reglab/statecodes huggingface dataset:
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 37 - PRIOR AUTHORIZATION FAIRNESS ACT (§§ 56-7-3701 — 56-7-3722) › Section 56-7-3713 - [Effective 1/1/2025] Payment

(a)
A health carrier or utilization review organization shall pay a healthcare provider at the contracted payment rate for a healthcare service provided by the healthcare provider per an approved prior authorization unless:
(1)
The healthcare provider knowingly and materially misrepresented the healthcare service in the prior authorization request with the specific intent to deceive and obtain an unlawful payment from the health carrier;
(2)
The healthcare provider was no longer contracted with the patient's health benefit plan on the date the healthcare service was provided;
(3)
The healthcare provider failed to meet the timely filing requirements of the health carrier; or
(4)
The health carrier does not have liability for a claim.
(b)
A health carrier shall pay a healthcare provider for performing a healthcare service if the prior authorization for the service was obtained by another healthcare provider.
(c)
The health carrier shall provide reimbursement for healthcare services retroactively deemed medically necessary, regardless of when prior authorization was approved, for a maximum period of eighteen (18) months.
(d)
Payment must be guaranteed when a prior authorization submitted under §
56-7-3705
is approved.
(e)
This section does not apply to prescription drugs that are covered under an enrollee's benefit plan.
Amended by 2023 Tenn. Acts, ch. 395, s 4, eff. 1/1/2025.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 37 - PRIOR AUTHORIZATION FAIRNESS ACT (§§ 56-7-3701 — 56-7-3722) › Section 56-7-3714 - [Effective 1/1/2025] Prior authorization transfers

(a)
Upon receipt of information documenting a prior authorization from the enrollee or from the enrollee's healthcare provider, a prior authorization granted to an enrollee from a previous utilization review organization or health carrier must be honored for at least the initial ninety (90) days of an enrollee's coverage under a new health benefit plan.
(b)
During the time period described under subsection (a), a health carrier or utilization review organization may perform its own review to approve or deny the prior authorization approved by the enrollee's previous health benefit plan effective when the initial ninety-day period expires.
(c)
If there is a change in coverage of, or approval criteria for, a previously authorized healthcare service, then the change in coverage or approval criteria must not affect an enrollee who received prior authorization before the effective date of the change for the remainder of the enrollee's health benefit plan year.
(d)
A health carrier or utilization review organization shall continue to honor a prior authorization it has granted to an enrollee when the enrollee changes plans carried or administered by the same health carrier.
Amended by 2023 Tenn. Acts, ch. 395, s 4, eff. 1/1/2025.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 37 - PRIOR AUTHORIZATION FAIRNESS ACT (§§ 56-7-3701 — 56-7-3722) › Section 56-7-3715 - [Effective 1/1/2025] Related service

(a)
A utilization review organization shall not deem as incidental or deny claims for supplies or healthcare services that are routinely used as part of a healthcare service when:
(1)
A closely related service has received prior authorization; or
(2)
Prior authorization for the healthcare service is not required.
(b)
As used in this section, "closely related service" means a similar service to the service allowed by prior authorization and required by the standard of care.
Amended by 2023 Tenn. Acts, ch. 395, s 4, eff. 1/1/2025.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 37 - PRIOR AUTHORIZATION FAIRNESS ACT (§§ 56-7-3701 — 56-7-3722) › Section 56-7-3716 - [Effective 1/1/2025] Reviewer criteria

(a)
A health carrier is responsible for monitoring all utilization review activities performed on its behalf and for ensuring that all requirements of this chapter and applicable rules are met.
(b)
The health carrier shall ensure that appropriate personnel have operational responsibility for the conduct of the utilization review program.
(c)
Whenever a health carrier contracts with a utilization review organization to perform services subject to this part or applicable rules, the commissioner shall hold the health carrier responsible for monitoring the activities of such utilization review organization and for ensuring that the requirements of this part and applicable rules are met.
(d)
A utilization review organization shall use clinical criteria as specified in §
56-7-3707(b)
.
Amended by 2023 Tenn. Acts, ch. 395, s 4, eff. 1/1/2025.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 37 - PRIOR AUTHORIZATION FAIRNESS ACT (§§ 56-7-3701 — 56-7-3722) › Section 56-7-3717 - [Effective 1/1/2025] Statistics

A health carrier or utilization review organization requiring prior authorization shall make de-identified aggregate statistics available by service code regarding prior authorization approvals and denials on its website in a readily accessible format. The commissioner shall determine the information required in order to comply with this section and in accordance with applicable state and federal privacy laws. Such statistics include, but are not limited to:
(1)
The number of initial prior authorization requests that were approved or denied during the previous benefit plan year by the health carrier or utilization review organization;
(2)
The number of prior authorization requests that were appealed;
(3)
The number of appeals overturned and the number granted;
(4)
The time between submission of an initial prior authorization request and response;
(5)
The top five (5) reasons for denial;
(6)
The average time between submission and response for an initial prior authorization request;
(7)
The average time between submission and response for an appeal of a prior authorization denial; and
(8)
Any other information that the commissioner determines appropriate.
Amended by 2023 Tenn. Acts, ch. 395, s 4, eff. 1/1/2025.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 37 - PRIOR AUTHORIZATION FAIRNESS ACT (§§ 56-7-3701 — 56-7-3722) › Section 56-7-3718 - [Effective 1/1/2025] Prior authorization requirements

A health carrier or utilization review organization shall, at least annually, review its prior authorization requirements and consider removal of prior authorization where a prescription or medical service check is customary and properly indicated or is a treatment for the clinical indication as supported by peer-reviewed medical publications.
Amended by 2023 Tenn. Acts, ch. 395, s 4, eff. 1/1/2025.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 37 - PRIOR AUTHORIZATION FAIRNESS ACT (§§ 56-7-3701 — 56-7-3722) › Section 56-7-3719 - [Effective 1/1/2025] Website notice requirements

(a)
A health carrier or utilization review organization shall make all current prior authorization requirements readily accessible on its website to healthcare providers.
(b)
The website must indicate each service subject to prior authorization while satisfying the following requirements:
(1)
Putting the lettering and notification for each service in bold typeface;
(2)
Indicating when prior authorization became required for policies issued or delivered in this state, including the termination date or dates, if applicable;
(3)
Identifying the date when the Tennessee-specific requirement was listed on the health carrier's or its contracted review utilization review organization's website;
(4)
Providing the date, the prior authorization requirement was removed from the Tennessee-issued policy, if applicable; and
(5)
Providing access to a standardized electronic prior authorization request transaction process, if applicable.
Amended by 2023 Tenn. Acts, ch. 395, s 4, eff. 1/1/2025.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 37 - PRIOR AUTHORIZATION FAIRNESS ACT (§§ 56-7-3701 — 56-7-3722) › Section 56-7-3720 - [Effective 1/1/2025] Applicability

(a)
Except as provided in subsection (b), this part applies to all:
(1)
Insurers providing a healthcare plan that pays for the provision of healthcare services to covered persons; and
(2)
Healthcare plans and state healthcare plans.
(b)
This part does not apply to:
(1)
Healthcare plans that are subject to the exclusive jurisdiction of the federal Employee Retirement Income Security Act of 1974 (
29 U.S.C. § 1001
et seq.);
(2)
A policy of insurance issued pursuant to a contract with the bureau of TennCare;
(3)
TennCare or a successor program provided for in title 71, chapter 5; or
(4)
CoverKids or a successor program provided for in the CoverKids Act of 2006, compiled in title 71, chapter 3, part 11.
Amended by 2023 Tenn. Acts, ch. 395, s 4, eff. 1/1/2025.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 37 - PRIOR AUTHORIZATION FAIRNESS ACT (§§ 56-7-3701 — 56-7-3722) › Section 56-7-3721 - [Effective 1/1/2025] Provider notification to health carrier

If a health carrier requires a healthcare provider to notify the health carrier that an enrollee has received a healthcare service or has been admitted to a facility, such notification requirement includes, if applicable, one (1) additional business day if the notification deadline falls on a weekend or state or federal holiday.
Amended by 2023 Tenn. Acts, ch. 395, s 4, eff. 1/1/2025.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 37 - PRIOR AUTHORIZATION FAIRNESS ACT (§§ 56-7-3701 — 56-7-3722) › Section 56-7-3722 - [Effective 1/1/2025.] Rules

The commissioner may promulgate rules to carry out this part in accordance with the Uniform Administrative Procedures Act, codified in title 4, chapter 5.
Amended by 2023 Tenn. Acts, ch. 395, s 4, eff. 1/1/2025.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 8 - UNFAIR COMPETITION AND UNFAIR OR DECEPTIVE PRACTICES (§§ 56-8-101 — 56-8-206) › Part 1 - UNFAIR TRADE PRACTICES AND UNFAIR CLAIMS SETTLEMENT ACT OF 2009 (§§ 56-8-101 — 56-8-114) › Section 56-8-101 - Short title - Purpose - Authority of commissioner

(a)
This part shall be known and may be cited as the "Tennessee Unfair Trade Practices and Unfair Claims Settlement Act of 2009".
(b)
The purpose of this part is to regulate trade and claims settlement practices in the business of insurance in accordance with the intent of congress as expressed in the Act of Congress of March 9, 1945, (Public Law 15, 79th Congress) and the Gramm-Leach-Bliley Act (Public Law 106-102, 106th Congress), by defining, or providing for the determination of, all such practices in this state that constitute unfair methods of competition or unfair or deceptive acts or practices and by prohibiting the trade practices and claim settlement practices so defined or determined.
(c)
Notwithstanding any other state law to the contrary, the commissioner shall have sole enforcement authority for this part, and nothing in this part shall be construed to create or imply a private cause of action for a violation of this part.
Acts 2008 , ch. 1079, §§ 1, 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 8 - UNFAIR COMPETITION AND UNFAIR OR DECEPTIVE PRACTICES (§§ 56-8-101 — 56-8-206) › Part 1 - UNFAIR TRADE PRACTICES AND UNFAIR CLAIMS SETTLEMENT ACT OF 2009 (§§ 56-8-101 — 56-8-114) › Section 56-8-103 - Unfair methods of competition and unfair or deceptive acts or practices prohibited

No person shall engage in an unfair trade practice from, in or into this state that is defined in §
56-8-104
or §
56-8-106
or determined by rule pursuant to §
56-8-108
to be an unfair method of competition or an unfair or deceptive act or practice in the business of insurance. No person shall engage in an unfair claim practice that is defined in §
56-8-105
or determined by rule pursuant to §
56-8-108
to be an unfair claim practice. However, the commissioner may not levy a civil penalty or suspend or revoke a license for violating an unfair claim practice unless:
(1)
It is committed knowingly; or
(2)
It has been committed with such frequency as to indicate a general business practice.
Acts 2008, ch. 1079, §§ 1, 4.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 8 - UNFAIR COMPETITION AND UNFAIR OR DECEPTIVE PRACTICES (§§ 56-8-101 — 56-8-206) › Part 1 - UNFAIR TRADE PRACTICES AND UNFAIR CLAIMS SETTLEMENT ACT OF 2009 (§§ 56-8-101 — 56-8-114) › Section 56-8-108 - Additional powers of commissioner

(a)
In addition to any other authority granted in this part, the commissioner shall have the authority to declare by rule certain acts to be unfair trade practices or unfair methods of competition or unfair or deceptive acts or practices in the business of insurance that are not specifically defined in this part. The commissioner may promulgate the rules by emergency rules upon making a finding that such is in the public interest.
(b)
The commissioner, at the rulemaking hearing, may administer oaths, and receive oral and documentary evidence. The commissioner shall have the power to subpoena witnesses, compel their attendance, and require the production of books, papers, records, correspondence or other documents the commissioner deems relevant to the inquiry; provided, however, that in the case of depository institutions, the commissioner shall have the power to require the production of books, papers, records, correspondence or other documents that the commissioner deems relevant to the inquiry only on the insurance activities of the depository institution. No person shall be compelled to provide a document or disclose information that is privileged under statutory or common law. The commissioner may and, upon the request of any party, shall cause to be made a stenographic record of all the evidence and all the proceedings at the hearing. In case of a refusal of any person to comply with any subpoena or to testify with respect to any matter concerning which that person may be lawfully interrogated, the chancery court of Davidson County or the county where the person resides, on application of the commissioner, may issue an order requiring the person to comply with the subpoena and to testify. Any failure to obey any order of the court may be punished by the court as contempt.
Acts 2008, ch. 1079, §§ 1, 9; 2009, ch. 566, § 12.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 8 - UNFAIR COMPETITION AND UNFAIR OR DECEPTIVE PRACTICES (§§ 56-8-101 — 56-8-206) › Part 1 - UNFAIR TRADE PRACTICES AND UNFAIR CLAIMS SETTLEMENT ACT OF 2009 (§§ 56-8-101 — 56-8-114) › Section 56-8-109 - Violations of part or rules

Whenever it appears to the commissioner that any person has violated or is about to violate this part or any rule promulgated under this part, the commissioner may, in the commissioner's discretion, bring an action in the chancery court of Davidson County to enjoin the violation and to enforce compliance with this part, any rule under this part or any order lawfully entered pursuant to this section. The court shall not require the commissioner to post a bond.
Acts 2008, ch. 1079, §§ 1, 10.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 8 - UNFAIR COMPETITION AND UNFAIR OR DECEPTIVE PRACTICES (§§ 56-8-101 — 56-8-206) › Part 1 - UNFAIR TRADE PRACTICES AND UNFAIR CLAIMS SETTLEMENT ACT OF 2009 (§§ 56-8-101 — 56-8-114) › Section 56-8-110 - Promulgation of rules and orders - Review

The commissioner is authorized, after notice and hearing, to promulgate reasonable rules and orders as are necessary or proper to carry out and effectuate this part. The rules shall be subject to review in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
Acts 2008, ch. 1079, §§ 1, 11.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 8 - UNFAIR COMPETITION AND UNFAIR OR DECEPTIVE PRACTICES (§§ 56-8-101 — 56-8-206) › Part 1 - UNFAIR TRADE PRACTICES AND UNFAIR CLAIMS SETTLEMENT ACT OF 2009 (§§ 56-8-101 — 56-8-114) › Section 56-8-111 - Powers of commissioner additional to existing law

The powers vested in the commissioner by this part shall be in addition to any other powers in this title to enforce any penalties, fines or forfeitures authorized by law with respect to the methods, acts and practices declared to be unfair or deceptive by this part.
Acts 2008, ch. 1079, §§ 1, 12.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 8 - UNFAIR COMPETITION AND UNFAIR OR DECEPTIVE PRACTICES (§§ 56-8-101 — 56-8-206) › Part 1 - UNFAIR TRADE PRACTICES AND UNFAIR CLAIMS SETTLEMENT ACT OF 2009 (§§ 56-8-101 — 56-8-114) › Section 56-8-112 - Voluntary wellness or health improvement program using incentives or rewards

(a)
An insurer issuing a group or individual benefit plan may offer a voluntary wellness or health improvement program that uses incentives or rewards, or any combination of incentives or rewards, to encourage or reward a plan member's participation in the program. Such incentives and rewards may include, but not be limited to, the following:
(1)
Merchandise;
(2)
Gift cards;
(3)
Debit cards;
(4)
Premium discounts or rebates;
(5)
Contributions towards a plan member's health savings account; or
(6)
Modifications to co-payment, deductible, or co-insurance amounts.
(b)
If an incentive or reward established pursuant to this section is disclosed in the insurer's policy or certificate, then giving, or offering to give, the incentive or reward to a plan member shall not constitute a violation of §
56-8-104(8)
.
(c)
An insurer may require a plan member to provide verification to the insurer that the plan member has a medical condition that makes the plan member's participation in the program unreasonably difficult or medically inadvisable prior to establishing a reasonable alternative standard for obtaining an incentive or reward.
(d)
Nothing in this section shall prohibit an insurer from offering or giving an incentive or reward to a plan member to encourage or reward the member's participation in a voluntary wellness or health improvement program if additional incentives or rewards, or uses of incentives or rewards, are otherwise permitted by state or federal law.
Acts 2011, ch. 118, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 8 - UNFAIR COMPETITION AND UNFAIR OR DECEPTIVE PRACTICES (§§ 56-8-101 — 56-8-206) › Part 1 - UNFAIR TRADE PRACTICES AND UNFAIR CLAIMS SETTLEMENT ACT OF 2009 (§§ 56-8-101 — 56-8-114) › Section 56-8-113 - Remedies and sanctions for breach of, or for alleged unfair or deceptive acts or practices in connection with, a contract of insurance

Notwithstanding any other law, title 50 and this title shall provide the sole and exclusive statutory remedies and sanctions applicable to an insurer, person, or entity licensed, permitted, or authorized to do business under this title for alleged breach of, or for alleged unfair or deceptive acts or practices in connection with, a contract of insurance as such term is defined in §
56-7-101(a)
. Nothing in this section shall be construed to eliminate or otherwise affect any:
(1)
Remedy, cause of action, right to relief or sanction available under common law;
(2)
Right to declaratory, injunctive or equitable relief, whether provided under title 29 or the Tennessee Rules of Civil Procedure; or
(3)
Statutory remedy, cause of action, right to relief or sanction referenced in title 50 or this title.
Acts 2011, ch. 130, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 8 - UNFAIR COMPETITION AND UNFAIR OR DECEPTIVE PRACTICES (§§ 56-8-101 — 56-8-206) › Part 1 - UNFAIR TRADE PRACTICES AND UNFAIR CLAIMS SETTLEMENT ACT OF 2009 (§§ 56-8-101 — 56-8-114) › Section 56-8-114

(a)
Insurers shall make determinations about the provision of services based on an analysis of sound underwriting and actuarial principles related to actual or reasonably anticipated loss experience unique to each current or prospective customer and shall not engage in a practice described in subsection (b). This subsection (a) does not restrict an insurer that claims a religious purpose from making such determinations based on the current or prospective customer's religious beliefs, religious exercise, or religious affiliations.
(b)
Except as otherwise provided in subsection (a), an insurer shall not refuse to insure, or charge a different rate to a person, solely on the basis of:
(1)
The person's political opinions, speech, or affiliations; or
(2)
The person's religious beliefs, religious exercise, or religious affiliations.
(c)
A violation of this section constitutes an unfair trade practice and is subject to the remedies as provided under this part.
Added by 2024 Tenn. Acts, ch. 746,s 3, eff. 7/1/2024.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 8 - UNFAIR COMPETITION AND UNFAIR OR DECEPTIVE PRACTICES (§§ 56-8-101 — 56-8-206) › Part 2 - DOMESTIC VIOLENCE VICTIMS HEALTH INSURANCE PROTECTION ACT (§§ 56-8-201 — 56-8-206) › Section 56-8-201 - Short title

This part shall be known and may be cited as the "Domestic Violence Victims Health Insurance Protection Act."
Acts 1996, ch. 723, § 6.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 8 - UNFAIR COMPETITION AND UNFAIR OR DECEPTIVE PRACTICES (§§ 56-8-101 — 56-8-206) › Part 2 - DOMESTIC VIOLENCE VICTIMS HEALTH INSURANCE PROTECTION ACT (§§ 56-8-201 — 56-8-206) › Section 56-8-203 - Discriminatory acts prohibited

No insurer or health carrier may engage in an unfairly discriminatory act or practice, as defined in §
56-8-204
, against a subject of abuse on the basis of that abuse status.
Acts 1996, ch. 723, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 8 - UNFAIR COMPETITION AND UNFAIR OR DECEPTIVE PRACTICES (§§ 56-8-101 — 56-8-206) › Part 2 - DOMESTIC VIOLENCE VICTIMS HEALTH INSURANCE PROTECTION ACT (§§ 56-8-201 — 56-8-206) › Section 56-8-204 - Discriminatory acts defined

(a)
Any of the following acts are prohibited as unfairly discriminatory:
(1)
Denying, refusing to issue, renew or reissue, canceling or otherwise terminating a health benefit plan, or restricting or excluding health benefit plan coverage, or adding a premium differential to any health benefit plan on the basis of the applicant's or insured's abuse status;
(2)
Excluding or limiting coverage or denying a claim incurred by an insured as a result of abuse on the basis of the insured's abuse status;
(3)
Terminating group coverage for a subject of abuse on the basis of the insured's abuse status where 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 voluntarily or involuntarily. Nothing in this subdivision (3) prohibits the insurer or health carrier from requiring the subject of abuse to pay the full premium for the person's coverage under the health plan or from requiring the subject of abuse to reside or work within its service area. Nothing in this subdivision (3) gives a subject of abuse any greater rights than the subject would otherwise have had to continued coverage under Tennessee or federal law. The continuation coverage required by this section shall be satisfied by any COBRA coverage provided to a subject of abuse and is not intended to be in addition to any coverage provided under COBRA; or
(4)
Disclosing or transferring any information, by a person employed by or contracting with a health carrier, relating to an applicant's or insured's abuse status or abuse-related medical condition, or the applicant's or insured's status as a family member, employer or associate of, or in a relationship with a subject of abuse, except:
(A)
For purposes related to the provision of health care services;
(B)
For the purpose of administering claims, utilization review or case management; or
(C)
Where required by the commissioner or a court of competent jurisdiction.
(b)
Nothing in this section shall be construed to prohibit a health carrier from asking an applicant or insured about a medical condition, even if the condition is abuse-related, or using information thereby obtained for the purpose of acts or practices permitted by this part. A subject of abuse, at the subject's absolute discretion, may provide evidence of abuse to a health carrier for the limited purpose of facilitating treatment of an abuse-related condition or demonstrating that a medical condition is abuse-related, and nothing in this section shall be construed as authorizing the health carrier to disregard that information.
Acts 1996, ch. 723, § 3.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 8 - UNFAIR COMPETITION AND UNFAIR OR DECEPTIVE PRACTICES (§§ 56-8-101 — 56-8-206) › Part 2 - DOMESTIC VIOLENCE VICTIMS HEALTH INSURANCE PROTECTION ACT (§§ 56-8-201 — 56-8-206) › Section 56-8-205 - Permissible actions by insurers

Underwriting in accordance with the standards set forth in this section shall be deemed not to be a violation of this part. Upon request of the commissioner, a health carrier or insurer of an individual or group policy that has taken an action that adversely affects a subject of abuse on the basis of an abuse-related medical condition must explain the reason for its action to the commissioner in writing and must be able to demonstrate that its action:
(1)
Does not have the purpose or effect of treating abuse status as a medical condition or underwriting criterion;
(2)
Is otherwise permissible by law and applies in the same manner and to the same extent to all applicants and insureds with a similar medical condition without regard to whether the condition or claim is abuse-related; and
(3)
Is based on a determination, made in conformance with actual or reasonably anticipated actuarial experience.
Acts 1996, ch. 723, § 4.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 8 - UNFAIR COMPETITION AND UNFAIR OR DECEPTIVE PRACTICES (§§ 56-8-101 — 56-8-206) › Part 2 - DOMESTIC VIOLENCE VICTIMS HEALTH INSURANCE PROTECTION ACT (§§ 56-8-201 — 56-8-206) › Section 56-8-206 - Investigations

The commissioner shall conduct a reasonable investigation based on a written and signed complaint received by the commissioner and issue a prompt determination as to whether a violation of this part has occurred. If the commissioner finds from the investigation that a violation of this part may have occurred, the commissioner shall promptly begin proceedings to address the violation pursuant to §§
56-8-108
and
56-8-109
.
Acts 1996, ch. 723, § 5.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 9 - INSURERS REHABILITATION AND LIQUIDATION ACT (§§ 56-9-101 — 56-9-511) › Part 1 - GENERAL PROVISIONS (§§ 56-9-101 — 56-9-109) › Section 56-9-101 - Short title - Liberal construction - Purpose

(a)
This chapter shall be known and may be cited as the "Insurers Rehabilitation and Liquidation Act."
(b)
This chapter shall not be interpreted to limit the powers granted the commissioner by other provisions of the law.
(c)
This chapter shall be liberally construed to effect the purpose stated in subsection (d).
(d)
The purpose of this chapter is the protection of the interests of insureds, claimants, creditors and the public generally, with minimum interference with the normal prerogatives of the owners and managers of insurers, through:
(1)
Early detection of any potentially dangerous condition in an insurer, and prompt application of appropriate corrective measures;
(2)
Improved methods for rehabilitating insurers, involving the cooperation and management expertise of the insurance industry;
(3)
Enhanced efficiency and economy of liquidation, through clarification of the law, to minimize legal uncertainty and litigation;
(4)
Equitable apportionment of any unavoidable loss;
(5)
Lessening the problems of interstate rehabilitation and liquidation by facilitating cooperation between states in the liquidation process, and by extending the scope of personal jurisdiction over debtors of the insurer outside this state;
(6)
Regulation of the insurance business by the impact of the law relating to delinquency procedures and substantive rules on the entire insurance business; and
(7)
Providing for a comprehensive scheme for the rehabilitation and liquidation of insurance companies and those subject to this chapter as part of the regulation of the business of insurance, insurance industry and insurers in this state. Proceedings in cases of insurer insolvency and delinquency are deemed an integral aspect of the business of insurance and are of vital public interest and concern.
Acts 1991, ch. 142, § 4.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 9 - INSURERS REHABILITATION AND LIQUIDATION ACT (§§ 56-9-101 — 56-9-511) › Part 1 - GENERAL PROVISIONS (§§ 56-9-101 — 56-9-109) › Section 56-9-102 - Applicability

The proceedings authorized by this chapter may be applied to:
(1)
All insurers who are doing, or have done, an insurance business in this state, and against whom claims arising from that business may exist now or in the future;
(2)
All insurers who purport to do an insurance business in this state;
(3)
All insurers who have insureds resident in this state;
(4)
All other persons organized or in the process of organizing with the intent to do an insurance business in this state;
(5)
All nonprofit service plans and all fraternal benefit societies and beneficial societies subject to §
56-25-606
;
(6)
All title insurance companies subject to chapter 35 of this title;
(7)
All prepaid health care delivery plans; and
(8)
All fidelity, bonding or surety companies under chapter 15 of this title, and all annuity companies who do business in this state.
Acts 1991, ch. 142, § 4.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 9 - INSURERS REHABILITATION AND LIQUIDATION ACT (§§ 56-9-101 — 56-9-511) › Part 1 - GENERAL PROVISIONS (§§ 56-9-101 — 56-9-109) › Section 56-9-104 - Delinquency proceeding - Commencement - Jurisdiction

(a)
No delinquency proceeding shall be commenced under this chapter by anyone other than the commissioner and no court has jurisdiction to entertain, hear or determine any proceeding commenced by any other person.
(b)
No court of this state has jurisdiction to entertain, hear or determine any complaint praying for the dissolution, liquidation, rehabilitation, sequestration, conservation or receivership of any insurer, or praying for an injunction or restraining order or other relief preliminary to, incidental to or relating to the proceedings other than in accordance with this chapter.
(c)
In addition to other grounds for jurisdiction provided by the law of this state, a court of this state having jurisdiction of the subject matter has jurisdiction over a person served pursuant to the Tennessee Rules of Civil Procedure or other applicable law in an action brought by the receiver of a domestic insurer or an alien insurer domiciled in this state if:
(1)
The person served is an agent, broker or other person who has at any time written policies of insurance for or has acted in any manner whatsoever on behalf of an insurer against which a delinquency proceeding has been instituted, in any action resulting from or incident to such a relationship with the insurer;
(2)
The person served is a reinsurer who has at any time entered into a contract of reinsurance with an insurer against which a delinquency proceeding has been instituted, or is an agent or broker of or for the reinsurer, in any action on or incident to the reinsurance contract;
(3)
The person served is or has been an officer, director, manager, trustee, organizer, promoter or other person in a position of comparable authority or influence over an insurer against which a delinquency proceeding has been instituted, in any action resulting from or incident to such a relationship with the insurer;
(4)
The person served is, or was at the time of the institution of the delinquency proceeding against the insurer, holding assets in which the receiver claims an interest on behalf of the insurer, in any action concerning the assets; or
(5)
The person served is obligated to the insurer in any way whatsoever, in any action on, or incident to, the obligation.
(d)
If the court on motion of any party finds that any action should as a matter of substantial justice be tried in a forum outside this state, the court may enter an appropriate order to stay further proceedings on the action in this state.
(e)
All actions authorized in this section shall be brought in the chancery court of Davidson County.
Acts 1991, ch. 142, § 4.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 9 - INSURERS REHABILITATION AND LIQUIDATION ACT (§§ 56-9-101 — 56-9-511) › Part 1 - GENERAL PROVISIONS (§§ 56-9-101 — 56-9-109) › Section 56-9-105 - Receivers - Restraining order and injunctive relief - Federal home loan bank

(a)
Any receiver appointed in a proceeding under this chapter may at any time apply for, and any court of general jurisdiction may grant, the restraining orders, preliminary and permanent injunctions, and other orders as may be deemed necessary and proper to prevent:
(1)
The transaction of further business;
(2)
The transfer of property;
(3)
Interference with the receiver or with a proceeding under this chapter;
(4)
Waste of the insurer's assets;
(5)
Dissipation and transfer of bank accounts;
(6)
The institution or further prosecution of any actions or proceedings;
(7)
The obtaining of preferences, judgments, attachments, garnishments or liens against the insurer, its assets or its policyholders;
(8)
The levying of execution against the insurer, its assets or its policyholders;
(9)
The making of any sale or deed for nonpayment of taxes or assessments that would lessen the value of the assets of the insurer;
(10)
The withholding from the receiver of books, accounts, documents or other records relating to the business of the insurer; or
(11)
Any other threatened or contemplated action that might lessen the value of the insurer's assets or prejudice the rights of policyholders, creditors or shareholders, or the administration of any proceeding under this chapter.
(b)
The receiver may apply to any court outside of this state for the relief described in subsection (a).
(c)
Notwithstanding subsections (a) and (b) and any other provision of this title, a federal home loan bank shall not be stayed, enjoined, or prohibited from exercising or enforcing any right or cause of action regarding collateral pledged under a security agreement or under any pledge agreement, security agreement, collateral agreement, or other similar arrangement or credit enhancement relating to a security agreement to which the federal home loan bank is a party.
Amended by 2019 Tenn. Acts, ch. 430,s 2, eff. 5/21/2019.
Acts 1991, ch. 142, § 4.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 9 - INSURERS REHABILITATION AND LIQUIDATION ACT (§§ 56-9-101 — 56-9-511) › Part 1 - GENERAL PROVISIONS (§§ 56-9-101 — 56-9-109) › Section 56-9-106 - Obligation to cooperate with commissioner - Obstruction of, or interference with, commissioner - Penalties

(a)
(1)
Any officer, manager, director, trustee, owner, employee or agent of any insurer, or any other persons with authority over, or in charge of, any segment of the insurer's affairs, shall cooperate with the commissioner in any proceeding under this chapter or any investigation preliminary to the proceeding.
(2)
As used in this section:
(A)
"Person" includes any person who exercises control directly or indirectly over activities of the insurer through any holding company or other affiliate of the insurer; and
(B)
"To cooperate" includes, but is not limited to, the following:
(i)
To reply promptly in writing to any inquiry from the commissioner requesting such a reply; and
(ii)
To make available to the commissioner any books, accounts, documents, or other records or information or property of, or pertaining to, the insurer and in the person's possession, custody or control.
(b)
No person shall obstruct or interfere with the commissioner in the conduct of any delinquency proceeding or any investigation preliminary or incidental thereto.
(c)
This section shall not be construed to abridge otherwise existing legal rights, including the right to resist a petition for liquidation or other delinquency proceedings, or other orders.
(d)
Any person included within subsection (a) who willfully and wrongfully obstructs or interferes with the commissioner in the conduct of any delinquency proceeding or any investigation preliminary or incidental thereto, or who violates any order the commissioner issued validly under this chapter may:
(1)
Be sentenced by a court of competent jurisdiction to pay a fine not exceeding ten thousand dollars ($10,000) or be punished for a Class E felony, or both; or
(2)
After a hearing, be subject to the imposition by the commissioner of a civil penalty not to exceed ten thousand dollars ($10,000) and shall be subject further to the revocation or suspension of any insurance licenses issued by the commissioner.
Acts 1991, ch. 142, § 4.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 9 - INSURERS REHABILITATION AND LIQUIDATION ACT (§§ 56-9-101 — 56-9-511) › Part 1 - GENERAL PROVISIONS (§§ 56-9-101 — 56-9-109) › Section 56-9-107 - Applicability

Every proceeding heretofore commenced under the laws in effect before July 1, 1991, shall be deemed to have commenced under this chapter for the purpose of conducting the proceeding henceforth, except that, in the discretion of the commissioner, the proceeding may be continued, in whole or in part, as it would have been continued had this chapter not been enacted.
Acts 1991, ch. 142, § 4.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 9 - INSURERS REHABILITATION AND LIQUIDATION ACT (§§ 56-9-101 — 56-9-511) › Part 1 - GENERAL PROVISIONS (§§ 56-9-101 — 56-9-109) › Section 56-9-108 - Insurers subject to delinquency proceedings - Restrictions

No insurer that is subject to any delinquency proceedings, whether formal or informal, administrative or judicial, shall:
(1)
Be released from the proceeding, unless the proceeding is converted into a judicial rehabilitation or liquidation proceeding;
(2)
Be permitted to solicit or accept new business or request or accept the restoration of any suspended or revoked license or certificate of authority;
(3)
Be returned to the control of its shareholders or private management; or
(4)
Have any of its assets returned to the control of its shareholders or private management until all payments of, or on account of, the insurer's contractual obligations by all guaranty associations, together with all expenses and interest on all the payments and expenses, have been repaid to the guaranty associations or a plan of repayment by the insurer has been approved by the guaranty association.
Acts 1991, ch. 142, § 4.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 9 - INSURERS REHABILITATION AND LIQUIDATION ACT (§§ 56-9-101 — 56-9-511) › Part 1 - GENERAL PROVISIONS (§§ 56-9-101 — 56-9-109) › Section 56-9-109 - Authentication of documents - Petitions and exhibitions - Cost of reproducing records

(a)
The receivership court shall receive as self-authenticated any of the following when offered by the commissioner:
(1)
Certified copies of the financial statements made by the insurer; and
(2)
Certified copies of examination reports of the insurer made by or on behalf of the commissioner.
(b)
The receiver has the authority to certify to the correctness of any paper, document or record of the office of the receiver and to make certificates of the receiver certifying any fact contained in the papers, documents or records of the office of the receiver; and the same shall be received in evidence in all cases in which the original would be evidence.
(c)
At any receivership hearing or proceeding, the verified petition and exhibits filed therewith shall be received as prima facie evidence of the facts therein contained.
(d)
The appointment of the commissioner as receiver shall in no way operate to bring records of a delinquent insurer under §
10-7-503
. If a third party successfully pursues a records request in the receivership court, the receiver shall be reimbursed for the reasonable cost of producing the records.
Acts 1999, ch. 348, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 9 - INSURERS REHABILITATION AND LIQUIDATION ACT (§§ 56-9-101 — 56-9-511) › Part 2 - SUMMARY PROCEEDINGS (§§ 56-9-201 — 56-9-202) › Section 56-9-201 - Grounds for filing by commissioner - Court order

(a)
The commissioner may file in the chancery court of Davidson County a petition alleging, with respect to a domestic insurer:
(1)
That there exists any grounds that would justify a court order for a formal delinquency proceeding against an insurer under this part;
(2)
That the interests of policyholders, creditors or the public will be endangered by delay; and
(3)
The contents of an order deemed necessary by the commissioner.
(b)
Upon a filing under subsection (a), the court may issue forthwith, ex parte and without a hearing, the requested order, which shall direct the commissioner to take possession and control of all or a part of the property, books, accounts, documents and other records of an insurer, and of the premises occupied by it for transaction of its business; and, until further order of the court, enjoin the insurer and its officers, managers, agents and employees from disposition of its property and from the transaction of its business except with the written consent of the commissioner.
(c)
The court shall specify in the order what its duration shall be, which shall be the time as the court deems necessary for the commissioner to ascertain the condition of the insurer. On motion of either party or on its own motion, the court may from time to time hold hearings as it deems desirable after notice as it deems appropriate, and may extend, shorten or modify the terms of the seizure order. The court shall vacate the seizure order if the commissioner fails to commence a formal proceeding under this chapter after having had a reasonable opportunity to do so. An order of the court pursuant to a formal proceeding under this chapter shall ipso facto vacate the seizure order.
(d)
Entry of a seizure order under this section shall not constitute an anticipatory breach of any contract of the insurer.
(e)
An insurer subject to an ex parte order under this section may petition the court at any time after the issuance of the order for a hearing and review of the order. The court shall hold such a hearing and review not more than fifteen (15) days after the request. A hearing under this subsection (e) may be held privately in chambers, and it shall be so held if the insurer proceeded against so requests.
(f)
If, at any time after the issuance of such an order, it appears to the court that any person whose interest is or will be substantially affected by the order did not appear at the hearing and has not been served, the court may order that notice be given. An order that notice be given shall not stay the effect of any order previously issued by the court.
Acts 1991, ch. 142, § 4.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 9 - INSURERS REHABILITATION AND LIQUIDATION ACT (§§ 56-9-101 — 56-9-511) › Part 2 - SUMMARY PROCEEDINGS (§§ 56-9-201 — 56-9-202) › Section 56-9-202 - Records of delinquency proceedings - Confidentiality

(a)
In all proceedings and judicial reviews under §
56-9-201
, all records of the insurer, other documents, and all insurance department files and court records and papers, so far as they pertain to, or are a part of, the record of the proceedings, shall be and remain confidential except as is necessary to obtain compliance therewith, unless and until the chancery court of Davidson County, after hearing arguments from the parties in chambers, shall order otherwise, or unless the insurer requests that the matter be made public. Until the court order, all papers filed with the clerk of the chancery court of Davidson County shall be held by the clerk in a confidential file.
(b)
Subsection (a) shall not be applicable in any proceeding where the insurer on the date of the filing of the proceeding had derived fifty-one percent (51%) or more of its revenue for the past twelve (12) months from a contract or contracts with a governmental entity to provide health care services to enrollees in a publicly funded medical assistance program pursuant to title 71. In these cases, the records of the insurer, other documents, and all insurance department files and court records and papers, so far as they pertain to, or are a part of, the record of the proceeding and that reflect the financial solvency of the insurer, shall be open to public inspection under the Tennessee Public Records Act, compiled in title 10, chapter 7, unless otherwise required to be maintained as confidential under federal or state law. An insurer within fifteen (15) days from the date of seizure may apply to the court for a stay of application of this subsection (b), or for a protective order for particularized information that is proprietary in nature, the disclosure of which would be injurious to the rehabilitation of the insurer. This subsection (b) shall be stayed from the date of seizure until a court of competent jurisdiction rules on the application for a stay or a protective order.
Acts 1991, ch. 142, § 4; 2002, ch. 660, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 9 - INSURERS REHABILITATION AND LIQUIDATION ACT (§§ 56-9-101 — 56-9-511) › Part 3 - FORMAL PROCEEDINGS (§§ 56-9-301 — 56-9-339) › Section 56-9-302 - Order to rehabilitate business of insurer - Effect

(a)
(1)
An order to rehabilitate the business of a domestic insurer, or an alien insurer domiciled in this state, shall appoint the commissioner and the commissioner's successors in office the rehabilitator, and shall direct the rehabilitator immediately to take possession of the assets of the insurer and to administer them under the general supervision of the court.
(2)
The filing or recording of the order with the clerk of the chancery court of Davidson County or recorder of deeds of the county in which the principal business of the company is conducted, or the county in which its principal office or place of business is located, shall impart the same notice as a deed, bill of sale, or other evidence of title duly filed or recorded with that recorder of deeds would have imparted.
(3)
The order to rehabilitate the insurer shall by operation of law vest title to all assets of the insurer in the rehabilitator.
(b)
Any order issued under this section shall require accountings to the court by the rehabilitator. Accountings shall be at intervals that the court specifies in its order, but no less frequently than semi-annually. Each accounting shall include a report concerning the rehabilitator's opinion as to the likelihood that a plan under §
56-9-303(e)
shall be prepared by the rehabilitator and the timetable for doing so.
(c)
Entry of an order of rehabilitation shall not constitute an anticipatory breach of any contracts of the insurer nor shall it be grounds for retroactive revocation or retroactive cancellation of any contracts of the insurer, unless the revocation or cancellation is done by the rehabilitator pursuant to §
56-9-303
.
Acts 1991, ch. 142, § 4.