                                 CODE OF VIRGINIA

NOTICE OF ADVERSE UNDERWRITING DECISION; FURNISHING REASONS FOR DECISIONS AND
SOURCES OF INFORMATION (§ 38.2-610)

A. In the event of an adverse underwriting decision, including those that
involve policies referred to in subdivision 1 of subsection E of § 38.2-2114
and in subdivision 3 of subsection F of § 38.2-2212, the insurance institution
or agent responsible for the decision shall give a written notice in a form
approved by the Commission that:

   1. Either provides the applicant, policyholder, or individual proposed for
   coverage with the specific reason or reasons for the adverse underwriting
   decision in writing or advises such person that upon written request he may
   receive the specific reason or reasons in writing; and

   2. Provides the applicant, policyholder, or individual proposed for coverage
   with a summary of the rights established under subsection B of this section
   and &#xA7;&#xA7; 38.2-608 and 38.2-609.

B. Upon receipt of a written request within ninety business days from the date
of the mailing of notice or other communication of an adverse underwriting
decision to an applicant, policyholder or individual proposed for coverage, the
insurance institution or agent shall furnish to such person within twenty-one
business days from the date of receipt of the written request:

   1. The specific reason or reasons for the adverse underwriting decision, in
   writing, if that information was not initially furnished in writing pursuant
   to subdivision 1 of subsection A of this section;

   2. The specific items of personal and privileged information that support
   those reasons, however:
   				a. The insurance institution or agent shall not be required to furnish
   specific items of privileged information if it has a reasonable suspicion,
   based upon specific information available for review by the Commission, that
   the applicant, policyholder, or individual proposed for coverage has engaged
   in criminal activity, fraud, material misrepresentation, or material
   nondisclosure; and
   				b. Specific items of medical-record information supplied by a medical-care
   institution or medical professional shall be disclosed either directly to the
   individual about whom the information relates or to a medical professional
   designated by the individual and licensed to provide medical care with respect
   to the condition to which the information relates, whichever the insurance
   institution or agent prefers; and

   3. The names and addresses of the institutional sources that supplied the
   specific items of information given pursuant to subdivision 2 of subsection B
   of this section. However, the identity of any medical professional or
   medical-care institution shall be disclosed either directly to the individual
   or to the designated medical professional, whichever the insurance institution
   or agent prefers.

C. The obligations imposed by this section upon an insurance institution or
agent may be satisfied by another insurance institution or agent authorized to
act on its behalf. However, the insurance institution or agent making an adverse
underwriting decision shall remain responsible for compliance with the
obligations imposed by this section.

D. When an adverse underwriting decision results solely from an oral request or
inquiry, the explanation of reasons and summary of rights required by subsection
A of this section may be given orally.

HISTORY: 1981, c. 389, § 38.1-57.13; 1986, c. 562.