§ 58-39-15. Definitions. - North Carolina Statutes

§ 58‑39‑15. Definitions.

As used in this Article:

(1)        "Adverseunderwriting decision" means:

a.         Any of the followingactions with respect to insurance transactions involving insurance coveragethat is individually underwritten:

1.         A declination ofinsurance coverage;

2.         A termination ofinsurance coverage;

3.         Failure of an agentto apply for insurance coverage with a specific insurance institution that anagent represents and that is requested by an applicant;

4.         In the case of aproperty or casualty insurance coverage:

I.          Placement by aninsurance institution or agent of a risk with a residual market mechanism, anunauthorized insurer, or an insurance institution that specializes insubstandard risks; or

II.         The charging of ahigher rate on the basis of information that differs from that which theapplicant or policyholder furnished; or

5.         In the case of alife, health, or disability insurance coverage, an offer to insure at higherthan standard rates.

b.         Notwithstandingsubdivision (1)a. of this section, the following actions shall not beconsidered adverse underwriting decisions, but the insurance institution oragent responsible for their occurrence shall nevertheless provide the applicantor policyholder with the specific reason or reasons for their occurrence:

1.         The termination ofan individual policy form on a class or statewide basis;

2.         A declination ofinsurance coverage solely because such coverage is not available on a class orstatewide basis; or

3.         The rescission of apolicy.

(2)        "Affiliate"or "affiliated" means a person that directly, or indirectly throughone or more intermediaries, controls, is controlled by, or is under commoncontrol with another person.

(3)        "Agent"has the meaning as set forth in G.S. 58‑33‑10, and includes limitedrepresentatives, limited line credit insurance producers, limited linesproducers, insurance producers, and surplus lines licensees.

(4)        "Applicant"means any person who seeks to contract for insurance coverage other than aperson seeking group insurance that is not individually underwritten.

(5)        "Consumerreport" means any written, oral, or other communication of informationbearing on a natural person's credit worthiness, credit standing, creditcapacity, character, general reputation, personal characteristics, or mode ofliving that is used or expected to be used in connection with an insurancetransaction.

(6)        "Consumerreporting agency" means any person who:

a.         Regularly engages,in whole or in part, in the practice of assembling or preparing consumerreports for a monetary fee;

b.         Obtains informationprimarily from sources other than insurance institutions; and

c.         Furnishes consumerreports to other persons.

(7)        "Control,"including the terms "controlled by" or "under common controlwith," means the possession, direct or indirect, of the power to direct orcause the direction of the management and policies of a person, whether throughthe ownership of voting securities, by contract other than a commercialcontract for goods or nonmanagement services, or otherwise, unless the power isthe result of an official position with or corporate office held by the person.

(8)        "Declination ofinsurance coverage" means a denial, in whole or in part, by an insuranceinstitution or agent of requested insurance coverage.

(9)        "Individual"means any natural person who:

a.         In the case ofproperty or casualty insurance, is a past, present, or proposed named insuredor certificate holder;

b.         In the case of life,health, or disability insurance, is a past, present, or proposed principalinsured or certificate holder;

c.         Is a past, presentor proposed policy owner;

d.         Is a past or presentapplicant;

e.         Is a past or presentclaimant;

f.          Derived, derives,or is proposed to derive insurance coverage under an insurance policy orcertificate subject to this Article; or

g.         Is the subject ofpersonal information collected or maintained by an insurance institution,agent, or insurance‑support organization in connection with mortgageguaranty insurance.

(10)      "Institutionalsource" means any person or governmental entity that provides informationabout an individual to an agent, insurance institution, or insurance‑supportorganization, other than:

a.         An agent;

b.         The individual whois the subject of the information; or

c.         A natural personacting in a personal capacity rather than in a business or professionalcapacity.

(11)      "Insuranceinstitution" means any corporation, association, partnership, reciprocalexchange, inter‑insurer, Lloyd's insurer, fraternal benefit society, orother person engaged in the business of insurance, including health maintenanceorganizations and medical, surgical, hospital, dental, and optometric serviceplans, governed by Articles 65 through 67 of this Chapter. "Insuranceinstitution" shall not include agents or insurance‑supportorganizations.

(12)      "Insurance‑supportorganization" means any person who regularly engages, in whole or in part,in the practice of assembling or collecting information about natural personsfor the primary purpose of providing the information to an insuranceinstitution or agent for insurance transactions, including: (i) the furnishingof consumer reports or investigative consumer reports to an insuranceinstitution or agent for use in connection with an insurance transaction; or(ii) the collection of personal information from insurance institutions,agents, or other insurance‑support organizations for the purpose ofdetecting or preventing fraud, material misrepresentation, or materialnondisclosure in connection with insurance underwriting or insurance claimactivity; provided, however, the following persons shall not be considered"insurance‑support organizations" for purposes of this Article:agents, governmental institutions, insurance institutions, medical‑careinstitutions, and medical professionals.

(13)      "Insurancetransaction" means any transaction involving insurance primarily forpersonal, family, or household needs rather than business or professional needsthat entails:

a.         The determination ofan individual's eligibility for an insurance coverage, benefit, or payment; or

b.         The servicing of aninsurance application, policy, contract, or certificate.

(14)      "Investigativeconsumer report" means a consumer report or portion thereof in whichinformation about a natural person's character, general reputation, personalcharacteristics, or mode of living is obtained through personal interviews withthe person's neighbors, friends, associates, acquaintances, or others who mayhave knowledge concerning such items of information.

(15)      "Life insurance"includes annuities.

(16)      "Medical‑careinstitution" means any facility or institution that is licensed to providehealth care services to natural persons, including but not limited to,hospitals, skilled nursing facilities, home‑health agencies, medicalclinics, rehabilitation agencies, public health agencies, or health‑maintenanceorganizations.

(17)      "Medicalprofessional" means any person licensed or certified to provide healthcare services to natural persons, including but not limited to, a physician,dentist, nurse, chiropractor, optometrist, physical or occupational therapist,licensed clinical social worker, clinical dietitian, clinical psychologist,pharmacist, or speech therapist.

(18)      "Medical‑recordinformation" means personal information that:

a.         Relates to anindividual's physical or mental condition, medical history, or medicaltreatment; and

b.         Is obtained from amedical professional or medical‑care institution, from the individual, orfrom the individual's spouse, parent, or legal guardian.

(19)      "Personalinformation" means any individually identifiable information gathered inconnection with an insurance transaction from which judgments can be made aboutan individual's character, habits, avocations, finances, occupation, generalreputation, credit, health, or any other personal characteristics."Personal information" includes an individual's name and address andmedical‑record information, but does not include privileged information.

(20)      "Policyholder"means any person who:

a.         In the case ofindividual property or casualty insurance, is a present named insured;

b.         In the case ofindividual life or accident and health insurance, is a present policy owner; or

c.         In the case of groupinsurance that is individually underwritten, is a present group certificateholder.

(21)      "Pretextinterview" means an interview whereby a person, in an attempt to obtaininformation about a natural person, performs one or more of the following acts:

a.         Pretends to besomeone he is not;

b.         Pretends torepresent a person he is not in fact representing;

c.         Misrepresents thetrue purpose of the interview; or

d.         Refuses to identifyhimself upon request.

(22)      "Privilegedinformation" means any individually identifiable information that (i)relates to a claim for insurance benefits or a civil or criminal proceedinginvolving an individual, and (ii) is collected in connection with or inreasonable anticipation of a claim for insurance benefits or civil or criminalproceeding involving an individual: Provided, however, information otherwisemeeting the requirements of this subsection shall nevertheless be consideredpersonal information under this Article if it is disclosed in violation of G.S.58‑39‑75.

(23)      "Residual marketmechanism" means any reinsurance facility, joint underwriting association,assigned risk plan, or other similar plan established under the laws of thisState.

(24)      "Termination ofinsurance coverage" or "termination of an insurance policy"means either a cancellation or nonrenewal of an insurance policy, in whole orin part, for any reason other than the failure to pay a premium as required bythe policy.

(25)      "Unauthorizedinsurer" means an insurance institution that has not been granted alicense by the Commissioner to transact the business of insurance in thisState. (1981, c.846, s. 1; 1987, c. 629, s. 13; 1993, c. 464, s. 1; 2001‑203, s. 30; 2001‑351,ss. 2, 3; 2001‑487, s. 40(f);  2003‑262, s. 2(1).)