I

104TH CONGRESS

1ST SESSION H. R. 2654

To prevent discrimination against victims of abuse in all lines of insurance.

IN THE HOUSE OF REPRESENTATIVES

NOVEMBER 16, 1995

Mr. SANDERS (for himself, Mrs. MORELLA, Mr. WYDEN, and Mr. DEFAZIO)

introduced the following bill; which was referred to the Committee on

Commerce, and in addition to the Committee on Economic and Educational Opportunities, for a period to be subsequently determined by the

Speaker, in each case for consideration of such provisions as fall within

the jurisdiction of the committee concerned

A BILL

To prevent discrimination against victims of abuse in all

lines of insurance.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Victims of Abuse

5 Insurance Protection Act’’.

6 SEC. 2. DEFINITIONS.

7 As used in this Act:

8 (1) The term ‘‘abuse’’ means the occurrence of

9 one or more of the following acts between household
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1 or family (including in-laws or extended family)

2 members, spouses or former spouses, or individuals

3 engaged in or formerly engaged in a sexually inti4 mate relationship:

5 (A) Attempting to cause or intentionally,

6 knowingly, or recklessly causing another person

7 bodily injury, physical harm, substantial emo8 tional distress, psychological trauma, rape, sex9 ual assault, or involuntary sexual intercourse.

10 (B) Engaging in a course of conduct or re11 peatedly committing acts toward another per12 son, including following the person without

13 proper authority and under circumstances that

14 place the person in reasonable fear of bodily in15 jury or physical harm.

16 (C) Subjecting another person to false im17 prisonment or kidnapping.

18 (D) Attempting to cause or intentionally,

19 knowingly, or recklessly causing damage to

20 property so as to intimidate or attempt to con21 trol the behavior of another person.

22 (2) The term ‘‘abuse-related medical condition’’

23 means a medical condition which arises in whole or

24 in part out of an action or pattern of abuse.
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1 (3) The term ‘‘abuse status’’ means the fact or

2 perception that a person is, has been, or may be a

3 subject of abuse, irrespective of whether the person

4 has sustained abuse-related medical conditions or

5 has incurred abuse-related claims.

6 (4) The term ‘‘health benefit plan’’ means any

7 public or private entity or program that provides for

8 payments for health care, including—

9 (A) a group health plan (as defined in sec10 tion 607 of the Employee Retirement Income

11 Security Act of 1974) or a multiple employer

12 welfare arrangement (as defined in section

13 3(40) of such Act) that provides health bene14 fits;

15 (B) any other health insurance arrange16 ment, including any arrangement consisting of

17 a hospital or medical expense incurred policy or

18 certificate, hospital or medical service plan con19 tract, or health maintenance organization sub20 scriber contract;

21 (C) workers’ compensation or similar in22 surance to the extent that it relates to workers’

23 compensation medical benefits (as defined by

24 the Federal Trade Commission); and
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1 (D) automobile medical insurance to the

2 extent that it relates to medical benefits (as de3 fined by the Federal Trade Commission).

4 (5) The term ‘‘health carrier’’ means a person

5 that contracts or offers to contract on a risk-assum6 ing basis to provide, deliver, arrange for, pay for or

7 reimburse any of the cost of health care services un8 less the person assuming the risk is accepting the

9 risk from a duly licensed health carrier.

10 (6) The term ‘‘insured’’ means a party named

11 on a policy, certificate, or health benefit plan as the

12 person with legal rights to the benefits provided by

13 the policy, certificate, or health benefit plan. For

14 group insurance, such term includes a person who is

15 a beneficiary covered by a group policy, certificate,

16 or health benefit plan.

17 (7) The term ‘‘insurer’’ means any person, re18 ciprocal exchange, interinsurer, Lloyds insurer, fra19 ternal benefit society, or other legal entity engaged

20 in the business of insurance, including agents, bro21 kers, adjusters, and third party administrators. The

22 term also includes health carriers, health benefit

23 plans, and life, disability, and property and casualty

24 insurers.
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1 (8) The term ‘‘policy’’ means a contract of in2 surance, certificate, indemnity, suretyship, or annu3 ity issued, proposed for issuance or intended for is4 suance by an insurer, including endorsements or rid5 ers to an insurance policy or contract.

6 (9) The term ‘‘subject of abuse’’ means a per7 son to whom an act of abuse is directed, a person

8 who has had prior or current injuries, illnesses, or

9 disorders that resulted from abuse, or a person who

10 seeks, may have sought, or should have sought medi11 cal or psychological treatment for abuse, protection,

12 court-ordered protection, or shelter from abuse.

13 SEC. 3. DISCRIMINATORY ACTS PROHIBITED.

14 (a) IN GENERAL.—No insurer or health carrier may,

15 directly or indirectly, engage in any of the following acts

16 or practices on the basis that the applicant or insured,

17 or any person employed by the applicant or insured or

18 with whom the applicant or insured is known to have a

19 relationship or association, is, has been, or may be the

20 subject of abuse:

21 (1) Denying, refusing to issue, renew or reissue,

22 or canceling or otherwise terminating an insurance

23 policy or health benefit plan.

24 (2) Restricting, excluding, or limiting insurance

25 or health benefit plan coverage for losses as a result
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1 of abuse or denying a claim incurred by an insured

2 as a result of abuse, except as otherwise permitted

3 or required by State laws relating to life insurance

4 beneficiaries.

5 (3) Adding a premium differential to any insur6 ance policy or health benefit plan.

7 (4) Terminating health coverage for a subject

8 of abuse because coverage was originally issued in

9 the name of the abuser and the abuser has divorced,

10 separated from, or lost custody of the subject of

11 abuse or the abuser’s coverage has terminated volun12 tarily or involuntarily and the subject of abuse does

13 not qualify for extension of coverage under part 6 of

14 subtitle B of title I or the Employee Retirement In15 come Security Act of 1974 (29 U.S.C. 1161 et seq.)

16 or 4980B of the Internal Revenue Code of 1986.

17 Nothing in this paragraph prohibits the insurer from

18 requiring the subject of abuse to pay the full pre19 mium for the subject’s coverage under the health

20 plan. The insurer may terminate group coverage

21 after the continuation coverage required by this

22 paragraph has been in force for 18 months if it of23 fers conversion to an equivalent individual plan. The

24 continuation of health coverage required by this

25 paragraph shall be satisfied by any extension of cov-
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1 erage under part 6 of subtitle B of title I or the Em2 ployee Retirement Income Security Act of 1974 (29

3 U.S.C. 1161 et seq.) or 4980B of the Internal Reve4 nue Code of 1986 provided to a subject of abuse and

5 is not intended to be in addition to any extension of

6 coverage provided under part 6 of subtitle B of title

7 I or the Employee Retirement Income Security Act

8 of 1974 (29 U.S.C. 1161 et seq.) or 4980B of the

9 Internal Revenue Code of 1986.

10 (b) USE OF INFORMATION.—

11 (1) IN GENERAL.—No insurer may use, dis12 close, or transfer information relating to an appli13 cant’s or insured’s abuse status or abuse-related

14 medical condition or the applicant’s or insured’s sta15 tus as a family member, employer or associate, per16 son in a relationship with a subject of abuse for any

17 purpose unrelated to the direct provision of health

18 care services unless such use, disclosure, or transfer

19 is required by an order of an entity with authority

20 to regulate insurance or an order of a court of com21 petent jurisdiction or by abuse reporting laws. Noth22 ing in this paragraph shall be construed as limiting

23 or precluding a subject of abuse from obtaining the

24 subject’s own medical records from an insurer.
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1 (2) AUTHORITY OF SUBJECT OF ABUSE.—A

2 subject of abuse, at the absolute discretion of the

3 subject of abuse, may provide evidence of abuse to

4 an insurer for the limited purpose of facilitating

5 treatment of an abuse-related condition or dem6 onstrating that a condition is abuse-related. Nothing

7 in this paragraph shall be construed as authorizing

8 an insurer or health carrier to disregard such pro9 vided evidence.

10 SEC. 4. REASONS FOR ADVERSE ACTIONS.

11 An insurer that takes any adverse action relating to

12 any plan or policy of a subject of abuse, shall advise the

13 subject of abuse applicant or insured of the specific rea14 sons for the action in writing. Reference to general under15 writing practices or guidelines does not constitute a spe16 cific reason.

17 SEC. 5. LIFE INSURANCE.

18 Nothing in this Act shall be construed to prohibit a

19 life insurer from declining to issue a life insurance policy

20 if the applicant or prospective owner of the policy is or

21 would be designated as a beneficiary of the policy, and

22 if—

23 (1) the applicant or prospective owner of the

24 policy lacks an insurable interest in the insured; or
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1 (2) the applicant or prospective owner of the

2 policy is known, on the basis of police or court

3 records, to have committed an act of abuse.

4 SEC. 6. SUBROGATION WITHOUT CONSENT PROHIBITED.

5 Except where the subject of abuse has already recov6 ered damages, subrogation of claims resulting from abuse

7 is prohibited with the informed consent of the subject of

8 abuse.

9 SEC. 7. ENFORCEMENT.

10 (a) FEDERAL TRADE COMMISSION.—The Federal

11 Trade Commission shall have the power to examine and

12 investigate any insurer to determine whether such insurer

13 has been or is engaged in any act or practice prohibited

14 by this Act. If the Federal Trade Commission determines

15 an insurer has been or is engaged in any act or practice

16 prohibited by this Act, the Commission may take action

17 against such insurer by the issuance of a cease and desist

18 order as if the insurer was in violation of section 5 of the

19 Federal Trade Commission Act. Such cease and desist

20 order may include any individual relief warranted under

21 the circumstances, including temporary, preliminary, and

22 permanent injunctive and compensatory relief.

23 (b) PRIVATE CAUSE OF ACTION.—An applicant or in24 sured claiming to be adversely affected by an act or prac25 tice of an insurer in violation of this Act may maintain
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1 an action against the insurer in a Federal or State court

2 of original jurisdiction. Upon proof of such conduct by a

3 preponderance of the evidence, the court may award ap4 propriate relief, including temporary, preliminary, and

5 permanent injunctive relief and compensatory and puni6 tive damages, as well as the costs of suit and reasonable

7 fees for the aggrieved individual’s attorneys and expert

8 witnesses. With respect to compensatory damages, the ag9 grieved individual may elect, at any time prior to the ren10 dering of final judgment, to recover in lieu of actual dam11 ages, an award of statutory damages in the amount of

12 $5,000 for each violation.

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