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2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175d - Massachusetts Insurers Insolvency Fund › Section 17 - High Net Worth Insureds; Payment of Claims; Financial Information

Section 17. (1) For purposes of this section ''high net worth insured'' shall mean any insured whose net worth exceeds $25 million on December 31 of the year before the year in which the insurer becomes an insolvent insurer; but, an insured's net worth on that date shall be considered to include the aggregate net worth of the insured and all of its subsidiaries and affiliates as calculated on a consolidated basis. ''High net worth insured'' shall not include a federal, state or local government entity.
(2) The fund shall not be obligated to pay a first party claim by a high net worth insured.
(3) The fund shall have the right to recover from a high net worth insured amounts paid by the fund to or on behalf of the insured, whether for indemnity, defense or otherwise.
(4) The fund shall not be obligated to pay a claim that would otherwise be a covered claim that is an obligation to or on behalf of a person who has a net worth greater than that allowed by the insurance guaranty association law of the state of residence of the claimant at the time specified by that state's applicable law, and which fund has denied coverage to that claimant on that basis.
(5) The fund shall establish reasonable procedures subject to the approval of the commissioner for requesting financial information from insureds on a confidential basis for purposes of applying this section; but, the financial information may be shared with any other state guaranty association or fund similar to the fund and the liquidator for the insolvent insurer on the same confidential basis. A request to an insured seeking financial information shall advise the insured of the consequences of failing to provide the financial information. If an insured refuses to provide the requested financial information where it is requested and available, the fund may, until such time as the information is provided, provisionally consider the insured to be a high net worth insured for the purposes of subsections (2) and (3).
(6) In a lawsuit contesting the applicability of this section where the insured has refused to provide financial information under the procedure established pursuant to subsection (5), the insured shall bear the burden of proof concerning its net worth at the relevant time. If the insured fails to prove that its net worth at the relevant time was less than the applicable amount, the court shall award the fund its full costs, expenses and reasonable attorneys' fees in contesting the claim.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175e - Regulation of Rates for Motor Vehicle Insurance › Section 1 - Definitions

Section 1. The following words, as used in this chapter, unless the text otherwise requires or a different meaning is specifically required, shall mean:—
''Board'', the board of appeals on motor vehicle liability policies and bonds established in section 8A of chapter 26.
''Commissioner'', the commissioner of insurance.
''Company'', ''insurance company'' or ''insurer'', all corporations, associations, partnerships or individuals engaged as principals in the business of insurance.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175e - Regulation of Rates for Motor Vehicle Insurance › Section 5 - Fixing Rates; Hearing; Report

Section 5. If the commissioner determines, after a hearing, at which representatives of consumers and other interested parties may participate, and on the basis of findings of fact and conclusions, that, with respect to any territory or to any kind, subdivision or class of insurance, competition is either (i) insufficient to assure that rates will not be excessive, or (ii) so conducted as to be destructive of competition or detrimental to the solvency of insurers, he shall, within ninety days or as soon thereafter as possible and without regard to calendar dates specified in section one hundred and thirteen B of chapter one hundred and seventy-five, fix and establish the rates for such insurance or territory pursuant to the provisions of section one hundred and thirteen B of chapter one hundred and seventy-five. Such procedure shall have a specified duration of not more than one year but may be renewed by the commissioner upon appropriate findings of fact, conclusions and order. Within thirty days after the close of the hearing the commissioner shall make this determination in a report which shall be made public.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175e - Regulation of Rates for Motor Vehicle Insurance › Section 8 - Investigations by Commissioner; Hearings; Disapproval or Suspension of Rates

Section 8. The commissioner may as often as he deems it expedient and in such manner as he deems it expedient examine any insurer or rating organization to ascertain whether its rating and underwriting practices are in accordance with law. Filed reports on examinations shall be available for public inspection.
If the commissioner determines after a hearing that any classification, rule or rates, rating plan or modification of any of the foregoing used by an insurer does not comply with this chapter or is violative of public policy he shall order that such classification or rule or rate or rating plan or any modification thereof be disapproved, and with respect to any such rate, such order may include a provision for premium adjustment.
Pending a hearing, the commissioner may order the suspension, prospectively, of a rate used by an insurer and reimpose the last previous rate in effect, in which event he shall, unless the requirement is waived by the insurer, hold a hearing within fifteen days after such order. Within fifteen days after the close of the hearing the commissioner shall make his determination as to whether the rate should be disapproved.
At any such hearing, the insurer shall have the burden of justifying the rate in question. All such determinations of the commissioner shall be on the basis of findings of fact and conclusions of law. If the commissioner disapproves a rate, the disapproval shall take effect not less than fifteen days after his order and the previous rate in effect for the insurer shall be thereupon reimposed for a period of six months unless, prior thereto, the commissioner shall approve a different rate.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175e - Regulation of Rates for Motor Vehicle Insurance › Section 9 - Bad-Faith Filing; Hearings

Section 9. No insurer or rating organization shall file in bad faith rates which it knows or should know are grossly inadequate for the insurance coverage provided, and which are filed and used for the purpose of unfairly competing for motor vehicle insurance risks.
At any hearing conducted under this section, the burden shall be on the filer to justify that such filing is not in violation of this section. If, after such hearing, the commissioner finds that the filer has failed to so justify such filing, he may order that all policies written under such bad-faith filing be rewritten at rates meeting the requirements of this chapter from the date of inception of such policies, or that all such policies be cancelled on a pro rata basis.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175e - Regulation of Rates for Motor Vehicle Insurance › Section 10 - Alteration or Amendment of Rules and Regulations

Section 10. The commissioner may make and, at any time, alter or amend, reasonable rules and regulations to facilitate the operation of this chapter, to enforce the application of this chapter, to govern the form and content of filings made pursuant to this chapter, and to expedite the conduct of hearings and investigations under this chapter.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175e - Regulation of Rates for Motor Vehicle Insurance › Section 11 - Information Guide

Section 11. The commissioner may once in each calendar year establish rules by which the companies shall produce an information guide which outlines in language prescribed or approved by the commissioner the various choices of coverage available to insureds and an approximation of differences in cost among various types of coverage and among competing carriers. Each company shall bear full responsibility for assuring that a copy of such information guide is forwarded to every person insured or solicited for insurance by that company or its agents.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175e - Regulation of Rates for Motor Vehicle Insurance › Section 11a - Disclosure of Coverage Options

Section 11A. Insurance companies or their agents shall disclose in simple language to every person they insure or solicit for insurance that person's coverage options, including the option to exclude oneself and members of one's household from personal injury protection coverage, so-called. The commissioner shall prescribe the form, content, and timing of said disclosures.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175e - Regulation of Rates for Motor Vehicle Insurance › Section 12 - Violations; Penalties

Section 12. Any insurer, rating organization or person that violates any provision of this chapter shall be punished by a fine of not more than ten thousand dollars for each offense or by imprisonment for not more than one year, or by both; or shall be subject to a civil penalty not to exceed one thousand dollars for each such offense which may be assessed in an action brought on behalf of the commonwealth in any court of competent jurisdiction. The issuance, procurement or negotiation of a single policy of insurance shall be deemed a separate offense.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175e - Regulation of Rates for Motor Vehicle Insurance › Section 13 - Enforcement of Orders; Jurisdiction; Review

Section 13. The supreme judicial court for the county of Suffolk shall have jurisdiction in equity upon the petition of the commissioner and upon a summary hearing to enforce all lawful orders of the commissioner. Any person aggrieved by any action of the commissioner under this chapter may, within twenty days of the action in question, file a petition for review in the supreme judicial court for the county of Suffolk.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175f - Medical Malpractice Self-Insurance Trust Funds › Section 1 - Definitions

Section 1. The following words, as used in this chapter, unless the context otherwise requires or a different meaning is specifically prescribed, shall have the following meanings:
''Certified fund'', a fund holding a certificate issued pursuant to section three and not revoked pursuant to section ten;
''Commissioner'', the commissioner of insurance;
''Fund'', a health care provider self-insurance trust fund;
''Health care provider'', a licensed hospital, clinic, nursing home, health maintenance organization, foundation, educational institution engaged in the training of health care personnel; or society of such other classification of health care providers, as that term is defined in section six of chapter three hundred and sixty-two of the acts of nineteen hundred and seventy-five, for which the commissioner determines that medical malpractice insurance is not adequately available at reasonable cost;
''Health care provider self-insurance trust fund'', a trust fund established in accordance with the provisions of this chapter to provide insurance to a group of two or more participating health care providers;
''Insurance'', formal self-insurance or commercial insurance, or a combination thereof, covering risks of medical malpractice liability and general liability of any participating health care provider, and, at the option of the fund, of any affiliated institution or person of a participating health care provider, and of staff members of participating health care providers and affiliates who are full-time employees or who satisfy other reasonable criteria for coverage. A fund with a participant which is a society of individual health care providers who are natural persons shall provide only medical malpractice coverage to the members of that society. Insurance shall include all layers of coverage, on either a claims made or occurrence basis, and reinsurance by one fund of the risk of another fund;
''Participating health care provider'' or ''Participant'', a health care provider that is a settlor or grantor and beneficiary of a health care provider self-insurance trust fund;
''Trustee'', the trustee of a fund.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175f - Medical Malpractice Self-Insurance Trust Funds › Section 2 - Establishment of Fund; Filing of Trust Instrument; Certification; Appointment of Trustee; Dissolution, Voluntary or Involuntary

Section 2. A group of two or more participating health care providers may establish a health care provider self-insurance trust fund under this chapter prior to the issuance of a certificate in accordance with section three. Said fund shall be deemed established upon the execution of a trust instrument by the initial participants and establishment of a fund balance.
When a group of participants has established a fund, said participants shall file the trust instrument with the commissioner with such supporting documentation as he might reasonably require by regulation. Such trust instrument shall be in compliance with the provisions of this chapter.
The coverage provisions of an insurance contract issued by a fund under its trust instrument shall not become effective to provide coverage until the fund is certified in accordance with section three although the fund may require and accept payments of premiums prior to certification.
A fund shall appoint a trustee to satisfy reasonable standards of performance which shall be promulgated by the commissioner by regulation.
A fund desiring to dissolve may petition the supreme judicial court for voluntary dissolution. The court may authorize such dissolution and may, upon such authorization, distribute the petitioner's assets in a manner consistent with the fund's legal obligations.
The commissioner may petition the supreme judicial court for the involuntary dissolution of any fund if such fund has not filed for two consecutive years, an annual statement in accordance with section six, or if the commissioner is satisfied that the fund is inactive and its continued existence is not in the public interest. Upon authorizing such dissolution, the court shall distribute all assets of the fund in accordance with the fund's legal obligations.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175f - Medical Malpractice Self-Insurance Trust Funds › Section 3 - Application for Certification; Denial; Approval

Section 3. Any fund established under section two may be certified to provide insurance in accordance with the provisions of this chapter upon filing an application for certification with the commissioner. Such application shall be on a form provided by the commissioner and shall include such information as he shall require by regulation. The commissioner shall review each application and may, after a hearing in accordance with chapter thirty A, deny any application for the following reasons:
(a) that the application is not on the prescribed form or the information as submitted is not in compliance with regulations promulgated under the provisions of section seventeen;
(b) that the dollar reserve is not in compliance with section eight;
(c) that the trustee is found by the commissioner to be unable to satisfy the standards of performance promulgated by the commissioner pursuant to section two; or
(d) that there was fraud or wilful misrepresentation in providing required written information.
Within sixty days of the date of filing of an application under this section an application shall be deemed approved, unless the commissioner shall schedule a hearing in accordance with chapter thirty A to consider denial thereof and shall hold such hearing within thirty days of such scheduling. The decision of the commissioner shall be rendered within thirty days following such hearing, or the application so filed will be deemed approved.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175f - Medical Malpractice Self-Insurance Trust Funds › Section 4 - Application of Chapter

Section 4. A certified fund shall be exempt from the provisions of chapters one hundred seventy-four A, one hundred seventy-five D, one hundred seventy-four B, one hundred seventy-five, one hundred seventy-five A, one hundred seventy-six, one hundred seventy-six A, one hundred seventy-six B, one hundred seventy-six C, one hundred seventy-six E, and one hundred seventy-six F, and from the provisions of any other statute relating to insurance. A certified fund shall not be considered to be an insurer and any participant shall not be considered a purchaser of insurance under the provisions of section six of chapter three hundred sixty-two of the acts of nineteen hundred and seventy-five. Any such participant or other person to whom coverage is provided by a fund shall receive any dividends to which it would be entitled and shall be subject to any assessments due from it as a ''policyholder'' under said section 6 if such dividends or assessments relate to any year during which that participant or other person purchased insurance from the Joint Underwriting Association under said section six.
The provisions of this chapter shall be subject to the enforcement provisions of sections three A and three B of chapter one hundred and seventy-five.
A hearing held under this chapter shall be subject to the commissioner's powers under section eight A of chapter one hundred and seventy-five.
A fund shall be subject to the provisions of section twenty of said chapter one hundred and seventy-five as they relate to insurance companies.
A fund shall be subject as an insurer to the provisions of chapter one hundred and seventy-six D.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175f - Medical Malpractice Self-Insurance Trust Funds › Section 5 - Rights, Obligations and Responsibilities of Fund and Trustee

Section 5. A fund and a trustee of such fund shall have the rights and shall be subject to the legal responsibilities and obligations applicable to a trust and trustee under the General Laws, except to the extent such rights, obligations and responsibilities are in conflict with this chapter.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175f - Medical Malpractice Self-Insurance Trust Funds › Section 6 - Annual Statement of Financial Condition; Penalty for Failure to File

Section 6. A fund shall annually on January first file with the commissioner a statement showing its financial condition as of September thirtieth of the prior year. Such statement shall be on a form provided by the commissioner. The commissioner may require in writing, at any time, such additional information as is reasonable and necessary to determine the financial condition of a fund. A fund unreasonably neglecting to file the statement required hereunder in a timely fashion, or unreasonably neglecting to comply with any such informational request by the commissioner within thirty days following receipt of a written request for said information, shall forfeit one hundred dollars for each day which such unreasonable neglect continues. Such fine shall be imposed only after a hearing in accordance with chapter thirty A, conducted by the commissioner.
The commissioner shall have the power to examine the financial condition of a fund.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175f - Medical Malpractice Self-Insurance Trust Funds › Section 8 - Claims Reserve

Section 8. A fund organized under this chapter shall, before it shall be certified pursuant to section three, satisfy the commissioner in its application that a claims reserve exists in accordance with this section. Such claims reserve shall be maintained at a level prescribed by an actuary or by a reasonable substitute for an actuary, which level shall exceed four hundred thousand dollars or some other reasonable minimum to be established by the commissioner by regulation. In establishing this minimum, the commissioner shall consider other legal obligations which might be required of the fund by other governmental units, in order to avoid unnecessary and duplicative or conflicting requirements.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175f - Medical Malpractice Self-Insurance Trust Funds › Section 9 - Amendment of Trust Instrument or Original Application for Certification; Notification to Commissioner

Section 9. A trustee of a fund shall notify the commissioner of any amendment to its trust instrument or to its original application for certification under section three within thirty days of the making of such amendment.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175f - Medical Malpractice Self-Insurance Trust Funds › Section 10 - Revocation or Suspension of Certification of Fund; Removal of Trustee

Section 10. The commissioner may, after a hearing in accordance with chapter thirty A, revoke or suspend the certification of any fund, or, in lieu of such suspension or revocation, fine that fund up to ten thousand dollars, for intentionally doing any of the following:
(1) violating any provision of this chapter or any regulations promulgated hereunder;
(2) presenting false or misleading statements on any document which is filed in accordance with this chapter;
(3) holding a claims reserve less than the minimum required to be maintained by section eight;
(4) using improper accounting procedures not in conformity with section seven.
If the certification of a fund is suspended, that fund shall not accept any new participants, but may continue to provide insurance to its present participants. If the certification of a fund is revoked, the fund shall not accept any new participant and such fund shall cease providing any insurance at the end of the policy period during which such revocation occurs or twelve months from the date of such revocation, whichever occurs first. Prior to the total cessation of provision of insurance under this section, such fund shall be treated as if it were a certified fund.
The commissioner may, after a hearing in accordance with chapter thirty A, remove any trustee of a fund for the reasons described in clauses one to four, inclusive, or for any fact which demonstrates that the trustee did not satisfy the standards of performance established pursuant to section two.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175f - Medical Malpractice Self-Insurance Trust Funds › Section 11 - Exclusion of Health Care Provider From Participation; New Participants; Request for Arbitration by Aggrieved

Section 11. No fund shall exclude a health care provider from participation except as provided in this section if the health care provider has complied with all necessary and required application procedures. A fund may exclude a health care provider from participation if:
(1) the applicant health care provider is not situated in a geographical location which is reasonably contiguous to the initial participants;
(2) the applicant health care provider does not meet standards of risk and claims management and financial management promulgated by a fund in its trust instrument;
(3) the applicant is not a nonprofit health care provider, if that fund's present participants are nonprofit; or
(4) the applicant is not a member of the classification of health care providers to which the fund's present participants belong. Each type of health care provider set forth in section 1 shall be considered to be a separate classification of health care providers.
No fund shall be required to provide insurance to a new participant except beginning at the start of the next policy year after the new participant's application is accepted, and no fund shall be required to accept more than one applicant health care provider during any policy year; provided, however, that a fund at its option may accept more than one such applicant during any policy year.
If any applicant health care provider is aggrieved by a decision to exclude him from participation in a fund, he may request arbitration by a board consisting of a member designated by the health care provider, a member chosen by the fund, and a member designated by the commissioner. Such board shall hold a hearing and render a decision on the issues presented.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175f - Medical Malpractice Self-Insurance Trust Funds › Section 12 - Trust Instrument Provisions

Section 12. The trust instrument may provide (a) that there shall be a minimum period during which any participant must participate in the fund; (b) that the fund may provide tail coverage to any participant which joins or withdraws from the fund; (c) that all participants shall execute a participation agreement; (d) that the trustee shall be free of all personal liability for his actions in good faith on behalf of the fund; and (e) that the trustee may be either an individual or an institution such as a bank, an insurance company or any other appropriate entity.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175f - Medical Malpractice Self-Insurance Trust Funds › Section 13 - Merger or Consolidation of Funds

Section 13. A fund desiring to consolidate or merge with any other fund shall comply with the procedures set forth in section seven of chapter one hundred and seventy-six, inserted by section one of chapter five hundred and forty of the acts of nineteen hundred and fifty-eight. Such merger or consolidation shall be considered to be approved by the commissioner unless, after a hearing in accordance with chapter thirty A, the commissioner disapproves said merger or consolidation in writing within sixty days after the filing of all materials.
Any such merger or consolidation shall have the effects on the rights and property of the funds which are set forth as to fraternal benefit societies in said section seven of said chapter one hundred and seventy-six, as so inserted.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175f - Medical Malpractice Self-Insurance Trust Funds › Section 14 - Legal Requirement of Insurance or Commercial Insurance

Section 14. Any participant shall be considered to have insurance equivalent to commercial insurance, to the extent of the limits of coverage provided by the fund, for the purpose of any requirements of insurance or commercial insurance contained in any law or any bonds, notes, mortgages, contracts or other agreements to which that participant is a party.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175f - Medical Malpractice Self-Insurance Trust Funds › Section 15 - Liability of Fund

Section 15. No money or other asset of any fund shall be liable to attachment, trustee process, equitable lien or other process, or to be seized, taken, appropriated or applied by any legal or equitable process or operation of law to pay any debt or liability of any legal person except as provided in this chapter or in the trust instrument governing the fund.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175f - Medical Malpractice Self-Insurance Trust Funds › Section 16 - Fund Declared to Be Charitable and Benevolent Institution; Exemption From Taxes

Section 16. A fund is hereby declared to be a charitable and benevolent institution, and all of its assets shall be exempt from all and every state, county, district, municipal and school tax, if all of its participants qualify for exemption from federal taxes under 26 U.S.C. Section 501, or qualify for the exclusion from gross income provided under 26 U.S.C. Section 115.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175f - Medical Malpractice Self-Insurance Trust Funds › Section 17 - Regulations to Consider Requirements of Federal Governmental or Quasi-Governmental Agencies

Section 17. All regulations promulgated by the commissioner pursuant to this chapter shall consider the requirements of federal governmental agencies or quasi-governmental agencies so as to permit funds to satisfy such requirements.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175g - The Pollution Liability Reinsurance Corporation › Section 5 - Percentage Surcharge for Supplemental Special Account, Establishment and Collection; Maximum Accumulated Amount; Surplus

Section 5. Subject to the plan of operation, the Corporation shall establish and collect a percentage surcharge of up to five per cent on ordinary reinsurance charges in order to build up a supplemental special account within the Pollution Liability Reinsurance Fund. The proceeds of this account and its related investment income shall be used to discharge the Corporation's liabilities under reinsurance contracts in the event that, for any specific reporting year, the losses and related expenses exceed the Corporation's income obtained from ordinary reinsurance premium charges and investment income thereon.
When the accumulated amount in the special account, less anticipated expenditures, is expected to exceed twenty-five million dollars at the end of a calendar year, the surcharges shall be discontinued until the special account is depleted to an amount below twenty-five million dollars. Every five years, the commissioner shall determine the proper maximum accumulated amount to be kept in the special account for the next five years. This determination shall be based on, but not limited to factors including the previous experience in the operation of the special account.
In the event that for any specific reporting year the claim reserves established in the Reinsurance Fund from ordinary reinsurance charges, including reasonably related investment income, are determined with reasonable actuarial certainty to be in excess of the amounts actually required to pay claims and claim expenses, the surplus amount shall be transferred to the special account. Such determination shall be made no sooner than five years after the inception date of any reporting year.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175g - The Pollution Liability Reinsurance Corporation › Section 7 - Rules and Regulations; Commissioner's Orders; Review

Section 7. The commissioner may make, and at any time, alter or amend, reasonable rules and regulations to facilitate the operation of this chapter. The commissioner may issue such orders as he finds proper, expedient or necessary to enforce and administer the provisions of this chapter and to secure compliance with any rules or regulations made thereunder. The superior court for the county of Suffolk shall have jurisdiction upon the complaints of the commissioner and upon a summary hearing, to enforce all lawful orders of the commissioner. Memoranda of all actions, orders, findings and decisions of the commissioner shall be signed by him and filed in his office as public records open to public inspection.
Any person or company aggrieved by any action, order, finding or decision of the commissioner pursuant to this chapter may seek review of such action, order, finding or decision by the superior court for the county of Suffolk in accordance with section five A of chapter one hundred and seventy-five A.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175h - False Health Care Claims › Section 1 - Definitions

Section 1. As used in this chapter the following words shall have the following meanings, unless the context otherwise requires:—
''False'', wholly or partially false, fictitious, fraudulent, untrue or deceptive.
''Health care benefit'', a payment for health care services or the right under a contract or a certificate or policy of insurance to have a payment made by a health care corporation or health care insurer for a specified health care service.
''Health care corporation'', a nonprofit hospital service corporation organized pursuant to chapter one hundred and seventy-six A, a nonprofit medical service corporation organized pursuant to chapter one hundred and seventy-six B, a medical service corporation organized pursuant to chapter one hundred and seventy-six C, a dental service corporation organized pursuant to chapter one hundred and seventy-six E, an optometric service plan organized pursuant to chapter one hundred and seventy-six F, and a health maintenance organization organized pursuant to chapter one hundred and seventy-six G.
''Health care insurer'', any insurance company authorized to provide health insurance in this state or any legal entity which is self-insured and providing health care benefits to its employees.
''Person'', an individual, corporation, partnership, association, or any other legal entity.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175h - False Health Care Claims › Section 2 - False Statements on Applications for Coverage and Claims; Failure to Disclose

Section 2. Any person who (1) knowingly and willfully makes or causes to be made any false statement or representation of a material fact in any application for a payment of a health care benefit; or (2) knowingly and willfully presents or causes to be presented an application for a health care benefit containing any false statement or representation of a material fact; or (3) knowingly and willfully makes or causes to be made any false statement or representation of a material fact for use in determining rights to a health care benefit, including whether goods or services were medically necessary in accordance with professionally accepted standards; or (4) having knowledge of the occurrence of any event affecting his initial or continued right to any health care benefit, conceals or fails to disclose such an event with an intent to fraudulently secure such benefit either in a greater amount than is due or when no such benefit is due; or (5) having knowledge of the occurrence of any event affecting the health care benefit of any other individual in whose behalf he has made or presented an application for such benefit, or in whose behalf he is receiving any health care benefit, conceals or fails to disclose such an event with an intent to fraudulently secure such benefit either in a greater amount than is due or when no such benefit is due, shall be punished by a fine of not more than ten thousand dollars, or by imprisonment in a jail or house of correction for not more than two and one-half years or in the state prison for not more than five years, or by both such fine and imprisonment, and may be held liable in a civil action under section seven. Notwithstanding the foregoing, a person who is not a provider of services for which a health care benefit may be paid shall not be subject to prosecution hereunder for any statement or representation which such person makes without fraudulent intent.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175h - False Health Care Claims › Section 6 - Liability for False Claims; Civil Proceedings

Section 6. A person who receives a health care benefit or payment from a health care corporation or health care insurer which such person knows that he or she is not entitled to receive or be paid, or a person who knowingly presents or causes to be presented with fraudulent intent a claim which contains a false statement, shall be liable to the health care corporation or health care insurer for the full amount of the benefit or payment made, and for reasonable attorneys fees and costs, inclusive of costs of investigation.
A health care corporation or health care insurer may bring a civil action under this chapter in the superior court department of the trial court.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175h - False Health Care Claims › Section 7 - Restitution; Attorneys Fees, Costs

Section 7. Any person convicted of a violation of sections two or three, in addition to any fines or sentences imposed, including any order of probation, shall be ordered to make restitution to a health care corporation or health care insurer for the full amount of the benefit or payment made, and for reasonable attorneys fees and costs, inclusive of costs of investigation.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175i - Insurance Information and Privacy Protection › Section 1 - Application of Chapter

Section 1. (a) The obligations imposed by this chapter shall apply to an insurance institution, insurance representative or insurance-support organization which in the case of life, health and disability insurance:
(1) collects, receives or maintains information in connection with an insurance transaction which pertains to a natural person who is a resident of the commonwealth; or
(2) engages in an insurance transaction with an applicant, individual or policyholder who is a resident of the commonwealth.
(b) In the case of life, health or disability insurance, the rights granted by this chapter shall extend to the following residents of the commonwealth:
(1) natural persons who are the subject of information collected, received or maintained in connection with insurance transactions; and
(2) applicants, individuals or policyholders who engage in or seek to engage in insurance transactions.
(c) For purposes of this section, a person shall be considered a resident of the commonwealth if such person's last known mailing address, as shown in the records of the insurance institution, insurance representative or insurance-support organization, is located in the commonwealth.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175i - Insurance Information and Privacy Protection › Section 3 - Pretext Interviews; Use

Section 3. No insurance institution, insurance representative, or insurance-support organization shall use or authorize the use of pretext interviews to obtain information in connection with an insurance transaction; provided, however, that a pretext interview may be undertaken to obtain information from a person or institution that does not have a generally or statutorily recognized privileged relationship with the person about whom the information relates for the purpose of investigating a claim where, based upon specific information available for review by the commissioner, there is a reasonable basis for suspecting criminal activity, fraud or material misrepresentation in connection with the claim.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175i - Insurance Information and Privacy Protection › Section 6 - Disclosure Authorization Form; Contents

Section 6. Notwithstanding any general or special law to the contrary, no insurance institution, insurance representative or insurance-support organization may utilize as its disclosure authorization form in connection with insurance transactions a form or statement which authorizes the disclosure of personal or privileged information about an individual to the insurance institution, insurance representative or insurance-support organization unless the form or statement:
(1) is written in plain language;
(2) is dated;
(3) specifies the types of persons authorized to disclose information about the individual;
(4) specifies the nature of the information authorized to be disclosed;
(5) names the insurance institution or insurance representative and identifies by generic reference the representative of the insurance institution to whom the individual is authorizing information to be disclosed;
(6) specifies the purposes for which the information is collected;
(7) specifies the length of time such authorization shall remain valid, which shall be no longer than:
(A) in the case of authorizations signed for the purpose of collecting information in connection with an application for an insurance policy, a policy reinstatement or a request for change in policy benefits, thirty months from the date the authorization is signed; or
(B) in the case of authorizations signed for the purpose of collecting information in connection with a claim for benefits under an insurance policy:
(i) the term of coverage of the policy if the claim is for a health insurance benefit; or
(ii) the duration of the claim if the claim is not for a health insurance benefit; and
(8) advises the individual or a person authorized to act on behalf of such individual that such individual or the individual's authorized representative is entitled to receive a copy of the authorization form.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175i - Insurance Information and Privacy Protection › Section 7 - Investigative Consumer Report; Personal Interview; Prohibited Information

Section 7. (a) No insurance institution, insurance representative or insurance-support organization may prepare or request an investigative consumer report about an individual in connection with an insurance transaction involving an application for insurance, a policy renewal, a policy reinstatement or a change in insurance benefits unless the insurance institution or insurance representative informs the individual:
(1) that each individual may request to be interviewed in connection with the preparation of the investigative consumer report; and
(2) that upon a request pursuant to section eight, such individual is entitled to receive a copy of the investigative consumer report.
(b) If an investigative consumer report is to be prepared by an insurance institution or insurance representative, such insurance institution or insurance representative shall institute reasonable procedures to conduct a personal interview requested by an individual.
(c) If an investigative consumer report is to be prepared by an insurance-support organization, the insurance institution or insurance representative desiring such report shall inform the insurance-support organization whether a personal interview has been requested by the individual. The insurance-support organization shall institute reasonable procedures to conduct such reviews, if requested.
(d) No investigative consumer report shall contain any information designed to determine the sexual orientation of an applicant, proposed insured, policyholder, beneficiary or any other person, or for such persons, information relating to counseling for Acquired Immune Deficiency Syndrome (AIDS) or AIDS–related Complex (ARC) as defined by the Centers for Disease Control of the United States Public Health Service. For purposes of this subsection, ''counseling'' shall not mean diagnosis of or treatment for AIDS or ARC.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175i - Insurance Information and Privacy Protection › Section 11 - Prior Adverse Underwriting Decisions; Requests for Information by Insurance Organizations

Section 11. No insurance institution, insurance representative or insurance-support organization may seek information in connection with an insurance transaction concerning any previous adverse underwriting decision experienced by an individual unless such inquiry also requests the reasons for any previous adverse underwriting decision.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175i - Insurance Information and Privacy Protection › Section 12 - Adverse Underwriting Decision; Basis

Section 12. No insurance institution or insurance representative may base an adverse underwriting decision in whole or in part:
(1) on the fact of a previous adverse underwriting decision or on the fact that an individual previously obtained insurance coverage through a residual market mechanism; provided, however, that an insurance institution or insurance representative may base an adverse underwriting decision on further information obtained from an insurance institution or insurance representative responsible for a previous adverse underwriting decision;
(2) on personal information received from an insurance-support organization whose primary source of information is insurance institutions; provided, however, that an insurance institution or insurance representative may base an adverse underwriting decision on further personal information obtained as the result of information received from such insurance-support organization; or
(3) on the basis of sexual orientation; provided, however, that neither the national origin, marital status, lifestyle or living arrangements, occupation, gender, medical history, beneficiary designation, nor zip code or other territorial classification of the applicant may be used to establish, or aid in establishing, the applicant's sexual orientation.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175i - Insurance Information and Privacy Protection › Section 14 - Investigations

Section 14. (a) The commissioner shall have power to examine and investigate into the affairs of every insurance institution or insurance representative doing business in the commonwealth to determine whether such insurance institution or insurance representative has been or is engaged in any conduct in violation of this chapter.
(b) The commissioner shall have the power to examine and investigate into the affairs of every insurance-support organization acting on behalf of an insurance institution or insurance representative which either transacts business in the commonwealth or transacts business outside the commonwealth that has an effect on a person residing in the commonwealth in order to determine whether such insurance-support organization has been or is engaged in any conduct in violation of this chapter.