[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[S. 467 Introduced in Senate (IS)]







105th CONGRESS
  1st Session
                                 S. 467

  To prevent discrimination against victims of abuse in all lines of 
                               insurance.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 18, 1997

  Mr. Wellstone (for himself, Mrs. Murray, Mr. Wyden, and Mr. Dorgan) 
introduced the following bill; which was read twice and referred to the 
                 Committee on Labor and Human Resources

_______________________________________________________________________

                                 A BILL


 
  To prevent discrimination against victims of abuse in all lines of 
                               insurance.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Victims of Abuse Insurance 
Protection Act''.

SEC. 2. DEFINITIONS.

    As used in this Act:
            (1) Abuse.--The term ``abuse'' means the occurrence of one 
        or more of the following acts by a current or former household 
        or family member, intimate partner, or caretaker:
                    (A) Attempting to cause or causing another person 
                bodily injury, physical harm, substantial emotional 
                distress, psychological trauma, rape, sexual assault, 
                or involuntary sexual intercourse.
                    (B) Engaging in a course of conduct or repeatedly 
                committing acts toward another person, including 
                following the person without proper authority and under 
                circumstances that place the person in reasonable fear 
                of bodily injury or physical harm.
                    (C) Subjecting another person to false imprisonment 
                or kidnapping.
                    (D) Attempting to cause or causing damage to 
                property so as to intimidate or attempt to control the 
                behavior of another person.
            (2) Abuse-related medical condition.--The term ``abuse-
        related medical condition'' means a medical condition which 
        arises in whole or in part out of an action or pattern of 
        abuse.
            (3) Abuse status.--The term ``abuse status'' means the fact 
        or perception that a person is, has been, or may be a subject 
        of abuse, irrespective of whether the person has sustained 
        abuse-related medical conditions or has incurred abuse-related 
        claims.
            (4) Health benefit plan.--The term ``health benefit plan'' 
        means any public or private entity or program that provides for 
        payments for health care, including--
                    (A) a group health plan (as defined in section 607 
                of the Employee Retirement Income Security Act of 1974 
                (29 U.S.C. 1167)) or a multiple employer welfare 
                arrangement (as defined in section 3(40) of such Act 
                (29 U.S.C. 1102(40)) that provides health benefits;
                    (B) any other health insurance arrangement, 
                including any arrangement consisting of a hospital or 
                medical expense incurred policy or certificate, 
                hospital or medical service plan contract, or health 
                maintenance organization subscriber contract;
                    (C) workers' compensation or similar insurance to 
                the extent that it relates to workers' compensation 
                medical benefits (as defined by the Federal Trade 
                Commission); and
                    (D) automobile medical insurance to the extent that 
                it relates to medical benefits (as defined by the 
                Federal Trade Commission).
            (5) Health carrier.--The term ``health carrier'' means a 
        person that contracts or offers to contract on a risk-assuming 
        basis to provide, deliver, arrange for, pay for or reimburse 
        any of the cost of health care services, including a sickness 
        and accident insurance company, a health maintenance 
        organization, a nonprofit hospital and health service 
        corporation or any other entity providing a plan of health 
        insurance, health benefits or health services.
            (6) Insured.--The term ``insured'' means a party named on a 
        policy, certificate, or health benefit plan, including an 
        individual, corporation, partnership, association, 
        unincorporated organization or any similar entity, as the 
        person with legal rights to the benefits provided by the 
        policy, certificate, or health benefit plan. For group 
        insurance, such term includes a person who is a beneficiary 
        covered by a group policy, certificate, or health benefit plan. 
        For life insurance, the term refers to the person whose life is 
        covered under an insurance policy.
            (7) Insurer.--The term ``insurer'' means any person, 
        reciprocal exchange, interinsurer, Lloyds insurer, fraternal 
        benefit society, or other legal entity engaged in the business 
        of insurance, including agents, brokers, adjusters, and third 
        party administrators. The term also includes health carriers, 
        health benefit plans, and life, disability, and property and 
        casualty insurers.
            (8) Policy.--The term ``policy'' means a contract of 
        insurance, certificate, indemnity, suretyship, or annuity 
        issued, proposed for issuance or intended for issuance by an 
        insurer, including endorsements or riders to an insurance 
        policy or contract.
            (9) Subject of abuse.--The term ``subject of abuse'' means 
        a person against whom an act of abuse has been directed, a 
        person who has prior or current injuries, illnesses, or 
        disorders that resulted from abuse, or a person who seeks, may 
        have sought, or had reason to seek medical or psychological 
        treatment for abuse, protection, court-ordered protection, or 
        shelter from abuse.

SEC. 3. DISCRIMINATORY ACTS PROHIBITED.

    (a) In General.--No insurer or health carrier may, directly or 
indirectly, engage in any of the following acts or practices on the 
basis that the applicant or insured, or any person employed by the 
applicant or insured or with whom the applicant or insured is known to 
have a relationship or association, is, has been, or may be the subject 
of abuse:
            (1) Denying, refusing to issue, renew or reissue, or 
        canceling or otherwise terminating an insurance policy or 
        health benefit plan.
            (2) Restricting, excluding, or limiting insurance or health 
        benefit plan coverage for losses incurred as a result of abuse 
        or denying a claim incurred by an insured as a result of abuse, 
        except as otherwise permitted or required by State laws 
        relating to life insurance beneficiaries.
            (3) Adding a premium differential to any insurance policy 
        or health benefit plan.
            (4) Terminating health coverage for a subject of abuse 
        because coverage was originally issued in the name of the 
        abuser and the abuser has divorced, separated from, or lost 
        custody of the subject of abuse or the abuser's coverage has 
        terminated voluntarily or involuntarily and the subject of 
        abuse does not qualify for extension of coverage under part 6 
        of subtitle B of title I or the Employee Retirement Income 
        Security Act of 1974 (29 U.S.C. 1161 et seq.) or 4980B of the 
        Internal Revenue Code of 1986. Nothing in this paragraph 
        prohibits the insurer from requiring the subject of abuse to 
        pay the full premium for the subject's coverage under the 
        health plan if the requirements are applied to all insureds of 
        the health carrier. The insurer may terminate group coverage 
        after the continuation coverage required by this paragraph has 
        been in force for 18 months if it offers conversion to an 
        equivalent individual plan. The continuation of health coverage 
        required by this paragraph shall be satisfied by any extension 
        of coverage under part 6 of subtitle B of title I or the 
        Employee Retirement Income Security Act of 1974 (29 U.S.C. 1161 
        et seq.) or 4980B of the Internal Revenue Code of 1986 provided 
        to a subject of abuse and is not intended to be in addition to 
        any extension of coverage provided under part 6 of subtitle B 
        of title I or the Employee Retirement Income Security Act of 
        1974 (29 U.S.C. 1161 et seq.) or 4980B of the Internal Revenue 
        Code of 1986.
    (b) Use of Information.--
            (1) In general.--No person employed by or contracting with 
        an insurer or health benefit plan may use, disclose, or 
        transfer information relating to an applicant's or insured's 
        abuse status or abuse-related medical condition or the 
        applicant's or insured's status as a family member, employer, 
        or associate, person in a relationship with a subject of abuse 
for any purpose unrelated to the direct provision of health care 
services unless such use, disclosure, or transfer is required by an 
order of an entity with authority to regulate insurance or an order of 
a court of competent jurisdiction. In addition, such a person may not 
disclose or transfer information relating to an applicant's or 
insured's location or telephone number. Nothing in this paragraph shall 
be construed as limiting or precluding a subject of abuse from 
obtaining the subject's own insurance records from an insurer.
            (2) Authority of subject of abuse.--A subject of abuse, at 
        the absolute discretion of the subject of abuse, may provide 
        evidence of abuse to an insurer for the limited purpose of 
        facilitating treatment of an abuse-related condition or 
        demonstrating that a condition is abuse-related. Nothing in 
        this paragraph shall be construed as authorizing an insurer or 
        health carrier to disregard such provided evidence.

SEC. 4. INSURANCE PROTOCOLS FOR SUBJECTS OF ABUSE.

    Insurers shall develop and adhere to written policies specifying 
procedures to be followed by employees, contractors, producers, agents 
and brokers for the purpose of protecting the safety and privacy of a 
subject of abuse and otherwise implementing the provisions of this Act 
when taking an application, investigating a claim, or taking any other 
action relating to a policy or claim involving a subject of abuse.

SEC. 5. REASONS FOR ADVERSE ACTIONS.

    An insurer that takes an action that adversely affects a subject of 
abuse, shall advise the subject of abuse applicant or insured of the 
specific reasons for the action in writing. Reference to general 
underwriting practices or guidelines does not constitute a specific 
reason.

SEC. 6. LIFE INSURANCE.

    Nothing in this Act shall be construed to prohibit a life insurer 
from declining to issue a life insurance policy if the applicant or 
prospective owner of the policy is or would be designated as a 
beneficiary of the policy, and if--
            (1) the applicant or prospective owner of the policy lacks 
        an insurable interest in the insured; or
            (2) the applicant or prospective owner of the policy is 
        known, on the basis of police or court records, to have 
        committed an act of abuse against the proposed insured.

SEC. 7. SUBROGATION WITHOUT CONSENT PROHIBITED.

    Subrogation of claims resulting from abuse is prohibited without 
the informed consent of the subject of abuse.

SEC. 8. ENFORCEMENT.

    (a) Federal Trade Commission.--The Federal Trade Commission shall 
have the power to examine and investigate any insurer to determine 
whether such insurer has been or is engaged in any act or practice 
prohibited by this Act. If the Federal Trade Commission determines an 
insurer has been or is engaged in any act or practice prohibited by 
this Act, the Commission may take action against such insurer by the 
issuance of a cease and desist order as if the insurer was in violation 
of section 5 of the Federal Trade Commission Act. Such cease and desist 
order may include any individual relief warranted under the 
circumstances, including temporary, preliminary, and permanent 
injunctive and compensatory relief.
    (b) Private Cause of Action.--An applicant or insured who believes 
that the applicant or insured has been adversely affected by an act or 
practice of an insurer in violation of this Act may maintain an action 
against the insurer in a Federal or State court of original 
jurisdiction. Upon proof of such conduct by a preponderance of the 
evidence, the court may award appropriate relief, including temporary, 
preliminary, and permanent injunctive relief and compensatory and 
punitive damages, as well as the costs of suit and reasonable fees for 
the aggrieved individual's attorneys and expert witnesses. With respect 
to compensatory damages, the aggrieved individual may elect, at any 
time prior to the rendering of final judgment, to recover in lieu of 
actual damages, an award of statutory damages in the amount of $5,000 
for each violation.

SEC. 9. EFFECTIVE DATE.

    This Act shall apply with respect to any action taken on or after 
the date of the enactment of this Act, except that section 4 shall only 
apply to actions taken after the expiration of 60 days after such date.
                                 <all>