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This entry was published on 2014-09-22
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Misrepresentations, misleading statements and incomplete comparisons by insurers
Insurance (ISC) CHAPTER 28, ARTICLE 42
§ 4226. Misrepresentations, misleading statements and incomplete
comparisons by insurers. (a) No insurer authorized to do in this state
the business of life, or accident and health insurance, or to make
annuity contracts shall:

(1) issue or circulate, or cause or permit to be issued or circulated
on its behalf, any illustration, circular, statement or memorandum
misrepresenting the terms, benefits or advantages of any of its policies
or contracts;

(2) make any estimate of the dividends or share of surplus or
additional amounts to be received on such policies or contracts;

(3) make any false or misleading statement of the dividends or share
of surplus or additional amounts paid by any such insurer on similar
policies or contracts;

(4) make any misleading representation, or any misrepresentation of
the financial condition of any such insurer or of the legal reserve
system upon which it operates; or

(5) make or deliver to any person or persons any incomplete comparison
of any such policies or contracts for the purpose of inducing, or
tending to induce, such person or persons to lapse, forfeit or surrender
any insurance policy or contract.

(6) replace the individual life insurance policies or individual
annuity contracts of an insurer by the same or different insurer without
conforming to the standards promulgated by regulation by the
superintendent. Such regulation shall:

(A) specify what constitutes the replacement of a life insurance
policy or annuity contract and the proper disclosure and notification
procedures to replace a policy or contract;

(B) require notification of the proposed replacement to the insurer
whose policies or contracts are intended to be replaced;

(C) require the timely exchange of illustrative and cost information
required by section three thousand two hundred nine of this chapter and
necessary for completion of a comparison of the proposed and replaced
coverage; and

(D) provide for a sixty-day period following issuance of the
replacement policies or contracts during which the policy or contract
owner may return the policies or contracts and reinstate the replaced
policies or contracts.

(b) Any comparison of the policies or contracts of any such insurer or
insurers shall be deemed to be an incomplete comparison if it does not
conform to all the requirements for comparisons established by the
superintendent by regulation.

(c) In any determination, judicial or otherwise, of the incompleteness
or misleading character of any such comparison or of representation, it
shall not be presumed that the insured knew or knows of any of the
provisions or benefits contained in any insurance policy or contract.

(d) Any such insurer that knowingly violates any provision of this
section, or knowingly receives any premium or other compensation in
consequence of such violation shall, in addition to any other penalty
provided in this chapter, be liable to a penalty in the amount of such
premium or compensation, which penalty may be sued for and recovered by
any person aggrieved for his own use and benefit, in accordance with the
provisions of the civil practice law and rules.