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This entry was published on 2014-09-22
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SECTION 2319
Information to be furnished insureds; aggrieved person
Insurance (ISC) CHAPTER 28, ARTICLE 23
§ 2319. Information to be furnished insureds; aggrieved person. (a)
Every insurer and rate service organization shall within a reasonable
time after receiving written request therefor, and upon payment of a
reasonable charge, furnish to any insured affected by a rate made by it,
or to the authorized representative of the insured, all pertinent
information as to the rate.

(b) Except as provided in subsection (c) of this section, every
insurer or rate service organization shall provide within this state
reasonable means whereby any person aggrieved by the application of its
rating system may be heard, in person or by an authorized
representative, on written request to review the manner in which such
rating system has been applied in connection with the insurance afforded
or offered. If the insurer or rate service organization fails to grant
or reject the request within thirty days, applicant may proceed in the
same manner as if the application had been rejected. Any party affected
by the action of the insurer or rate service organization on the request
may within thirty days after written notice of such action appeal to the
superintendent, who, after a hearing held upon not less than ten days
written notice to the appellant and to the insurer or rate service
organization, may affirm, modify or reverse such action.

(c) (1) Subject to the regulations of the superintendent, every
workers' compensation rate service organization shall establish and
implement procedures for the review of its determination to make a
rating classification, relating to insurance authorized pursuant to
paragraph fifteen of subsection (a) of section one thousand one hundred
thirteen of this chapter, which has been filed with and approved by the
superintendent. Such procedures for review shall (A) ensure that such
organization shall, within a reasonable period of time after receiving
written request therefor, furnish any insured affected by a rating
classification made by the organization, or to the authorized
representative of the insured, any information pertaining to the
insured's file and any information, upon request, pertaining to the
application of the classification, and (B) require an insured aggrieved
by such determination to submit a written request for review of the
rating classification. The failure of such rate service organization to
respond in writing to a written request submitted pursuant to this
subsection within sixty days, shall authorize the applicant for review
to proceed as though the classification challenged was disapproved by
the rate service organization. If the workers' compensation rate service
organization cannot, within such sixty day period, make such
determination or advise the insured that an inspection, audit or study
is required, the organization shall submit a written request to the
superintendent, within the sixty day period, requesting a reasonable
extension of the time period in which to make such determination.

(2) Any insured adversely affected by a review, completed pursuant to
paragraph one of this subsection, may, within thirty days of receiving
written notice of the results of the review, appeal such review in
writing to the superintendent. Such appeal shall specify the grounds to
be relied upon by the appellant. The superintendent shall make a
determination and notify the insured within sixty days of receipt of the
request for an appeal as to whether he or she finds that the application
is made in good faith, that the applicant would be so aggrieved if his
grounds are established, and that such grounds otherwise justify holding
such a hearing. If the superintendent determines that such criteria have
been met by the insured's application, then the superintendent shall
hold a hearing on such matter within sixty days of receipt of the
request for an appeal, but upon no less than ten days written notice to
the parties of the hearing. The superintendent may affirm, modify or
reverse the review of the rate service organization.

(3) Any determination by the superintendent, pursuant to paragraph two
of this subsection, shall be reviewable pursuant to article
seventy-eight of the civil practice law and rules.