reglab/statecodes huggingface dataset:
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 46 - RISK-BASED CAPITAL (§§ 56-46-101 — 56-46-214) › Part 2 - RISK-BASED CAPITAL FOR HEALTH ORGANIZATIONS (§§ 56-46-201 — 56-46-214) › Section 56-46-205 - Authorized Control Level Events

(a)
"Authorized Control Level Event" means any of the following events:
(1)
The filing of an RBC report by the health organization that indicates that the health organization's total adjusted capital is greater than or equal to its Mandatory Control Level RBC but less than its Authorized Control Level RBC;
(2)
The notification by the commissioner to the health organization of an adjusted RBC report that indicates the event in subdivision (a)(1); provided, that the health organization does not challenge the adjusted RBC report under §
56-46-207
;
(3)
If, pursuant to §
56-46-207
, the health organization challenges an adjusted RBC report that indicates the event in subdivision (a)(1), notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge;
(4)
The failure of the health organization to respond, in a manner satisfactory to the commissioner, to a corrective order; provided, that the health organization has not challenged the corrective order under §
56-46-207
; or
(5)
If the health organization has challenged a corrective order under §
56-46-207
and the commissioner has, after a hearing, rejected the challenge or modified the corrective order, the failure of the health organization to respond, in a manner satisfactory to the commissioner, to the corrective order subsequent to rejection or modification by the commissioner.
(b)
If an Authorized Control Level Event occurs with respect to a health organization, the commissioner shall:
(1)
Take such actions as are required under §
56-46-204
regarding a health organization with respect to which a Regulatory Action Level Event has occurred; or
(2)
If the commissioner deems it to be in the best interests of the policyholders and creditors of the health organization and of the public, take such actions as are necessary to cause the health organization to be placed under regulatory control under chapter 9 of this title. In the event the commissioner takes such actions, the Authorized Control Level Event shall be deemed sufficient grounds for the commissioner to take action under chapter 9 of this title, and the commissioner shall have the rights, powers and duties with respect to the health organization as are set forth in chapter 9 of this title. In the event the commissioner takes actions under this subsection (b) pursuant to an adjusted RBC report, the health organization shall be entitled to such protections as are afforded to health organizations under chapter 9, part 2 of this title pertaining to summary proceedings.
Acts 2014, ch. 559, § 7.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 46 - RISK-BASED CAPITAL (§§ 56-46-101 — 56-46-214) › Part 2 - RISK-BASED CAPITAL FOR HEALTH ORGANIZATIONS (§§ 56-46-201 — 56-46-214) › Section 56-46-206 - Mandatory Control Level Events

(a)
"Mandatory Control Level Event" means any of the following events:
(1)
The filing of an RBC report which indicates that the health organization's total adjusted capital is less than its Mandatory Control Level RBC;
(2)
Notification by the commissioner to the health organization of an adjusted RBC report that indicates the event in subdivision (a)(1); provided, that the health organization does not challenge the adjusted RBC report under §
56-46-207
; or
(3)
If, pursuant to §
56-46-207
, the health organization challenges an adjusted RBC report that indicates the event in subdivision (a)(1), notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge.
(b)
(1)
In the event of a Mandatory Control Level Event, the commissioner shall take such actions as are necessary to place the health organization under regulatory control under chapter 9 of this title. In that event, the Mandatory Control Level Event shall be deemed sufficient grounds for the commissioner to take action under chapter 9 of this title, and the commissioner shall have the rights, powers and duties with respect to the health organization as are set forth in chapter 9 of this title. If the commissioner takes actions pursuant to an adjusted RBC report, the health organization shall be entitled to the protections of chapter 9, part 2 of this title pertaining to summary proceedings.
(2)
Notwithstanding subdivision (b)(1), the commissioner may forego action for up to ninety (90) days after the Mandatory Control Level Event if the commissioner finds there is a reasonable expectation that the Mandatory Control Level Event may be eliminated within the ninety-day period.
Acts 2014, ch. 559, § 7.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 46 - RISK-BASED CAPITAL (§§ 56-46-101 — 56-46-214) › Part 2 - RISK-BASED CAPITAL FOR HEALTH ORGANIZATIONS (§§ 56-46-201 — 56-46-214) › Section 56-46-207 - Confidential hearings

Upon the occurrence of any of the following events the health organization shall have the right to a confidential departmental hearing, on the record, at which the health organization may challenge any determination or action by the commissioner. The health organization shall notify the commissioner of its request for a hearing within five (5) days after the notification by the commissioner under subdivision (1), (2), (3) or (4). Upon receipt of the health organization's request for a hearing, the commissioner shall set a date for the hearing, which shall be no less than ten (10) nor more than thirty (30) days after the date of the health organization's request. The events include:
(1)
Notification to a health organization by the commissioner of an adjusted RBC report;
(2)
Notification to a health organization by the commissioner that:
(A)
The health organization's RBC plan or revised RBC plan is unsatisfactory; and
(B)
Notification constitutes a Regulatory Action Level Event with respect to the health organization;
(3)
Notification to a health organization by the commissioner that the health organization has failed to adhere to its RBC plan or revised RBC plan and that the failure has a substantial adverse effect on the ability of the health organization to eliminate the Company Action Level Event with respect to the health organization in accordance with its RBC plan or revised RBC plan; or
(4)
Notification to a health organization by the commissioner of a corrective order with respect to the health organization.
Acts 2014, ch. 559, § 7.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 46 - RISK-BASED CAPITAL (§§ 56-46-101 — 56-46-214) › Part 2 - RISK-BASED CAPITAL FOR HEALTH ORGANIZATIONS (§§ 56-46-201 — 56-46-214) › Section 56-46-209 - Construction with other laws - Rules - Exemptions

(a)
This part is supplemental to any other laws of this state, and shall not preclude or limit any other powers or duties of the commissioner under such laws, including, but not limited to, chapter 9 of this title.
(b)
The commissioner is authorized to promulgate rules and regulations to effectuate the purposes of this part.
(c)
The commissioner may exempt from the application of this part a domestic health organization that:
(1)
Writes direct business only in this state;
(2)
Assumes no reinsurance in excess of five percent (5%) of direct premium written; and
(3)
(A)
Writes direct annual premiums for comprehensive medical business of two million dollars ($2,000,000) or less; or
(B)
Is a limited health service organization that covers less than two thousand (2,000) lives.
Acts 2014, ch. 559, § 7.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 46 - RISK-BASED CAPITAL (§§ 56-46-101 — 56-46-214) › Part 2 - RISK-BASED CAPITAL FOR HEALTH ORGANIZATIONS (§§ 56-46-201 — 56-46-214) › Section 56-46-210 - Foreign health organizations

(a)
(1)
A foreign health organization shall, upon the written request of the commissioner, submit to the commissioner an RBC report as of the end of the calendar year just ended the later of:
(A)
The date an RBC report would be required to be filed by a domestic health organization under this part; or
(B)
Fifteen (15) days after the request is received by the foreign health organization.
(2)
A foreign health organization shall, at the written request of the commissioner, promptly submit to the commissioner a copy of any RBC plan that is filed with the insurance commissioner of any other state.
(b)
In the event of a Company Action Level Event, Regulatory Action Level Event or Authorized Control Level Event with respect to a foreign health organization as determined under the RBC statute applicable in the state of domicile of the health organization, or, if no RBC statute is in force in that state, under this part, if the insurance commissioner of the state of domicile of the foreign health organization fails to require the foreign health organization to file an RBC plan in the manner specified under that state's RBC statute, or, if no RBC statute is in force in that state, under §
56-46-203
, the commissioner may require the foreign health organization to file an RBC plan with the commissioner. In such event, the failure of the foreign health organization to file an RBC plan with the commissioner shall be grounds to order the health organization to cease and desist from writing new insurance business in this state.
(c)
In the event of a Mandatory Control Level Event with respect to a foreign health organization, if no domiciliary receiver has been appointed with respect to the foreign health organization under the rehabilitation and liquidation statute applicable in the state of domicile of the foreign health organization, the commissioner may make application to the chancery court of Davidson County pursuant to chapter 9 of this title with respect to the liquidation of property of foreign health organizations found in this state, and the occurrence of the Mandatory Control Level Event shall be considered adequate grounds for the application.
Acts 2014, ch. 559, § 7.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 46 - RISK-BASED CAPITAL (§§ 56-46-101 — 56-46-214) › Part 2 - RISK-BASED CAPITAL FOR HEALTH ORGANIZATIONS (§§ 56-46-201 — 56-46-214) › Section 56-46-211 - Immunity of commissioner and department

There shall be no liability on the part of, and no cause of action shall arise against, the commissioner or the department or its employees or agents for any action taken by them in the performance of their powers and duties under this part.
Acts 2014, ch. 559, § 7.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 46 - RISK-BASED CAPITAL (§§ 56-46-101 — 56-46-214) › Part 2 - RISK-BASED CAPITAL FOR HEALTH ORGANIZATIONS (§§ 56-46-201 — 56-46-214) › Section 56-46-212 - When notices by commissioner that may result in regulatory action are effective

All notices by the commissioner to a health organization that may result in regulatory action under this part shall be effective upon dispatch if transmitted by registered or certified mail, or in the case of any other transmission shall be effective upon the health organization's receipt of notice.
Acts 2014, ch. 559, § 7.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 46 - RISK-BASED CAPITAL (§§ 56-46-101 — 56-46-214) › Part 2 - RISK-BASED CAPITAL FOR HEALTH ORGANIZATIONS (§§ 56-46-201 — 56-46-214) › Section 56-46-213 - Requirements applicable to RBC reports filed with respect to year 2015

For RBC reports required to be filed by health organizations with respect to 2015, the following requirements shall apply in lieu of §§
56-46-203
,
56-46-204
,
56-46-205
and
56-46-206
:
(1)
In the event of a Company Action Level Event with respect to a domestic health organization, the commissioner shall take no regulatory action under this part;
(2)
In the event of a Regulatory Action Level Event under §
56-46-204(a)(1), (a)(2) or (a)(3)
the commissioner shall take the actions required under §
56-46-203
;
(3)
In the event of a Regulatory Action Level Event under §
56-46-204(a)(4), (a)(5), (a)(6), (a)(7), (a)(8) or (a)(9)
or an Authorized Control Level Event, the commissioner shall take the actions required under §
56-46-204
with respect to the health organization;
(4)
In the event of a Mandatory Control Level Event with respect to a health organization, the commissioner shall take the actions required under §
56-46-205
with respect to the health organization.
Acts 2014, ch. 559, § 7.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 46 - RISK-BASED CAPITAL (§§ 56-46-101 — 56-46-214) › Part 2 - RISK-BASED CAPITAL FOR HEALTH ORGANIZATIONS (§§ 56-46-201 — 56-46-214) › Section 56-46-214 - Severability

If any provision of this part, or its application to any person or circumstance, is held invalid, that determination shall not affect the provisions or applications of this part that can be given effect without the invalid provision or application, and to that end the provisions of this part are severable.
Acts 2014, ch. 559, § 7.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 47 - WORKERS' COMPENSATION FRAUD ACT (§§ 56-47-101 — 56-47-112) › Section 56-47-101 - Short title

This chapter shall be known and may be cited as the "Workers' Compensation Fraud Act."
Acts 1996, ch. 944, § 48.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 47 - WORKERS' COMPENSATION FRAUD ACT (§§ 56-47-101 — 56-47-112) › Section 56-47-104 - Unlawful insurance acts

(a)
Any person who commits, or participates in, or permits its employees or its agents to commit any of the following acts with an intent to induce reliance, has committed an unlawful insurance act:
(1)
Presents, causes to be presented or prepares with knowledge or belief that it will be presented, by or on behalf of an insured, insurer, claimant or applicant to an insurer or insurance professional in connection with an insurance transaction, any information that the person knows to contain false representations, or representations, the falsity of which the person has recklessly disregarded, as to any material fact, or that withholds or conceals a material fact, concerning any of the following:
(i)
The application for, rating of or renewal of, any insurance policy;
(ii)
A claim for payment or benefit pursuant to any insurance policy; or
(iii)
Payments made in accordance with the terms of any insurance policy;
(2)
Presents, causes to be presented, or prepares with knowledge or belief that it will be presented, to or by an insurer, insurance professional in connection with an insurance transaction, any information that the person knows to contain false representations, or representations, the falsity of which the person has recklessly disregarded, as to any material fact, or that withholds or conceals a material fact, concerning any of the following:
(i)
The solicitation for sale of any insurance policy or purported insurance policy;
(ii)
An application for certificate of authority; or
(iii)
The financial condition of any insurer;
(3)
Solicits or accepts new or renewal insurance risks by or for an insurer that the person knows was insolvent or the insolvency of which the person recklessly disregards;
(4)
Presents, causes to be presented, or prepares with knowledge or belief that it will be presented, by or on behalf of an insured or insurer, or insurance professional or any other person to a claimant in connection with an insurance transaction, any information that the person knows to contain false representations, or representations, the falsity of which the person has recklessly disregarded, as to any material fact, or that withholds or conceals a material fact, concerning any of the following:
(i)
A claim for payment for benefit pursuant to any insurance policy; or
(ii)
Payments made in accordance with the terms of any insurance policy.
(b)
It is unlawful for any person to commit, or to attempt to commit, or to aid, assist, abet or solicit another to commit, or to conspire to commit an unlawful insurance act.
(c)
A practitioner violates this section only if the practitioner has been engaged in conduct that constitutes a pattern or practice of violation of this section.
Acts 1996, ch. 944, § 48.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 47 - WORKERS' COMPENSATION FRAUD ACT (§§ 56-47-101 — 56-47-112) › Section 56-47-105 - Penalties

Violations of §
56-47-103(a), (b) and (c)
are to be valued according to §
39-11-106(a)(38)
, and punished as theft under §
39-14-105
. Violations of §
56-47-103(d)
shall be valued to include the total amount of workers' compensation premiums that the employer avoided paying, to be calculated by utilizing the appropriate Tennessee assigned risk plan advisory prospective loss cost and multiplier for such an employer for the total number of years, and parts of years, during which the employer was subject to the workers' compensation law and intentionally failed to secure payment of compensation as required by the workers' compensation law, and the violations shall be punished as theft under §
39-14-105
.
Acts 1996, ch. 944, § 48; 1998, ch. 1024, § 12; 2000, ch. 852, § 11.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 47 - WORKERS' COMPENSATION FRAUD ACT (§§ 56-47-101 — 56-47-112) › Section 56-47-106 - Restitution

(a)
A person convicted of a violation of §
56-47-103
shall be ordered to make monetary restitution for any financial loss or damages sustained by an injured employee or any other person as a result of the violation. Financial loss or damage shall include, but is not necessarily limited to, loss of earnings, out-of-pocket and other expenses, paid deductible amounts under an insurance policy, insurer claim payments, costs reasonably attributed to investigations and recovery efforts by owners, insurers, insurance professionals, law enforcement and other public authorities, and costs of prosecution.
(b)
When restitution is ordered, the court shall determine its extent and methods. Restitution may be imposed in addition to a fine and, if ordered, any other penalty, but not in lieu thereof. The court shall determine whether restitution, if ordered, shall be paid in a single payment or installments and shall fix a period of time within which payment of restitution is to be made in full.
Acts 1996, ch. 944, § 48.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 47 - WORKERS' COMPENSATION FRAUD ACT (§§ 56-47-101 — 56-47-112) › Section 56-47-107 - Violations by licensed professionals deemed moral turpitude

Any practitioner determined by the court to have violated §
56-47-103
shall be deemed to have committed an act involving moral turpitude that is inimical to the public well-being. The court or prosecutor shall notify the appropriate licensing authority in this state of the judgment for appropriate disciplinary action, including revocation of any such professional's license, and may notify appropriate licensing authorities in any other jurisdictions where the practitioner is licensed. Any victim may notify the appropriate licensing authorities in this state and any other jurisdiction where the practitioner is licensed, of the conviction. The state licensing authority shall take appropriate administrative action authorized by state law, to consider the imposition of any administrative sanctions or license revocations as provided by law against the practitioner. It is recommended by the general assembly that the state supreme court shall take appropriate action, including, but not limited to, disbarment with respect to any attorney found guilty of such felony. All the referrals to the appropriate licensing or other agencies, and all dispositive actions of the licensing or other agencies, shall be a matter of public record.
Acts 1996, ch. 944, § 48.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 47 - WORKERS' COMPENSATION FRAUD ACT (§§ 56-47-101 — 56-47-112) › Section 56-47-109 - Exclusivity of remedies under section 56-47-108

(a)
The remedies expressly provided in §
56-47-108
shall be the only private remedies for violations of this chapter and no additional remedies shall be implied. The remedies available under §
56-47-108
shall not be used in conjunction with or in addition to any other remedies available at law or in equity to duplicate recovery for the same element of economic damage. Further, in any civil action pleading both exemplary damages and the treble damages available in §
56-47-108(c)
, the plaintiff shall elect one or the other remedy, but not both, at the conclusion of the evidentiary phase of the trial.
(b)
However, nothing in this chapter shall limit or abrogate any right of action that would have existed in the absence of this chapter, but no action based on such a right shall rely on this chapter to establish a standard of conduct or for any other purpose.
Acts 1996, ch. 944, § 48.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 47 - WORKERS' COMPENSATION FRAUD ACT (§§ 56-47-101 — 56-47-112) › Section 56-47-110 - Cooperation with official investigating - Disclosure required - Right of insurer to request information

(a)
When any law enforcement official or authority, the department of commerce and insurance or department of labor and workforce development requests information from an insurer, insurance professional or any other person for the purpose of detecting, prosecuting or preventing insurance fraud, the insurer, insurance professional or other person shall take all reasonable actions to promptly provide the information requested, subject to any legal privilege protecting the information.
(b)
Any insurer, insurance professional or other person who has reasonable belief that an act violating §
56-47-103
or §
56-47-104
will be, is being, or has been committed, shall furnish and disclose any information in its possession concerning the act to the appropriate law enforcement official or authority, department of commerce and insurance or department of labor and workforce development, subject to any legal privilege protecting the information.
(c)
An insurer, insurance professional or other person providing information to any law enforcement, regulatory, licensing or other governmental agency under subsection (a) or (b), shall have the right to request information in the possession or control of the agency relating to the suspected violation or to a pattern of related activity, except information that was privileged or confidential under the laws of this state prior to its submission to the agency. In instances where disclosure would not jeopardize an ongoing investigation or prosecution, the agency shall provide the requested information to the insurer, insurance professional or other person. The agency may request that the insurer, insurance professional or other person keep the disclosed information confidential.
(d)
Any person that has a reasonable belief that an act violating this chapter will be, is being, or has been committed or any person who collects, reviews or analyzes information concerning insurance fraud, may furnish and disclose any information in its possession concerning the act to an authorized representative of an insurer that requests the information for the purpose of detecting, prosecuting or preventing insurance fraud.
(e)
Failure to cooperate with a request for information from an appropriate local or state authority shall bar a person's eligibility for restitution from any proceeds resulting from the governmental investigation and prosecution.
Acts 1996, ch. 944, § 48; 1999, ch. 520, § 42.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 47 - WORKERS' COMPENSATION FRAUD ACT (§§ 56-47-101 — 56-47-112) › Section 56-47-111 - Immunity of persons providing information

In the absence of actual malice, no person furnishing, disclosing or requesting information pursuant to §
56-47-110
shall be subject to civil liability for libel, slander or any other cause of action arising from the furnishing, disclosing or requesting of the information. No person providing information pursuant to §
56-47-110(a)
shall be subject to civil liability for any cause of action arising from the person's provision of requested information. Any person against whom any action is brought who is found to be immune from liability under this section shall be entitled to recover reasonable attorney's fees and costs from the person or party who brought the action. This section does not abrogate or modify in any way any common law or statutory privilege or immunity heretofore enjoyed by any person.
Acts 1996, ch. 944, § 48.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 48 - PROVIDER-SPONSORED ORGANIZATION ACT OF 1998 (§§ 56-48-101 — 56-48-104) › Section 56-48-101 - Short title

This chapter shall be known and may be cited as the "Provider-Sponsored Organization Act of 1998."
Acts 1998, ch. 896, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 48 - PROVIDER-SPONSORED ORGANIZATION ACT OF 1998 (§§ 56-48-101 — 56-48-104) › Section 56-48-102 - Chapter definitions

As used in this chapter, unless the context otherwise requires:
(1)
"Commissioner" means the commissioner of commerce and insurance;
(2)
"Health care services" means a health or medical care procedure or service rendered by a health care provider that:
(A)
Provides testing, diagnosis or treatment of a human disease or dysfunction; or
(B)
Dispenses drugs, medical devices, medical appliances, or medical goods for the treatment of a human disease or dysfunction;
(3)
"HHS" means the United States department of health and human services;
(4)
"Medicare+Choice program" means the criteria developed by United States Public Law 105-33, The Balanced Budget Act of 1997 (BBA), whereby risk-bearing organizations are permitted to offer health insurance or health benefits coverage to Medicare-eligible enrollees through a Medicare+Choice plan;
(5)
"Provider" means any person, including a physician or hospital that is licensed or otherwise authorized in this state to provide health care services; and
(6)
"Provider-sponsored organization" or "PSO" means a public or private entity that:
(A)
Is established or organized, and operated, by a health care provider, or group of affiliated health care providers;
(B)
Provides a substantial proportion, as defined by rule or regulation promulgated by HHS, of the health care items and services under the Medicare+Choice program directly through the provider or affiliated group of providers; and
(C)
(i)
With respect to which the affiliated providers share, directly or indirectly, substantial financial risk with respect to the provision of such items and services and have at least a majority financial interest in the entity;
(ii)
As used in subdivision (6)(C)(i), a provider is "affiliated" with another provider if, through contract, ownership or otherwise:
(a)
One (1) provider, directly or indirectly, controls, is controlled by, or is under common control with the other;
(b)
The providers are part of a controlled group of corporations under the Internal Revenue Code of 1986, § 1563;
(c)
Each provider is a participant in a lawful combination under which each provider shares substantial financial risk in connection with the organization's operations; or
(d)
The providers are part of an affiliated service group under the Internal Revenue Code of 1986, § 414.
Acts 1998, ch. 896, § 3.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 48 - PROVIDER-SPONSORED ORGANIZATION ACT OF 1998 (§§ 56-48-101 — 56-48-104) › Section 56-48-103 - "Medicare+Choice" programs - Licensure - Waiver

Before an entity may operate under the Medicare+Choice program, the entity must obtain a license from the commissioner or be a PSO that obtains a waiver of the requirement for state licensure from HHS in accordance with United States Public Law 105-33, the Balanced Budget Act of 1997. Any entity that obtains such a waiver is not required to obtain a license from the commissioner to operate as a PSO offering a Medicare+Choice plan in this state.
Acts 1998, ch. 896, § 4.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 48 - PROVIDER-SPONSORED ORGANIZATION ACT OF 1998 (§§ 56-48-101 — 56-48-104) › Section 56-48-104 - Rules and regulations

The commissioner is authorized to adopt rules and regulations in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, to implement this chapter, including solvency standards, that do not impose requirements in addition to those required by federal regulations applicable to PSOs.
Acts 1998, ch. 896, § 5.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 49 - TENNESSEE CREDITOR-PLACED INSURANCE ACT OF 1999 (§§ 56-49-101 — 56-49-115) › Section 56-49-101 - Short title - Purpose

(a)
This chapter shall be known and may be cited as the "Tennessee Creditor-Placed Insurance Act of 1999."
(b)
The purposes of this chapter are to:
(1)
Promote the public welfare by regulating creditor-placed insurance;
(2)
Create a legal framework within which creditor-placed insurance may be written in this state;
(3)
Help maintain the separation between creditors and insurers; and
(4)
Minimize the possibilities of unfair competitive practices in the sale of creditor-placed insurance.
Acts 1999, ch. 144, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 49 - TENNESSEE CREDITOR-PLACED INSURANCE ACT OF 1999 (§§ 56-49-101 — 56-49-115) › Section 56-49-102 - Applicability - Enforcement

(a)
This chapter applies to an insurer or agent transacting creditor-placed insurance as defined in this chapter.
(b)
All creditor-placed insurance written in connection with credit transactions for personal, family or household purposes is subject to this chapter, except:
(1)
Transactions involving extensions of credit primarily for business or commercial purposes;
(2)
Insurance on collateralized real property;
(3)
Insurance offered by the creditor and elected by the debtor at the debtor's option;
(4)
Insurance for which no specific charge is made to the debtor or the debtor's account; or
(5)
Blanket insurance, whether paid for by the debtor or the creditor.
(c)
Nothing in this chapter shall be construed to create or imply a private cause of action for violation of this chapter, and the commissioner shall have authority to bring administrative or judicial proceedings to enforce this chapter.
Acts 1999, ch. 144, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 49 - TENNESSEE CREDITOR-PLACED INSURANCE ACT OF 1999 (§§ 56-49-101 — 56-49-115) › Section 56-49-104 - Effective dates of insurance - Insurance charges

(a)
Creditor-placed insurance shall become effective on the latest of the following dates:
(1)
The date of the credit transaction;
(2)
The date prior coverage, including prior creditor-placed insurance coverage, lapsed;
(3)
One (1) year before the date on which the related insurance charge is made to the debtor's account; or
(4)
A later date provided for in the agreement between the creditor and insurer.
(b)
Creditor-placed insurance shall terminate on the earliest of the following dates:
(1)
The date other acceptable insurance becomes effective, subject to the debtor providing acceptable evidence of the other insurance to the creditor;
(2)
The date the collateralized personal property is repossessed, unless the property is returned to the debtor within ten (10) days of the repossession;
(3)
The date the collateralized personal property is determined by the insurer to be a total loss;
(4)
The date the debt is completely extinguished; or
(5)
An earlier date specified in the individual policy or certificate of insurance.
(c)
An insurance charge shall not be made to a debtor for a term longer than the scheduled term of the creditor-placed insurance when it becomes effective, nor may an insurance charge be made to the debtor for creditor-placed insurance before the effective date of the insurance.
(d)
If a charge is made to a debtor for creditor-placed insurance coverage that exceeds a term of one (1) year, the debtor shall be notified at least annually that the insurance will be cancelled and a refund or credit of unearned charges made if evidence of acceptable insurance secured by the debtor is provided.
Acts 1999, ch. 144, § 4.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 49 - TENNESSEE CREDITOR-PLACED INSURANCE ACT OF 1999 (§§ 56-49-101 — 56-49-115) › Section 56-49-105 - Premium rates

(a)
Premiums for creditor-placed insurance coverage may be calculated based on:
(1)
An amount not exceeding the net debt even though the coverage may limit the insurer's liability to the net debt, actual cash value or cost of repair; or
(2)
Other premium calculation methods that more closely reflect the exposure of each item insured and approximate the premium calculation method of the coverage required by the credit agreement.
(b)
An insurer shall not write creditor-placed insurance for which the premium rate differs from that determined by the schedules of the insurer on file with the commissioner. The premium or amount charged to the debtor for creditor-placed insurance shall not exceed the premiums charged by the insurer, computed at the time the charge to the debtor is determined.
(c)
A method of billing insurance charges to the debtor on closed-end credit transactions that creates a balloon payment at the end of the credit transaction or extends the credit transaction's maturity date is prohibited, unless specifically disclosed at the time of the origination of the credit agreement and specifically agreed to by the debtor at the time the charge is added to the outstanding credit balance.
Acts 1999, ch. 144, § 5.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 49 - TENNESSEE CREDITOR-PLACED INSURANCE ACT OF 1999 (§§ 56-49-101 — 56-49-115) › Section 56-49-106 - Exclusion from coverage

(a)
Creditor-placed insurance coverage shall not include:
(1)
Coverage for the cost of repossession;
(2)
Skip, confiscation and conversion coverage;
(3)
Coverage for payment of mechanics' or other liens that do not arise from a covered loss occurrence;
(4)
Coverage that requires a debtor's insurance deductible to be less than two hundred dollars ($200); or
(5)
Coverage that is broader than the insurance coverages that meets the minimum insurance requirements of the credit agreement.
(b)
Nothing in this section shall be deemed to prohibit the issuance of a separate policy or endorsement providing the coverages listed in subsection (a). However, no charge shall be passed along to the debtor for the coverages.
Acts 1999, ch. 144, § 6.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 49 - TENNESSEE CREDITOR-PLACED INSURANCE ACT OF 1999 (§§ 56-49-101 — 56-49-115) › Section 56-49-107 - Policy delivery to debtor

Creditor-placed insurance shall be set forth in an individual policy or certificate of insurance. A copy of the individual policy, certificate of insurance coverage, or other evidence of insurance coverage shall be mailed, first class mail, or delivered in person to the last known address of the debtor.
Acts 1999, ch. 144, § 7.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 49 - TENNESSEE CREDITOR-PLACED INSURANCE ACT OF 1999 (§§ 56-49-101 — 56-49-115) › Section 56-49-109 - Refund of unearned premiums and charges

(a)
Within sixty (60) calendar days after the termination of creditor-placed insurance coverage, and in accordance with the formulas approved by the commissioner, an insurer shall refund any unearned premium or other identifiable charges.
(b)
Within sixty (60) calendar days after the termination date of creditor-placed insurance coverage, the insurer shall provide to the debtor a statement of refund disclosing the effective date, the termination date, the amount of premium being refunded and the amount of premium charged for the coverage provided. No statement shall be required in the event that the policy terminates pursuant to §
56-49-104(b)(4)
.
(c)
The entire amount of premiums, minimum premiums, fees or charges of any kind shall be refunded if no coverage was provided.
Acts 1999, ch. 144, § 9.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 49 - TENNESSEE CREDITOR-PLACED INSURANCE ACT OF 1999 (§§ 56-49-101 — 56-49-115) › Section 56-49-110 - Payment in event of loss

(a)
In the event of a loss under the creditor-placed insurance policy, the insurer shall pay, at a minimum, the least of the following, the value of which shall be determined as of the date of loss:
(1)
The cost to repair the collateral less any applicable deductible;
(2)
The actual cash value of the collateral less any applicable deductible;
(3)
The net debt, less any applicable deductible. The method of calculation of net debt payable pursuant to this subdivision (a)(3) shall be identical to the method of calculation of net debt for payment of premiums pursuant to §
56-49-105(a)
; or
(4)
If single interest insurance is provided, the amount by which the creditor's interest is impaired.
(b)
The net debt or actual cash value amounts in subsection (a) may be reduced by the value of salvage if the insurer does not take possession of the insured property.
(c)
In the event of a loss, no subrogation shall run against the debtor from the insurer.
(d)
Whenever a claim is made on a creditor-placed insurance policy, the insurer shall furnish to the claimant a written statement of the loss explaining the settlement amount and the method of settlement.
(e)
A creditor or insurer may not abandon salvage to a towing or storage facility in lieu of payment of storage fees without the consent of the facility and the claimant. The insurer shall be responsible for the payment of towing and storage charges for a covered loss occurrence from the time the claim is reported to the insurer in accordance with the terms of the policy to the time the claim is paid. The insurer shall give written notice to the claimant when the claim is paid that the claimant may incur storage charges after the date the claim is paid.
Acts 1999, ch. 144, § 10.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 49 - TENNESSEE CREDITOR-PLACED INSURANCE ACT OF 1999 (§§ 56-49-101 — 56-49-115) › Section 56-49-111 - Creditor right to require insurance

(a)
In order for the creditor to place insurance on the collateral pledged by the debtor and pass the cost of the insurance on to the debtor:
(1)
The creditor must have a security interest in the personal property;
(2)
The credit agreement must require the debtor to maintain insurance on the collateral to protect the creditor's interest;
(3)
The credit agreement must authorize the creditor to place the insurance if the debtor fails to provide evidence of the insurance; and
(4)
These requirements must be clearly disclosed to the debtor at the inception of the credit transaction.
(b)
The debtor shall always have the right to provide required insurance through existing policies of insurance owned or controlled by the debtor or of procuring and furnishing the required coverage through an insurer authorized to transact insurance within this state. However, a creditor may establish maximum acceptable deductibles, insurer solidity standards and other reasonable conditions with respect to the required insurance.
Acts 1999, ch. 144, § 11.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 49 - TENNESSEE CREDITOR-PLACED INSURANCE ACT OF 1999 (§§ 56-49-101 — 56-49-115) › Section 56-49-115 - Rules and regulations

The commissioner is authorized to promulgate rules and regulations to effectuate the purposes of this chapter. All rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
Acts 1999, ch. 144, § 15.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 50 - TENNESSEE VIATICAL SETTLEMENT ACT OF 2009 (§§ 56-50-101 — 56-50-117) › Section 56-50-101 - Scope and short title

This chapter applies to life settlements as defined in this chapter and shall be known and may be cited as the "Tennessee Viatical Settlement Act of 2009."
Acts 2009, ch. 604, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 50 - TENNESSEE VIATICAL SETTLEMENT ACT OF 2009 (§§ 56-50-101 — 56-50-117) › Section 56-50-105 - Approval of viatical settlement contracts and disclosure statements

A person shall not use a viatical settlement contract form or provide to a viator a disclosure statement form in this state unless first filed with and approved by the commissioner. The commissioner shall disapprove a viatical settlement contract form or disclosure statement form if, in the commissioner's opinion, the contract or provisions contained in the contract fail to meet the requirements of this chapter, including, but not limited to §§
56-50-108
,
56-50-110
,
56-50-113
and
56-50-114(b)
, or are unreasonable, contrary to the interests of the public or otherwise misleading or unfair to the viator. At the commissioner's discretion, the commissioner may require the submission of advertising material prior to its use in this state.
Acts 2009, ch. 604, § 6.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 50 - TENNESSEE VIATICAL SETTLEMENT ACT OF 2009 (§§ 56-50-101 — 56-50-117) › Section 56-50-106 - Reporting requirements and privacy

(a)
Each viatical settlement provider shall file with the commissioner on or before March 1 of each year an annual statement containing such information as the commissioner may prescribe by regulation. In addition to any other requirements, the annual statement shall specify the total number, aggregate face amount and life settlement proceeds of policies settled during the immediately preceding calendar year, together with a breakdown of the information by policy issue year.
(b)
Except as otherwise allowed or required by law, a viatical settlement provider, viatical settlement broker, viatical settlement investment agent, insurance company, insurance producer, information bureau, rating agency or company or any other person with actual knowledge of an insured's identity shall not disclose that identity as an insured or the insured's financial or medical information to any other person unless the disclosure:
(1)
Is necessary to effect a viatical settlement between the viator and a viatical settlement provider and the viator and insured have provided prior written consent to the disclosure;
(2)
Is necessary to effect a viatical settlement purchase agreement between the viatical settlement purchaser and a viatical settlement provider and the viator and insured have provided prior written consent to the disclosure;
(3)
Is provided in response to an investigation or examination by the commissioner or any other governmental officer or agency or pursuant to the requirements of §
56-50-114(c)
;
(4)
Is a term of or condition to the transfer of a policy by one (1) viatical settlement provider to another viatical settlement provider;
(5)
Is necessary to permit a financing entity, related provider trust or special purpose entity to finance the purchase of policies by a viatical settlement provider and the viator and insured have provided prior written consent to the disclosure;
(6)
Is necessary to allow the viatical settlement provider or viatical settlement broker or their authorized representatives to make contacts for the purpose of determining health status; or
(7)
Is required to purchase stop loss coverage or financial guaranty insurance.
Acts 2009, ch. 604, § 7.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 50 - TENNESSEE VIATICAL SETTLEMENT ACT OF 2009 (§§ 56-50-101 — 56-50-117) › Section 56-50-109 - Disclosure to insurer

Prior to the initiation of a plan, transaction or series of transactions, a viatical settlement broker or viatical settlement provider shall fully disclose to an insurer a plan, transaction or series of transactions to which the viatical settlement broker or viatical settlement provider is a party, to originate, renew, continue or finance a life insurance policy with the insurer for the purpose of engaging in the business of viatical settlements at anytime prior to or during the first five (5) years after issuance of the policy. The insurer shall not disclose this information to any other viatical settlement provider or viatical settlement broker, including those affiliates of the insurer engaged in viatical settlement activity.
Acts 2009, ch. 604, § 10.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 50 - TENNESSEE VIATICAL SETTLEMENT ACT OF 2009 (§§ 56-50-101 — 56-50-117) › Section 56-50-116 - Unfair trade practices

A violation of this chapter, including the commission of a fraudulent viatical settlement act, shall be considered an unfair trade practice under chapter 8 of this title, subject to the penalties contained in chapter 8 of this title.
Acts 2009, ch. 604, § 17.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 50 - TENNESSEE VIATICAL SETTLEMENT ACT OF 2009 (§§ 56-50-101 — 56-50-117) › Section 56-50-117 - Authority to promulgate regulations

The commissioner shall have the authority to:
(1)
Promulgate rules to effectuate the purposes of this chapter. The rules shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5;
(2)
Establish standards for evaluating reasonableness of payments under viatical settlement contracts for persons who are terminally or chronically ill. This authority includes, but is not limited to, regulation of discount rates used to determine the amount paid in exchange for assignment, transfer, sale, devise or bequest of a benefit under a life insurance policy insuring the life of a person who is chronically or terminally ill;
(3)
Establish appropriate licensing requirements, fees and standards for continued licensure for viatical settlement providers, brokers and viatical settlement investment agents;
(4)
Require a bond or other mechanism for financial accountability for viatical settlement providers and brokers;
(5)
Adopt rules governing the relationship and responsibilities of both insurers and viatical settlement providers, viatical settlement brokers and viatical settlement investment agents during the viatication of a life insurance policy or certificate; and
(6)
Establish guidelines and standards of permissible and impermissible conduct in the advertising of viatical settlements to assure that product descriptions are presented in a manner that prevents unfair, deceptive or misleading advertising, and is conducive to accurate presentation and description of viatical settlements through the advertising media and materials used by viatical settlement licensees.
Acts 2009, ch. 604, § 18.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-101 - Short title

This chapter shall be known and may be cited as the "Tennessee Prepaid Limited Health Service Organization Act of 2000."
Acts 2000, ch. 948, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-103 - Exemption from Tennessee insurance code

Except as provided in this chapter, prepaid limited health service organizations are governed by this chapter and are exempt from this title unless specifically referenced.
Acts 2000, ch. 948, § 3.