Code of Massachusetts Regulations › 940 CMR - OFFICE OF THE ATTORNEY GENERAL › Title 940 CMR 18.00 - Viatical Settlements And Viatical Loans › Section 18.05 - Viatical Settlement Disclosures

Current through Register 1525, July 5, 2024
(1)
			 It is an unfair or deceptive act or practice for a Viatical Settlement
			 Provider, Broker, or Representative to fail to mail to the last known
			 address(es) of, or to provide in person to, the Viator and the Insured the
			 following Attorney General's Viatical Settlement Disclosure Form (the "Form").
			 This Form shall be completed and mailed to the last known address(es) of, or
			 provided in person to, the Viator and the Insured pursuant to 940 CMR 18.05(7),
			 on a separate document, in at least ten point type or ten pitch courier.
VIATICAL SETTLEMENT DISCLOSURES REQUIRED BY THE ATTORNEY
				GENERAL'S CONSUMER PROTECTION REGULATIONS
Business Name:
Business or Mailing Address:
Viatical Settlement Provider/Broker/Representative
				Massachusetts License Number: (if applicable)
Date License Issued:
License Expiration Date:
I am/We are a Viatical Settlement
				Provider/Broker/Representative. I/We shall not divulge Patient Identifying
				Information without the express, written consent of the Insured. I/We shall
				take every reasonable precaution to ensure that those individuals or entities
				who rightfully obtain Patient Identifying Information do not further divulge
				such information without the express, written consent of the Insured.
We shall provide the Insured with a copy of this completed
				disclosure form. We shall attempt to obtain the consent of the Insured to the
				dissemination of his/her Patient Identifying Information in connection with
				this Viatical Settlement.
As part of the Viatical Settlement, the health of the Insured
				will/ will not be monitored. We must obtain the Insured's consent to the
				following method of monitoring prior to the execution of the Viatical
				Settlement Contract: (state method in specific, detailed terms).
You will/will not pay an application fee of $ . This fee is/is
				not refundable.
You will/will not pay a brokerage fee of $ . This fee is/is not
				refundable.
The Viatical Settlement proceeds shall be maintained in an
				escrow account until final payment is made to you. We will provide you with the
				name, address and telephone number of the escrow account agent who will
				maintain the proceeds pending execution of the Viatical Settlement within two
				business days of our identifying that escrow account agent.
The proceeds will be sent to you within two business days after
				the Viatical Settlement Provider, (insert name here, if known) has received
				your insurer or group administrator's acknowledgment that ownership of the
				policy or interest in the certificate has been transferred and the beneficiary
				has been designated pursuant to the Viatical Settlement Contract.
If you have any questions about your legal rights, you should
				consult your own lawyer, especially before you sign any documents or pay any
				money or anything of value.
DO NOT sign any application forms with blank spaces or with
				incorrect information.
PLEASE NOTE:
You do/do not have the RIGHT TO CANCEL this contract within
				____ days following any of the following events: [Provide detailed method for
				cancellation and for effective notification. Include notice of the effects of
				cancellation and the Viator's responsibilities thereunder.]
We shall not pay a finder's fee to any Person who is providing,
				or has previously provided, care or services to the Insured, including, but not
				limited to, any medical or mental health provider, social services provider,
				attorney, accountant, financial advisor or planner, investment advisor or
				planner, or any other Person who has a demonstrable conflict of interest in
				collecting a finder's fee.
Receipt of the proceeds of a Viatical Settlement may adversely
				affect your eligibility for Medicaid or other government benefits or
				entitlements. You should obtain advice from the appropriate government agencies
				regarding the impact such a settlement may have on your eligibility for such
				benefits before executing the Viatical Settlement Contract.
Some or all of the proceeds of the Viatical Settlement may be
				free from federal income tax and from state franchise and income taxes. You
				should obtain advice from a qualified professional tax advisor regarding the
				tax implications of entering into the Viatical Settlement Contract.
We do/do not meet the requirements of sections 8 and 9 of the
				Viatical Settlements Model Act of the National Association of Insurance
				Commissioners. We do/do not meet the requirements of the Model Regulations of
				the National Association of Insurance Commissioners (relating to standards for
				evaluation of reasonable payments) in determining amounts paid by such person
				in connection with such purchases or assignments.
Entering into a Viatical Settlement Contract may cause other
				rights or benefits, including, but not limited to, conversion rights and waiver
				of premium benefits which may exist under the policy or certificate to be
				forfeited by you. You should seek assistance regarding the effect of entering
				into this Viatical Settlement from a qualified, independent financial
				advisor.
The proceeds of the Viatical Settlement may be subject to the
				claims of your creditors.
If you have any problems, please call us at:.
Printed Name and Address of Viator
Please sign and date below after you have received these
				disclosures.
Signature of Viator
Date:
(2)
			 It is an unfair or deceptive act or practice for a Viatical Settlement
			 Provider, Broker, or Representative to fail to disclose, during the initial
			 meeting with the Viator, its licensing status in Massachusetts.
(3) It is an unfair or deceptive act or
			 practice for a Viatical Settlement Provider, Broker, or Representative to fail
			 to take reasonable steps to communicate the material facts of the
			 transaction(s) in a language that is understood by the Viator and the Insured,
			 respectively. Reasonable steps which shall comply with
			 940 CMR 18.00 may include,
			 but shall not be limited to:
(a) using adult
			 interpreters; and
(b) providing the
			 Viator and the Insured with a translated copy of the Attorney General's
			 Viatical Settlement Disclosure Form described in 940 CMR 18.05(1) in a language
			 understood by the Viator and the Insured, respectively.