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 Edu-
cational 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.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Victims of Abuse
Insurance Protection Act’’.
SEC. 2. DEFINITIONS.
As used in this Act:
(1) The term ‘‘abuse’’ means the occurrence of
one or more of the following acts between household
or family (including in-laws or extended family)
members, spouses or former spouses, or individuals
engaged in or formerly engaged in a sexually inti-
mate relationship:
(A) Attempting to cause or intentionally,
knowingly, or recklessly causing another person
bodily injury, physical harm, substantial emo-
tional distress, psychological trauma, rape, sex-
ual assault, or involuntary sexual intercourse.
(B) Engaging in a course of conduct or re-
peatedly committing acts toward another per-
son, including following the person without
proper authority and under circumstances that
place the person in reasonable fear of bodily in-
jury or physical harm.
(C) Subjecting another person to false im-
prisonment or kidnapping.
(D) Attempting to cause or intentionally,
knowingly, or recklessly causing damage to
property so as to intimidate or attempt to con-
trol the behavior of another person.
(2) The term ‘‘abuse-related medical condition’’
means a medical condition which arises in whole or
in part out of an action or pattern of abuse.
(3) The term ‘‘abuse status’’ means the fact or
perception that a person is, has been, or may be a
subject of abuse, irrespective of whether the person
has sustained abuse-related medical conditions or
has incurred abuse-related claims.
(4) The term ‘‘health benefit plan’’ means any
public or private entity or program that provides for
payments for health care, including—
(A) a group health plan (as defined in sec-
tion 607 of the Employee Retirement Income
Security Act of 1974) or a multiple employer
welfare arrangement (as defined in section
3(40) of such Act) that provides health bene-
fits;
(B) any other health insurance arrange-
ment, including any arrangement consisting of
a hospital or medical expense incurred policy or
certificate, hospital or medical service plan con-
tract, or health maintenance organization sub-
scriber contract;
(C) workers’ compensation or similar in-
surance to the extent that it relates to workers’
compensation medical benefits (as defined by
the Federal Trade Commission); and
(D) automobile medical insurance to the
extent that it relates to medical benefits (as de-
fined by the Federal Trade Commission).
(5) The term ‘‘health carrier’’ means a person
that contracts or offers to contract on a risk-assum-
ing basis to provide, deliver, arrange for, pay for or
reimburse any of the cost of health care services un-
less the person assuming the risk is accepting the
risk from a duly licensed health carrier.
(6) The term ‘‘insured’’ means a party named
on a policy, certificate, or health benefit plan as the
person with legal rights to the benefits provided by
the policy, certificate, or health benefit plan. For
group insurance, such term includes a person who is
a beneficiary covered by a group policy, certificate,
or health benefit plan.
(7) The term ‘‘insurer’’ means any person, re-
ciprocal exchange, interinsurer, Lloyds insurer, fra-
ternal benefit society, or other legal entity engaged
in the business of insurance, including agents, bro-
kers, adjusters, and third party administrators. The
term also includes health carriers, health benefit
plans, and life, disability, and property and casualty
insurers.
(8) The term ‘‘policy’’ means a contract of in-
surance, certificate, indemnity, suretyship, or annu-
ity issued, proposed for issuance or intended for is-
suance by an insurer, including endorsements or rid-
ers to an insurance policy or contract.
(9) The term ‘‘subject of abuse’’ means a per-
son to whom an act of abuse is directed, a person
who has had prior or current injuries, illnesses, or
disorders that resulted from abuse, or a person who
seeks, may have sought, or should have sought medi-
cal or psychological treatment for abuse, protection,
court-ordered protection, or shelter from abuse.
SEC. 3. DISCRIMINATORY ACTS PROHIBITED.
(a) IN GENERAL.—No insurer or health carrier may,
directly or indirectly, engage in any of the following acts
or practices on the basis that the applicant or insured,
or any person employed by the applicant or insured or
with whom the applicant or insured is known to have a
relationship or association, is, has been, or may be the
subject of abuse:
(1) Denying, refusing to issue, renew or reissue,
or canceling or otherwise terminating an insurance
policy or health benefit plan.
(2) Restricting, excluding, or limiting insurance
or health benefit plan coverage for losses as a result
of abuse or denying a claim incurred by an insured
as a result of abuse, except as otherwise permitted
or required by State laws relating to life insurance
beneficiaries.
(3) Adding a premium differential to any insur-
ance policy or health benefit plan.
(4) Terminating health coverage for a subject
of abuse because coverage was originally issued in
the name of the abuser and the abuser has divorced,
separated from, or lost custody of the subject of
abuse or the abuser’s coverage has terminated volun-
tarily or involuntarily and the subject of abuse does
not qualify for extension of coverage under part 6 of
subtitle B of title I or the Employee Retirement In-
come Security Act of 1974 (29 U.S.C. 1161 et seq.)
or 4980B of the Internal Revenue Code of 1986.
Nothing in this paragraph prohibits the insurer from
requiring the subject of abuse to pay the full pre-
mium for the subject’s coverage under the health
plan. The insurer may terminate group coverage
after the continuation coverage required by this
paragraph has been in force for 18 months if it of-
fers conversion to an equivalent individual plan. The
continuation of health coverage required by this
paragraph shall be satisfied by any extension of cov-
erage under part 6 of subtitle B of title I or the Em-
ployee Retirement Income Security Act of 1974 (29
U.S.C. 1161 et seq.) or 4980B of the Internal Reve-
nue Code of 1986 provided to a subject of abuse and
is not intended to be in addition to any extension of
coverage provided under part 6 of subtitle B of title
I or the Employee Retirement Income Security Act
of 1974 (29 U.S.C. 1161 et seq.) or 4980B of the
Internal Revenue Code of 1986.
(b) USE OF INFORMATION.—
(1) IN
GENERAL.—No insurer may use, dis-
close, or transfer information relating to an appli-
cant’s or insured’s abuse status or abuse-related
medical condition or the applicant’s or insured’s sta-
tus as a family member, employer or associate, per-
son in a relationship with a subject of abuse for any
purpose unrelated to the direct provision of health
care services unless such use, disclosure, or transfer
is required by an order of an entity with authority
to regulate insurance or an order of a court of com-
petent jurisdiction or by abuse reporting laws. Noth-
ing in this paragraph shall be construed as limiting
or precluding a subject of abuse from obtaining the
subject’s own medical records from an insurer.
(2) AUTHORITY
OF
SUBJECT
OF
ABUSE.—A
subject of abuse, at the absolute discretion of the
subject of abuse, may provide evidence of abuse to
an insurer for the limited purpose of facilitating
treatment of an abuse-related condition or dem-
onstrating that a condition is abuse-related. Nothing
in this paragraph shall be construed as authorizing
an insurer or health carrier to disregard such pro-
vided evidence.
SEC. 4. REASONS FOR ADVERSE ACTIONS.
An insurer that takes any adverse action relating to
any plan or policy of a subject of abuse, shall advise the
subject of abuse applicant or insured of the specific rea-
sons for the action in writing. Reference to general under-
writing practices or guidelines does not constitute a spe-
cific reason.
SEC. 5. LIFE INSURANCE.
Nothing in this Act shall be construed to prohibit a
life insurer from declining to issue a life insurance policy
if the applicant or prospective owner of the policy is or
would be designated as a beneficiary of the policy, and
if—
(1) the applicant or prospective owner of the
policy lacks an insurable interest in the insured; or
(2) the applicant or prospective owner of the
policy is known, on the basis of police or court
records, to have committed an act of abuse.
SEC. 6. SUBROGATION WITHOUT CONSENT PROHIBITED.
Except where the subject of abuse has already recov-
ered damages, subrogation of claims resulting from abuse
is prohibited with the informed consent of the subject of
abuse.
SEC. 7. ENFORCEMENT.
(a) FEDERAL TRADE COMMISSION.—The Federal
Trade Commission shall have the power to examine and
investigate any insurer to determine whether such insurer
has been or is engaged in any act or practice prohibited
by this Act. If the Federal Trade Commission determines
an insurer has been or is engaged in any act or practice
prohibited by this Act, the Commission may take action
against such insurer by the issuance of a cease and desist
order as if the insurer was in violation of section 5 of the
Federal Trade Commission Act. Such cease and desist
order may include any individual relief warranted under
the circumstances, including temporary, preliminary, and
permanent injunctive and compensatory relief.
(b) PRIVATE CAUSE OF ACTION.—An applicant or in-
sured claiming to be adversely affected by an act or prac-
tice of an insurer in violation of this Act may maintain
an action against the insurer in a Federal or State court
of original jurisdiction. Upon proof of such conduct by a
preponderance of the evidence, the court may award ap-
propriate relief, including temporary, preliminary, and
permanent injunctive relief and compensatory and puni-
tive damages, as well as the costs of suit and reasonable
fees for the aggrieved individual’s attorneys and expert
witnesses. With respect to compensatory damages, the ag-
grieved individual may elect, at any time prior to the ren-
dering of final judgment, to recover in lieu of actual dam-
ages, an award of statutory damages in the amount of
$5,000 for each violation.
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