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HOUSE HOUSE DOCKET, NO 2096 FILED ON: 1

1/20/2011 No 2074 By Mr Sannicandro of Ashland, a petition (accompanied by bill, House, No 2074) of Tom Sannicandro and others for legislation to prohibit certain discretionary authority by insurers Financial Services The Commonwealth of Massachusetts _____ In the Year Two Thousand Eleven _____

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1 of 1HOUSE DOCKET, NO. 2096 FILED ON: 1/20/2011HOUSE . . . . . . . . . . . . . . . No. 2074The Commonwealth of Massachusetts_________________PRESENTED BY:Tom Sannicandro_________________To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General

Court

assembled:The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:An Act relative to greater fairness in insurance._______________PETITION OF:NAME:DISTRICT/ADDRESS:DATE ADDED:Tom Sannicandro7th Middlesex1/20/2011Carl M. Sciortino, Jr.34th Middlesex2/3/2011Antonio F. D. Cabral13th Bristol2/4/2011Cleon H. Turner1st Barnstable2/4/2011Chris Walsh6th Middlesex2/4/2011

1 of 3HOUSE DOCKET, NO. 2096 FILED ON: 1/20/2011HOUSE . . . . . . . . . . . . . . . No. 2074By Mr. Sannicandro of Ashland, a petition (accompanied by bill, House, No. 2074) of Tom

Sannicandro

and others for legislation to prohibit certain discretionary authority by insurers.

Financial

Services.The Commonwealth of Massachusetts

_______________In the Year Two Thousand Eleven_______________An Act relative to greater fairness in insurance.Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority

of

the same, as follows:1SECTION 1. Section 226 is added to the General Laws of Massachusetts, Chapter 175

2INSURANCE to read: 3Section 226. 4(a) If a policy, contract, certificate, or agreement offered, issued, delivered, or renewed,

5whether or not in Massachusetts, that provides, backs up, reinsures, or funds, in whole or in part,

6life insurance, health insurance, annuities, accident insurance, long term care insurance, or

7disability insurance coverage for any Massachusetts resident contains a provision that reserves

8discretionary authority to the insurer, or an agent of the insurer, to determine eligibility for

9benefits or coverage, to interpret the terms of the policy, contract, certificate, or agreement, or to

10provide standards of interpretation or review that are inconsistent with the laws of this state, that

11provision is void and unenforceable.

2 of 312(b) For purposes of this section, "renewed" means continued in force on or after the

13policy's anniversary date.14(c) For purposes of this section, the term "discretionary authority" means a policy

15provision that has the effect of conferring discretion on an insurer or other claim administrator to

16determine entitlement to benefits or interpret policy language that, in turn, could lead to a

17deferential standard of review by any reviewing court.18(d) Nothing in this section prohibits an insurer from including a provision in a contract

19that informs an insured that as part of its routine operations the insurer applies the terms of its

20contracts for making decisions, including making determinations regarding eligibility, receipt of

21benefits and claims, or explaining policies, procedures, and processes, so long as the provision

22could not give rise to a deferential standard of review by any reviewing court.23(e) The Commissioner of Insurance ("Commissioner") shall not approve any health, life

24or disability policy for issuance or delivery in Massachusetts in any of the following

25circumstances:26If it includes a provision that reserves discretionary authority, as defined by Section 226,

27to the insurer, or an agent of the insurer, to determine eligibility for benefits or coverage or to

28interpret the terms of the policy; or if it provides standards of interpretation or review that are

29inconsistent with the laws of Massachusetts; or if it contains or incorporates by reference, where

30the incorporation is otherwise permissible, any inconsistent, ambiguous, or misleading clauses or

31exceptions and conditions that deceptively affect the risk purported to be assumed in the general

32coverage of the contract; or if it has any title, heading, or other indication of its provisions that is

33misleading; or if it is printed or otherwise reproduced in a manner that renders any provision of

3 of 334the form substantially illegible; or if it fails to conform in any respect with any law of

35Massachusetts.36 (f) If any provision of this Section or its application to any person or circumstance is

37held to be illegal, invalid, or unenforceable, no other provisions or applications of this Section

38that can be given effect without the illegal, invalid or unenforceable provision or application

39shall be affected; and to this end the provisions of this Section are severable.

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