commissioner of commerce and insurance; (4) "Creditor" means: (A) The lender in a loan or credit transaction; (B) The lessor in a lease transaction; (C) Any motor vehicle dealer as defined in § 55-17-102 ; (D) The seller in commercial retail installment transactions; or (E) The assignees of any of subdivisions (4)(A)-(D) to whom the credit obligation is payable; (5) "Finance agreement" means a loan, lease or retail installment sales contract for the purchase of a motor vehicle; (6) "Free look period" means the period of time from the effective date of the GAP waiver until the date the borrower may cancel the contract without penalty, fees or costs to the borrower. This period of time shall not be shorter than thirty (30) days; (7) "Guaranteed asset protection waiver" or "GAP waiver" means a contractual agreement wherein a creditor agrees for a separate charge to cancel or waive all or part of amounts due on a borrower's finance agreement in the event of a total physical damage loss or unrecovered theft of a motor vehicle, which agreement must be part of, or a separate addendum to, the finance agreement; (8) "Insurer" means an insurance company licensed, registered, or otherwise authorized to do business under the laws of this state, including surplus lines insurers; (9) "Motor vehicle" means self propelled or towed vehicles designed for personal or commercial use, including, but not limited to, automobiles, trucks, motorcycles, recreational vehicles, all terrain vehicles, campers, boats, personal watercraft, and motorcycle, boat, camper and personal watercraft trailers; (10) "Person" includes an individual, company, association, organization, partnership, business trust, corporation, and every form of legal entity; (11) "Related finance company" means a finance company that has common ownership of fifty percent (50%) or more with the retail seller; (12) "Retail buyer" means a person who buys motor vehicles not principally for the purpose of resale; and (13) "Retail seller" means a person that is regularly engaged in the selling of motor vehicles to a retail buyer and that holds any necessary license or licenses to sell to a retail buyer. Amended by 2014 Tenn. Acts, ch. 971,s 1, eff. 7/1/2014. Acts 2008, ch. 1055, § 3.
The following definitions are for purposes of this chapter and are not intended to provide actual terms required in GAP waivers:
(1) "Administrator" means a person, other than an insurer or creditor, that performs administrative or operational functions pursuant to the GAP waiver program;
(2) "Borrower" means a debtor, retail buyer or lessee under a finance agreement;
(3) "Commissioner" means the commissioner of commerce and insurance;
(4) "Creditor" means: (A) The lender in a loan or credit transaction; (B) The lessor in a lease transaction; (C) Any motor vehicle dealer as defined in § 55-17-102 ; (D) The seller in commercial retail installment transactions; or (E) The assignees of any of subdivisions (4)(A)-(D) to whom the credit obligation is payable;
(A) The lender in a loan or credit transaction;
(B) The lessor in a lease transaction;
(C) Any motor vehicle dealer as defined in § 55-17-102 ;
(D) The seller in commercial retail installment transactions; or
(E) The assignees of any of subdivisions (4)(A)-(D) to whom the credit obligation is payable;
(5) "Finance agreement" means a loan, lease or retail installment sales contract for the purchase of a motor vehicle;
(6) "Free look period" means the period of time from the effective date of the GAP waiver until the date the borrower may cancel the contract without penalty, fees or costs to the borrower. This period of time shall not be shorter than thirty (30) days;
(7) "Guaranteed asset protection waiver" or "GAP waiver" means a contractual agreement wherein a creditor agrees for a separate charge to cancel or waive all or part of amounts due on a borrower's finance agreement in the event of a total physical damage loss or unrecovered theft of a motor vehicle, which agreement must be part of, or a separate addendum to, the finance agreement;
(8) "Insurer" means an insurance company licensed, registered, or otherwise authorized to do business under the laws of this state, including surplus lines insurers;
(9) "Motor vehicle" means self propelled or towed vehicles designed for personal or commercial use, including, but not limited to, automobiles, trucks, motorcycles, recreational vehicles, all terrain vehicles, campers, boats, personal watercraft, and motorcycle, boat, camper and personal watercraft trailers;
(10) "Person" includes an individual, company, association, organization, partnership, business trust, corporation, and every form of legal entity;
(11) "Related finance company" means a finance company that has common ownership of fifty percent (50%) or more with the retail seller;
(12) "Retail buyer" means a person who buys motor vehicles not principally for the purpose of resale; and
(13) "Retail seller" means a person that is regularly engaged in the selling of motor vehicles to a retail buyer and that holds any necessary license or licenses to sell to a retail buyer.
Amended by 2014 Tenn. Acts, ch. 971,s 1, eff. 7/1/2014.
Acts 2008, ch. 1055, § 3.
Tenn. Code Ann. § 56-2-210 — TN Code / Title 56 / Chapter 2 / Section 56-2-210
Responsibilities and obligations of limited credit life and credit accident and health reinsurer
Status: in_force

(a) As used in this section, "limited credit life and credit accident and health reinsurer" means a domestic credit life and credit accident and health reinsurer that: (1) Reinsures only credit life insurance or credit accident and health insurance as defined in § 56-2-201 , or both, in the manner provided for in § 56-2-114(b) ; (2) Has been authorized by the commissioner to do so in Tennessee and is not so authorized in any other state; and (3) Secures all of its reinsurance reserve liabilities that have been assumed under a reinsurance agreement that has been approved by the commissioner with funds withheld or maintained in a trust fund that complies with §§ 56-2-207 , 56-2-208 and 56-2-209 and in an amount that is not less than one hundred ten percent (110%) of the amount of the liabilities assumed. (b) (1) The responsibilities and obligations of a limited credit life and credit accident and health reinsurer under this title shall be modified as set out in this section. A limited credit life and credit accident and health reinsurer shall demonstrate its compliance with the requirements in subsection (a) in the annual statement filed with the commissioner for the preceding year and shall maintain assets to secure the liabilities in the percentage relationship at all times. In determining compliance with this requirement, the commissioner shall value securities in the manner prescribed in §§ 56-3-113 and 56-3-114 , and shall take into account only the securities that constitute admitted assets under chapter 3, part 3 of this title, and § 56-1-405 . (2) A company may not be a limited credit life and credit accident and health reinsurer during any period in which it is an affiliate of an insurer. In determining whether a company is an affiliate, tests provided for in § 56-11-101 shall be applied to determine a company's status. (c) Notwithstanding any contrary provision in this title, a limited credit life and credit accident and health reinsurer shall be excused from: (1) Filing personal financial statements to accompany insurance holding company forms under § 56-11-105 ; (2) Filing any audited financial statements pursuant to rules authorized by § 56-1-501(h) ; (3) Filing any risk-based capital reports under chapter 46 of this title; (4) Filing any management discussion and analysis; (5) Filing with respect to material transactions under §§ 56-10-301 - 56-10-303; (6) Filing any actuarial certification; (7) Any filing of its annual statement or quarterly statement with the National Association of Insurance Commissioners; and (8) Filing with respect to extraordinary dividends under § 56-11-106(b) . (d) The commissioner is excused from any obligation to perform regular examination of a limited credit life and credit accident and health reinsurer under § 56-1-408 , but shall retain the power to make an examination of any accounts, records, files, documents, and transactions pertaining to insurance of the limited credit life and credit disability reinsurer whenever the commissioner deems it prudent to do so under § 56-1-409 . (e) A limited credit life and credit accident and health reinsurer shall file with the commissioner copies of all reinsurance agreements, including amendments to the agreements, to which the reinsurer is a party. The agreement or amendment shall not be effective until and unless the agreement or amendment is approved by the commissioner; provided, however, that the agreement or amendment shall be deemed approved if the commissioner does not disapprove the agreement or amendment in writing within thirty (30) days after the reinsurer files a copy of the agreement or amendment with the commissioner. (f) The commissioner may approve a merger in which a limited credit life and credit accident insurance company is a constituent party without holding the otherwise required hearing on a merger of a limited credit life and credit accident and health reinsurer with another entity, unless the requirement of a hearing under § 56-10-104(b) applies to another party to the merger. (g) The commissioner may permit an applicant to seek a certificate of authority pursuant to a simplified and abbreviated application form under which the company seeking authority from the commissioner to engage in the business of being a limited credit life and credit accident and health reinsurer may apply for a certificate of authority to engage in the business. (h) This section shall apply to all reports and documents required to be filed after December 31, 2000. Acts 2001, ch. 118, § 1.
(a) As used in this section, "limited credit life and credit accident and health reinsurer" means a domestic credit life and credit accident and health reinsurer that: (1) Reinsures only credit life insurance or credit accident and health insurance as defined in § 56-2-201 , or both, in the manner provided for in § 56-2-114(b) ; (2) Has been authorized by the commissioner to do so in Tennessee and is not so authorized in any other state; and (3) Secures all of its reinsurance reserve liabilities that have been assumed under a reinsurance agreement that has been approved by the commissioner with funds withheld or maintained in a trust fund that complies with §§ 56-2-207 , 56-2-208 and 56-2-209 and in an amount that is not less than one hundred ten percent (110%) of the amount of the liabilities assumed.
(1) Reinsures only credit life insurance or credit accident and health insurance as defined in § 56-2-201 , or both, in the manner provided for in § 56-2-114(b) ;
(2) Has been authorized by the commissioner to do so in Tennessee and is not so authorized in any other state; and
(3) Secures all of its reinsurance reserve liabilities that have been assumed under a reinsurance agreement that has been approved by the commissioner with funds withheld or maintained in a trust fund that complies with §§ 56-2-207 , 56-2-208 and 56-2-209 and in an amount that is not less than one hundred ten percent (110%) of the amount of the liabilities assumed.
(b) (1) The responsibilities and obligations of a limited credit life and credit accident and health reinsurer under this title shall be modified as set out in this section. A limited credit life and credit accident and health reinsurer shall demonstrate its compliance with the requirements in subsection (a) in the annual statement filed with the commissioner for the preceding year and shall maintain assets to secure the liabilities in the percentage relationship at all times. In determining compliance with this requirement, the commissioner shall value securities in the manner prescribed in §§ 56-3-113 and 56-3-114 , and shall take into account only the securities that constitute admitted assets under chapter 3, part 3 of this title, and § 56-1-405 . (2) A company may not be a limited credit life and credit accident and health reinsurer during any period in which it is an affiliate of an insurer. In determining whether a company is an affiliate, tests provided for in § 56-11-101 shall be applied to determine a company's status.
(1) The responsibilities and obligations of a limited credit life and credit accident and health reinsurer under this title shall be modified as set out in this section. A limited credit life and credit accident and health reinsurer shall demonstrate its compliance with the requirements in subsection (a) in the annual statement filed with the commissioner for the preceding year and shall maintain assets to secure the liabilities in the percentage relationship at all times. In determining compliance with this requirement, the commissioner shall value securities in the manner prescribed in §§ 56-3-113 and 56-3-114 , and shall take into account only the securities that constitute admitted assets under chapter 3, part 3 of this title, and § 56-1-405 .
(2) A company may not be a limited credit life and credit accident and health reinsurer during any period in which it is an affiliate of an insurer. In determining whether a company is an affiliate, tests provided for in § 56-11-101 shall be applied to determine a company's status.
(c) Notwithstanding any contrary provision in this title, a limited credit life and credit accident and health reinsurer shall be excused from: (1) Filing personal financial statements to accompany insurance holding company forms under § 56-11-105 ; (2) Filing any audited financial statements pursuant to rules authorized by § 56-1-501(h) ; (3) Filing any risk-based capital reports under chapter 46 of this title; (4) Filing any management discussion and analysis; (5) Filing with respect to material transactions under §§ 56-10-301 - 56-10-303; (6) Filing any actuarial certification; (7) Any filing of its annual statement or quarterly statement with the National Association of Insurance Commissioners; and (8) Filing with respect to extraordinary dividends under § 56-11-106(b) .
(1) Filing personal financial statements to accompany insurance holding company forms under § 56-11-105 ;
(2) Filing any audited financial statements pursuant to rules authorized by § 56-1-501(h) ;
(3) Filing any risk-based capital reports under chapter 46 of this title;
(4) Filing any management discussion and analysis;
(5) Filing with respect to material transactions under §§ 56-10-301 - 56-10-303;
(6) Filing any actuarial certification;
(7) Any filing of its annual statement or quarterly statement with the National Association of Insurance Commissioners; and
(8) Filing with respect to extraordinary dividends under § 56-11-106(b) .
(d) The commissioner is excused from any obligation to perform regular examination of a limited credit life and credit accident and health reinsurer under § 56-1-408 , but shall retain the power to make an examination of any accounts, records, files, documents, and transactions pertaining to insurance of the limited credit life and credit disability reinsurer whenever the commissioner deems it prudent to do so under § 56-1-409 .
(e) A limited credit life and credit accident and health reinsurer shall file with the commissioner copies of all reinsurance agreements, including amendments to the agreements, to which the reinsurer is a party. The agreement or amendment shall not be effective until and unless the agreement or amendment is approved by the commissioner; provided, however, that the agreement or amendment shall be deemed approved if the commissioner does not disapprove the agreement or amendment in writing within thirty (30) days after the reinsurer files a copy of the agreement or amendment with the commissioner.
(f) The commissioner may approve a merger in which a limited credit life and credit accident insurance company is a constituent party without holding the otherwise required hearing on a merger of a limited credit life and credit accident and health reinsurer with another entity, unless the requirement of a hearing under § 56-10-104(b) applies to another party to the merger.
(g) The commissioner may permit an applicant to seek a certificate of authority pursuant to a simplified and abbreviated application form under which the company seeking authority from the commissioner to engage in the business of being a limited credit life and credit accident and health reinsurer may apply for a certificate of authority to engage in the business.
(h) This section shall apply to all reports and documents required to be filed after December 31, 2000.
Acts 2001, ch. 118, § 1.
Tenn. Code Ann. § 56-2-108 — TN Code / Title 56 / Chapter 2 / Section 56-2-108
Violation of Section 56-2-105 - Penalty
Status: in_force

(a) Any company that violates § 56-2-105 is subject to a fine or a civil penalty, or both, of not less than one hundred dollars ($100) nor more than five thousand dollars ($5,000) for each violation. (b) Each day in which a violation occurs constitutes a separate violation. Acts 1968, ch. 536, § 3; 1973, ch. 244, § 1; T.C.A., § 56-208.
(a) Any company that violates § 56-2-105 is subject to a fine or a civil penalty, or both, of not less than one hundred dollars ($100) nor more than five thousand dollars ($5,000) for each violation.
(b) Each day in which a violation occurs constitutes a separate violation.
Acts 1968, ch. 536, § 3; 1973, ch. 244, § 1; T.C.A., § 56-208.
Tenn. Code Ann. § 56-50-114 — TN Code / Title 56 / Chapter 50 / Section 56-50-114
Fraud prevention and control
Status: in_force

(a) Fraudulent Viatical Settlement Acts, Interference and Participation of Convicted Felons Prohibited. (1) A person shall not commit a fraudulent viatical settlement act. (2) A person shall not knowingly or intentionally interfere with the enforcement of this chapter or investigations of suspected or actual violations of this chapter. (3) A person in the business of viatical settlements shall not knowingly or intentionally permit any person convicted of a felony involving dishonesty or breach of trust to participate in the business of viatical settlements. (b) Fraud Warning Required. (1) Viatical settlement contracts and purchase agreement forms and applications for viatical settlements, regardless of the form of transmission, shall contain the following statement or a substantially similar statement: Any person who knowingly presents false information in an application for insurance, viatical settlement contract or a viatical settlement purchase agreement is guilty of a crime and may be subject to fines and confinement in prison. (2) The lack of a statement as required in subdivision (b)(1) does not constitute a defense in any prosecution for a fraudulent viatical settlement act. (c) Mandatory Reporting of Fraudulent Viatical Settlement Acts. (1) Any person engaged in the business of viatical settlements having knowledge or a reasonable suspicion that a fraudulent viatical settlement act is being, will be or has been committed shall provide to the commissioner such information as required by, and in a manner prescribed by, the commissioner. (2) Any other person having knowledge or a reasonable belief that a fraudulent viatical settlement act is being, will be, or has been committed may provide to the commissioner the information required by, and in a manner prescribed by, the commissioner. (d) Immunity from Liability. (1) No civil liability shall be imposed on and no cause of action shall arise from a person's furnishing information concerning suspected, anticipated or completed fraudulent viatical settlement acts or suspected or completed fraudulent insurance acts, if the information is provided to or received from: (A) The commissioner or the commissioner's employees, agents or representatives; (B) Federal, state or local law enforcement or regulatory officials or their employees, agents or representatives; (C) A person involved in the prevention and detection of fraudulent viatical settlement acts or that person's agents, employees or representatives; (D) The National Association of Insurance Commissioners (NAIC), the Financial Industry Regulatory Authority (FINRA), the North American Securities Administrators Association (NASAA), or their employees, agents or representatives, or other regulatory body overseeing life insurance, viatical settlements, securities or investment fraud; or (E) The life insurer that issued the life insurance policy covering the life of the insured. (2) Subdivision (d)(1) shall not apply to statements made with actual malice. In an action brought against a person for filing a report or furnishing other information concerning a fraudulent viatical settlement act, the party bringing the action shall plead specifically any allegation that subdivision (d)(1) does not apply because the person filing the report or furnishing the information did so with actual malice. (3) A person furnishing information as identified in subdivision (d)(1) shall be entitled to an award of attorney's fees and costs if the person is the prevailing party in a civil cause of action for libel, slander or any other relevant tort arising out of activities in carrying out this chapter and the party bringing the action was not substantially justified in doing so. For purposes of this subdivision (d)(3), a proceeding is "substantially justified" if it had a reasonable basis in law or fact at the time that it was initiated. However, such an award does not apply to any person furnishing information concerning the person's own fraudulent viatical settlement acts. (4) This section does not abrogate or modify common law or statutory privileges or immunities enjoyed by a person described in subdivision (d)(1). (e) Confidentiality. (1) The documents and evidence provided pursuant to subsection (d) or obtained by the commissioner in an investigation of suspected or actual fraudulent viatical settlement acts shall be privileged and confidential and shall not be a public record and shall not be subject to discovery or subpoena in a civil or criminal action. (2) Subdivision (e)(1) does not prohibit release by the commissioner of documents and evidence obtained in an investigation of suspected or actual fraudulent viatical settlement acts: (A) In administrative or judicial proceedings to enforce laws administered by the commissioner; (B) To federal, state or local law enforcement or regulatory agencies, to an organization established for the purpose of detecting and preventing fraudulent viatical settlement acts or to the NAIC; or (C) At the discretion of the commissioner, to a person in the business of viatical settlements that is aggrieved by a fraudulent viatical settlement act. (3) Release of documents and evidence under subdivision (e)(2) does not abrogate or modify the privilege granted in subdivision (e)(1). (f) Other Law Enforcement or Regulatory Authority. This chapter shall not: (1) Preempt the authority or relieve the duty of other law enforcement or regulatory agencies to investigate, examine and prosecute suspected violations of law; (2) Prevent or prohibit a person from voluntarily disclosing information concerning viatical settlement fraud to a law enforcement or regulatory agency other than the department of commerce and insurance; or (3) Limit the powers granted elsewhere by the laws of this state to the commissioner or an insurance fraud unit to investigate and examine possible violations of law and to take appropriate action against wrongdoers. (g) Viatical Settlement Antifraud Initiatives. (1) Viatical settlement providers and viatical settlement brokers shall have in place antifraud initiatives reasonably calculated to detect, prosecute and prevent fraudulent viatical settlement acts. At the discretion of the commissioner, the commissioner may order, or a licensee may request and the commissioner may grant, such modifications of the required initiatives in subdivision (g)(2) as necessary to ensure an effective antifraud program. The modifications may be more or less restrictive than the required initiatives so long as the modifications may reasonably be expected to accomplish the purpose of this chapter. (2) Antifraud initiatives shall include: (A) Fraud investigators, who may be viatical settlement provider or viatical settlement broker employees or independent contractors; and (B) An antifraud plan, which shall be submitted to the commissioner. The antifraud plan shall include, but not be limited to: (i) A description of the procedures for detecting and investigating possible fraudulent viatical settlement acts and procedures for resolving material inconsistencies between medical records and insurance applications; (ii) A description of the procedures for reporting possible fraudulent viatical settlement acts to the commissioner; (iii) A description of the plan for antifraud education and training of underwriters and other personnel; and (iv) A description or chart outlining the organizational arrangement of the antifraud personnel who are responsible for the investigation and reporting of possible fraudulent viatical settlement acts and investigating unresolved material inconsistencies between medical records and insurance applications. (3) Antifraud plans submitted to the commissioner shall be privileged and confidential and shall not be a public record and shall not be subject to discovery or subpoena in a civil or criminal action. Acts 2009, ch. 604, § 15.
(a) Fraudulent Viatical Settlement Acts, Interference and Participation of Convicted Felons Prohibited. (1) A person shall not commit a fraudulent viatical settlement act. (2) A person shall not knowingly or intentionally interfere with the enforcement of this chapter or investigations of suspected or actual violations of this chapter. (3) A person in the business of viatical settlements shall not knowingly or intentionally permit any person convicted of a felony involving dishonesty or breach of trust to participate in the business of viatical settlements.
(1) A person shall not commit a fraudulent viatical settlement act.
(2) A person shall not knowingly or intentionally interfere with the enforcement of this chapter or investigations of suspected or actual violations of this chapter.
(3) A person in the business of viatical settlements shall not knowingly or intentionally permit any person convicted of a felony involving dishonesty or breach of trust to participate in the business of viatical settlements.
(b) Fraud Warning Required. (1) Viatical settlement contracts and purchase agreement forms and applications for viatical settlements, regardless of the form of transmission, shall contain the following statement or a substantially similar statement: Any person who knowingly presents false information in an application for insurance, viatical settlement contract or a viatical settlement purchase agreement is guilty of a crime and may be subject to fines and confinement in prison. (2) The lack of a statement as required in subdivision (b)(1) does not constitute a defense in any prosecution for a fraudulent viatical settlement act.
(1) Viatical settlement contracts and purchase agreement forms and applications for viatical settlements, regardless of the form of transmission, shall contain the following statement or a substantially similar statement: Any person who knowingly presents false information in an application for insurance, viatical settlement contract or a viatical settlement purchase agreement is guilty of a crime and may be subject to fines and confinement in prison.
Any person who knowingly presents false information in an application for insurance, viatical settlement contract or a viatical settlement purchase agreement is guilty of a crime and may be subject to fines and confinement in prison.
(2) The lack of a statement as required in subdivision (b)(1) does not constitute a defense in any prosecution for a fraudulent viatical settlement act.
(c) Mandatory Reporting of Fraudulent Viatical Settlement Acts. (1) Any person engaged in the business of viatical settlements having knowledge or a reasonable suspicion that a fraudulent viatical settlement act is being, will be or has been committed shall provide to the commissioner such information as required by, and in a manner prescribed by, the commissioner. (2) Any other person having knowledge or a reasonable belief that a fraudulent viatical settlement act is being, will be, or has been committed may provide to the commissioner the information required by, and in a manner prescribed by, the commissioner.
(1) Any person engaged in the business of viatical settlements having knowledge or a reasonable suspicion that a fraudulent viatical settlement act is being, will be or has been committed shall provide to the commissioner such information as required by, and in a manner prescribed by, the commissioner.
(2) Any other person having knowledge or a reasonable belief that a fraudulent viatical settlement act is being, will be, or has been committed may provide to the commissioner the information required by, and in a manner prescribed by, the commissioner.
(d) Immunity from Liability. (1) No civil liability shall be imposed on and no cause of action shall arise from a person's furnishing information concerning suspected, anticipated or completed fraudulent viatical settlement acts or suspected or completed fraudulent insurance acts, if the information is provided to or received from: (A) The commissioner or the commissioner's employees, agents or representatives; (B) Federal, state or local law enforcement or regulatory officials or their employees, agents or representatives; (C) A person involved in the prevention and detection of fraudulent viatical settlement acts or that person's agents, employees or representatives; (D) The National Association of Insurance Commissioners (NAIC), the Financial Industry Regulatory Authority (FINRA), the North American Securities Administrators Association (NASAA), or their employees, agents or representatives, or other regulatory body overseeing life insurance, viatical settlements, securities or investment fraud; or (E) The life insurer that issued the life insurance policy covering the life of the insured. (2) Subdivision (d)(1) shall not apply to statements made with actual malice. In an action brought against a person for filing a report or furnishing other information concerning a fraudulent viatical settlement act, the party bringing the action shall plead specifically any allegation that subdivision (d)(1) does not apply because the person filing the report or furnishing the information did so with actual malice. (3) A person furnishing information as identified in subdivision (d)(1) shall be entitled to an award of attorney's fees and costs if the person is the prevailing party in a civil cause of action for libel, slander or any other relevant tort arising out of activities in carrying out this chapter and the party bringing the action was not substantially justified in doing so. For purposes of this subdivision (d)(3), a proceeding is "substantially justified" if it had a reasonable basis in law or fact at the time that it was initiated. However, such an award does not apply to any person furnishing information concerning the person's own fraudulent viatical settlement acts. (4) This section does not abrogate or modify common law or statutory privileges or immunities enjoyed by a person described in subdivision (d)(1).
(1) No civil liability shall be imposed on and no cause of action shall arise from a person's furnishing information concerning suspected, anticipated or completed fraudulent viatical settlement acts or suspected or completed fraudulent insurance acts, if the information is provided to or received from: (A) The commissioner or the commissioner's employees, agents or representatives; (B) Federal, state or local law enforcement or regulatory officials or their employees, agents or representatives; (C) A person involved in the prevention and detection of fraudulent viatical settlement acts or that person's agents, employees or representatives; (D) The National Association of Insurance Commissioners (NAIC), the Financial Industry Regulatory Authority (FINRA), the North American Securities Administrators Association (NASAA), or their employees, agents or representatives, or other regulatory body overseeing life insurance, viatical settlements, securities or investment fraud; or (E) The life insurer that issued the life insurance policy covering the life of the insured.
(A) The commissioner or the commissioner's employees, agents or representatives;
(B) Federal, state or local law enforcement or regulatory officials or their employees, agents or representatives;
(C) A person involved in the prevention and detection of fraudulent viatical settlement acts or that person's agents, employees or representatives;
(D) The National Association of Insurance Commissioners (NAIC), the Financial Industry Regulatory Authority (FINRA), the North American Securities Administrators Association (NASAA), or their employees, agents or representatives, or other regulatory body overseeing life insurance, viatical settlements, securities or investment fraud; or
(E) The life insurer that issued the life insurance policy covering the life of the insured.
(2) Subdivision (d)(1) shall not apply to statements made with actual malice. In an action brought against a person for filing a report or furnishing other information concerning a fraudulent viatical settlement act, the party bringing the action shall plead specifically any allegation that subdivision (d)(1) does not apply because the person filing the report or furnishing the information did so with actual malice.
(3) A person furnishing information as identified in subdivision (d)(1) shall be entitled to an award of attorney's fees and costs if the person is the prevailing party in a civil cause of action for libel, slander or any other relevant tort arising out of activities in carrying out this chapter and the party bringing the action was not substantially justified in doing so. For purposes of this subdivision (d)(3), a proceeding is "substantially justified" if it had a reasonable basis in law or fact at the time that it was initiated. However, such an award does not apply to any person furnishing information concerning the person's own fraudulent viatical settlement acts.
(4) This section does not abrogate or modify common law or statutory privileges or immunities enjoyed by a person described in subdivision (d)(1).
(e) Confidentiality. (1) The documents and evidence provided pursuant to subsection (d) or obtained by the commissioner in an investigation of suspected or actual fraudulent viatical settlement acts shall be privileged and confidential and shall not be a public record and shall not be subject to discovery or subpoena in a civil or criminal action. (2) Subdivision (e)(1) does not prohibit release by the commissioner of documents and evidence obtained in an investigation of suspected or actual fraudulent viatical settlement acts: (A) In administrative or judicial proceedings to enforce laws administered by the commissioner; (B) To federal, state or local law enforcement or regulatory agencies, to an organization established for the purpose of detecting and preventing fraudulent viatical settlement acts or to the NAIC; or (C) At the discretion of the commissioner, to a person in the business of viatical settlements that is aggrieved by a fraudulent viatical settlement act. (3) Release of documents and evidence under subdivision (e)(2) does not abrogate or modify the privilege granted in subdivision (e)(1).
(1) The documents and evidence provided pursuant to subsection (d) or obtained by the commissioner in an investigation of suspected or actual fraudulent viatical settlement acts shall be privileged and confidential and shall not be a public record and shall not be subject to discovery or subpoena in a civil or criminal action.
(2) Subdivision (e)(1) does not prohibit release by the commissioner of documents and evidence obtained in an investigation of suspected or actual fraudulent viatical settlement acts: (A) In administrative or judicial proceedings to enforce laws administered by the commissioner; (B) To federal, state or local law enforcement or regulatory agencies, to an organization established for the purpose of detecting and preventing fraudulent viatical settlement acts or to the NAIC; or (C) At the discretion of the commissioner, to a person in the business of viatical settlements that is aggrieved by a fraudulent viatical settlement act.
(A) In administrative or judicial proceedings to enforce laws administered by the commissioner;
(B) To federal, state or local law enforcement or regulatory agencies, to an organization established for the purpose of detecting and preventing fraudulent viatical settlement acts or to the NAIC; or
(C) At the discretion of the commissioner, to a person in the business of viatical settlements that is aggrieved by a fraudulent viatical settlement act.
(3) Release of documents and evidence under subdivision (e)(2) does not abrogate or modify the privilege granted in subdivision (e)(1).
(f) Other Law Enforcement or Regulatory Authority. This chapter shall not: (1) Preempt the authority or relieve the duty of other law enforcement or regulatory agencies to investigate, examine and prosecute suspected violations of law; (2) Prevent or prohibit a person from voluntarily disclosing information concerning viatical settlement fraud to a law enforcement or regulatory agency other than the department of commerce and insurance; or (3) Limit the powers granted elsewhere by the laws of this state to the commissioner or an insurance fraud unit to investigate and examine possible violations of law and to take appropriate action against wrongdoers.
(1) Preempt the authority or relieve the duty of other law enforcement or regulatory agencies to investigate, examine and prosecute suspected violations of law;
(2) Prevent or prohibit a person from voluntarily disclosing information concerning viatical settlement fraud to a law enforcement or regulatory agency other than the department of commerce and insurance; or
(3) Limit the powers granted elsewhere by the laws of this state to the commissioner or an insurance fraud unit to investigate and examine possible violations of law and to take appropriate action against wrongdoers.
(g) Viatical Settlement Antifraud Initiatives. (1) Viatical settlement providers and viatical settlement brokers shall have in place antifraud initiatives reasonably calculated to detect, prosecute and prevent fraudulent viatical settlement acts. At the discretion of the commissioner, the commissioner may order, or a licensee may request and the commissioner may grant, such modifications of the required initiatives in subdivision (g)(2) as necessary to ensure an effective antifraud program. The modifications may be more or less restrictive than the required initiatives so long as the modifications may reasonably be expected to accomplish the purpose of this chapter. (2) Antifraud initiatives shall include: (A) Fraud investigators, who may be viatical settlement provider or viatical settlement broker employees or independent contractors; and (B) An antifraud plan, which shall be submitted to the commissioner. The antifraud plan shall include, but not be limited to: (i) A description of the procedures for detecting and investigating possible fraudulent viatical settlement acts and procedures for resolving material inconsistencies between medical records and insurance applications; (ii) A description of the procedures for reporting possible fraudulent viatical settlement acts to the commissioner; (iii) A description of the plan for antifraud education and training of underwriters and other personnel; and (iv) A description or chart outlining the organizational arrangement of the antifraud personnel who are responsible for the investigation and reporting of possible fraudulent viatical settlement acts and investigating unresolved material inconsistencies between medical records and insurance applications. (3) Antifraud plans submitted to the commissioner shall be privileged and confidential and shall not be a public record and shall not be subject to discovery or subpoena in a civil or criminal action.
(1) Viatical settlement providers and viatical settlement brokers shall have in place antifraud initiatives reasonably calculated to detect, prosecute and prevent fraudulent viatical settlement acts. At the discretion of the commissioner, the commissioner may order, or a licensee may request and the commissioner may grant, such modifications of the required initiatives in subdivision (g)(2) as necessary to ensure an effective antifraud program. The modifications may be more or less restrictive than the required initiatives so long as the modifications may reasonably be expected to accomplish the purpose of this chapter.
(2) Antifraud initiatives shall include: (A) Fraud investigators, who may be viatical settlement provider or viatical settlement broker employees or independent contractors; and (B) An antifraud plan, which shall be submitted to the commissioner. The antifraud plan shall include, but not be limited to: (i) A description of the procedures for detecting and investigating possible fraudulent viatical settlement acts and procedures for resolving material inconsistencies between medical records and insurance applications; (ii) A description of the procedures for reporting possible fraudulent viatical settlement acts to the commissioner; (iii) A description of the plan for antifraud education and training of underwriters and other personnel; and (iv) A description or chart outlining the organizational arrangement of the antifraud personnel who are responsible for the investigation and reporting of possible fraudulent viatical settlement acts and investigating unresolved material inconsistencies between medical records and insurance applications.
(A) Fraud investigators, who may be viatical settlement provider or viatical settlement broker employees or independent contractors; and
(B) An antifraud plan, which shall be submitted to the commissioner. The antifraud plan shall include, but not be limited to: (i) A description of the procedures for detecting and investigating possible fraudulent viatical settlement acts and procedures for resolving material inconsistencies between medical records and insurance applications; (ii) A description of the procedures for reporting possible fraudulent viatical settlement acts to the commissioner; (iii) A description of the plan for antifraud education and training of underwriters and other personnel; and (iv) A description or chart outlining the organizational arrangement of the antifraud personnel who are responsible for the investigation and reporting of possible fraudulent viatical settlement acts and investigating unresolved material inconsistencies between medical records and insurance applications.
(i) A description of the procedures for detecting and investigating possible fraudulent viatical settlement acts and procedures for resolving material inconsistencies between medical records and insurance applications;
(ii) A description of the procedures for reporting possible fraudulent viatical settlement acts to the commissioner;
(iii) A description of the plan for antifraud education and training of underwriters and other personnel; and
(iv) A description or chart outlining the organizational arrangement of the antifraud personnel who are responsible for the investigation and reporting of possible fraudulent viatical settlement acts and investigating unresolved material inconsistencies between medical records and insurance applications.
(3) Antifraud plans submitted to the commissioner shall be privileged and confidential and shall not be a public record and shall not be subject to discovery or subpoena in a civil or criminal action.
Acts 2009, ch. 604, § 15.