(215 ILCS 5/155.22a)
Sec. 155.22a.
Coverage for subjects of abuse.
(a) No company authorized to
transact life, health,
disability income, or property and casualty insurance in this State may:
(1) Deny, refuse to issue, refuse to renew, refuse to |
| reissue, cancel, or otherwise terminate an insurance policy or restrict coverage on an individual because that individual is or has been the subject of abuse or because that individual seeks or has sought: (i) medical or psychological treatment for abuse; or (ii) protection or shelter from abuse;
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(2) Charge a different rate for the same coverage for
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| an insurance policy because an individual insured under such policy has a history of or is a subject of abuse;
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(3) Deny a claim by an insured as a result of his or
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| her status as being or having been a subject of abuse, except as otherwise permitted or required by the laws of this State; or
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(4) Ask an insured or an applicant for insurance
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| whether that individual is or has been a subject of abuse or whether that individual seeks or has sought: (i) medical or psychological treatment specifically for abuse; or (ii) protection or shelter from abuse.
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(b) No company authorized to transact life, health, disability
income,
or property and casualty
insurance in this State may fail to maintain strict confidentiality of
information, as defined in the Insurance Information and Privacy Protection
Article of this Code, relating to an applicant's or insured's abuse status or
to a medical or psychological condition that the company knows is
abuse-related. Disclosure of such abuse-related information shall be subject
to the disclosure limitations and conditions contained in Section 1014 of this
Code.
(c) Nothing in this Section shall be construed to prohibit a company
specified in subsection (a) from (i) refusing to insure, refusing to
continue to insure, limiting the amount, extent, or kind of coverage available
to an individual, or charging a different rate for the same coverage on the
basis of that individual's physical or mental condition regardless of the
underlying cause of such condition; (ii) declining to issue a life
insurance policy
insuring an individual who is or has been the subject of abuse if the
perpetrator of the
abuse is the applicant or would be the owner of the insurance policy; or (iii)
inquiring about a physical or mental condition, even if that condition was
caused by or is related in any manner to
abuse.
(d) As used in this Section, "abuse" means the occurrence of one or more of
the following acts between family members, current or former household members,
or current or former intimate partners:
(1) Attempting to cause or intentionally, knowingly,
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| or recklessly causing another person, including a minor child, to be harassed or intimidated or subject to bodily injury, physical harm, rape, sexual assault, or involuntary sexual intercourse; or
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(2) Knowingly engaging in a course of conduct or
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| repeatedly committing acts without proper authority that place the person toward whom such acts are directed, including a minor child, in a reasonable fear of bodily injury or physical harm; or
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(3) Subjecting another person, including a minor
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| child, to false imprisonment.
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(e) No company specified in subsection (a) above shall be held civilly or
criminally liable for any cause of action that may be brought because of
compliance with this Section. Nothing in
this Section, however, shall preclude the jurisdiction of any administrative
agency to carry out its statutory authority.
(Source: P.A. 93-200, eff. 1-1-04.)
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(215 ILCS 5/155.23) (from Ch. 73, par. 767.23)
Sec. 155.23.
Fraud reporting.
(1) The Director is authorized to promulgate |
| reasonable rules requiring insurers, as defined in Section 155.24, doing business in the State of Illinois to report factual information in their possession that is pertinent to suspected fraudulent insurance claims, fraudulent insurance applications, or premium fraud after he has made a determination that the information is necessary to detect fraud or arson. Claim information may include:
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(a) Dates and description of accident or loss.
(b) Any insurance policy relevant to the accident or
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(c) Name of the insurance company claims adjustor and
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| claims adjustor supervisor processing or reviewing any claim or claims made under any insurance policy relevant to the accident or loss.
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(d) Name of claimant's or insured's attorney.
(e) Name of claimant's or insured's physician, or any
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| person rendering or purporting to render medical treatment.
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(f) Description of alleged injuries, damage or loss.
(g) History of previous claims made by the claimant
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(h) Places of medical treatment.
(i) Policy premium payment record.
(j) Material relating to the investigation of the
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| accident or loss, including statements of any person, proof of loss, and any other relevant evidence.
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(k) any facts evidencing fraud or arson.
The Director shall establish reporting requirements for application and
premium fraud information reporting by rule.
(2) The Director of Insurance may designate one or more data processing
organizations or governmental agencies to assist him in gathering such
information
and making
compilations thereof, and may by rule establish the form and procedure
for gathering and compiling such information. The rules may name any
organization or agency designated by the Director to provide this service,
and may in such case provide for a fee to be paid by the
reporting insurers
directly to the designated organization or agency to cover any of the costs
associated with providing this service. After determination by the
Director of substantial
evidence of false
or fraudulent claims, fraudulent applications, or premium fraud, the
information shall be forwarded by the Director
or the Director's designee to the proper law enforcement agency
or prosecutor. Insurers shall have
access to, and may use, the information compiled under the
provisions
of this Section. Insurers shall release
information to, and shall cooperate with, any law enforcement agency
requesting such information.
In the absence of malice, no insurer, or person who
furnishes
information on its behalf, is liable for damages in a civil action or subject
to criminal prosecution for any oral or written statement made or any other
action taken that is necessary to supply information required pursuant to
this Section.
(Source: P.A. 92-233, eff. 1-1-02.)
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(215 ILCS 5/155.24) (from Ch. 73, par. 767.24)
Sec. 155.24.
Motor Vehicle Theft and Motor Insurance Fraud
Reporting and Immunity Law.
(a) As used in this Section:
(1) "authorized governmental agency" means the |
| Illinois State Police, a local governmental police department, a county sheriff's office, a State's Attorney, the Attorney General, a municipal attorney, a United States district attorney, a duly constituted criminal investigative agency of the United States government, the Illinois Department of Insurance, the Illinois Department of Professional Regulation and the office of the Illinois Secretary of State;
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(2) "relevant" means having a tendency to make the
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| existence of any information that is of consequence to an investigation of motor vehicle theft or insurance fraud investigation or a determination of such issue more probable or less probable than it would be without such information;
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(3) information will be "deemed important" if within
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| the sole discretion of the authorized governmental agency such information is requested by that authorized governmental agency;
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(4) "Illinois authorized governmental agency" means
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| an authorized governmental agency as defined in item (1) that is a part of the government of the State of Illinois or any of the counties or municipalities of this State or any other authorized entity; and
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(5) For the purposes of this Section and Section
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| 155.23, "insurer" means insurance companies, insurance support organizations, self-insured entities, and other providers of insurance products and services doing business in the State of Illinois.
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(b) Upon written request to an insurer by an authorized governmental agency,
an insurer or agent authorized by an insurer to act on its behalf shall
release to the requesting authorized governmental agency any or all relevant
information deemed important to the authorized governmental agency which
the insurer may possess relating to any specific motor vehicle theft or motor
vehicle insurance fraud. Relevant information may include, but is not limited
to:
(1) Insurance policy information relevant to the
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| motor vehicle theft or motor vehicle insurance fraud under investigation, including any application for such a policy.
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(2) Policy premium payment records which are
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(3) History of previous claims made by the insured.
(4) Information relating to the investigation of the
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| motor vehicle theft or motor vehicle insurance fraud, including statements of any person, proofs of loss and notice of loss.
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(c) When an insurer knows or reasonably believes to know the identity
of a person whom it has reason to believe committed a criminal or fraudulent
act relating to a motor vehicle theft or a motor vehicle insurance claim
or has knowledge of such a criminal or fraudulent act which is reasonably
believed not to have been reported to an authorized governmental agency,
then for the purpose of notification and investigation, the insurer or an
agent authorized by an insurer to act on its behalf shall notify an authorized
governmental agency of such knowledge or reasonable belief and provide any
additional relevant information in accordance with subsection
(b) of this Section. When the motor vehicle
theft or motor vehicle claim that gives rise to the suspected criminal or
fraudulent act has already generated an incident report to an Illinois
authorized governmental agency, the insurer shall report the suspected
criminal or fraudulent act to that agency. When no prior
incident report has been made, the insurer shall report the suspected criminal
or
fraudulent act to the Attorney General or State's Attorney in the county or
counties where the incident is claimed to have occurred. When the incident
that gives rise to the suspected criminal or fraudulent act is claimed to have
occurred outside the State of Illinois, but the suspected criminal or
fraudulent act occurs within the State of Illinois, the insurer shall make the
report to the Attorney General or State's Attorney in the county or counties
where the suspected criminal or fraudulent act occurred. When the fraud occurs
in multiple counties the report shall also be sent to the Attorney General.
(d) When an insurer provides any of the authorized governmental agencies
with notice pursuant to this Section it shall be deemed sufficient notice
to all authorized governmental agencies for the purpose of this Act.
(e) The authorized governmental agency provided with information pursuant
to this Section may release or provide such information to any other authorized
governmental agency.
(f) Any insurer providing information to an authorized governmental agency
pursuant to this Section shall have the right to request and receive relevant
information from such authorized governmental agency, and receive within
a reasonable time after the completion of the investigation, not to exceed
30 days, the information requested.
(g) Any information furnished pursuant to this Section shall be privileged
and not a part of any public record. Except as otherwise provided by law,
any authorized governmental agency, insurer, or an agent authorized by an
insurer to act on its behalf which receives any information furnished pursuant
to this Section, shall not release such information to public inspection.
Such evidence or information shall not be subject to subpoena duces tecum
in a civil or criminal proceeding unless, after reasonable notice to any
insurer, agent authorized by an insurer to act on its behalf and authorized
governmental agency which has an interest in such information and a hearing,
the court determines that the public interest and any ongoing investigation
by the authorized governmental agency, insurer, or any agent authorized
by an insurer to act on its behalf will not be jeopardized by obedience to
such a subpoena duces tecum.
(h) No insurer, or agent authorized by an insurer on its behalf, authorized
governmental agency or their respective employees shall be subject to any
civil or criminal liability in a cause of action of any kind for releasing
or receiving any information pursuant to this Section. Nothing herein is
intended to or does in any way or manner abrogate or lessen the common and
statutory law privileges and immunities of an insurer, agent authorized
by an insurer to act on its behalf or authorized governmental agency or
any of their respective employees.
(Source: P.A. 102-538, eff. 8-20-21.)
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(215 ILCS 5/155.25) (from Ch. 73, par. 767.25)
Sec. 155.25.
Reports by certain property and casualty insurers.
(A) The Director shall promulgate rules and regulations which shall
require, at the request of the Director, any insurer licensed to write medical
liability insurance in this State to file a report on a form furnished by the
Director showing its direct experience in this State. All experience shall
be on a direct basis, prior to reinsurance, and shall be required only in
the aggregate. Individual claim reports shall not be required.
(B) The reports required under subsection (A) shall include the
following data for the previous year ending on the 31st of December:
(1) Direct premium written for the prior 12 months.
(2) Direct premium earned for the prior 12 months.
(3) (a) Incurred claims by accident year, showing the |
| most recent 8 accident years, and a subtotal combining all accident years prior to the most recent 8, valued as of the most recent December 31, valued as of the prior December 31, each developed as the sum of, and with figures provided for under division (b) of this paragraph (3).
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(b) Show for each such item, the difference between 2
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(i) dollar amount of claim payments, cumulated
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| from the beginning of each accident year, where the dollar amount of claim payments shall be separately reported for closed claims under paragraph (3) (a) and for open and reopened claims under paragraph (3) (a), plus
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(ii) reserves for reported claims as of the
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| valuation dates, open or reopened, plus
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(iii) reserves for claims incurred but not
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| reported as the valuation dates, plus
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(iv) any other loss reserves carried by the
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| company as of the valuation dates and not reported in (3) (ii) or (3) (iii).
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(v) number of claims, cumulated from the
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| beginning of each accident year, showing the most recent 8 accident years, and a subtotal combining all accident years prior to the most recent 8 valued as of the most recent December 31, land valued as of the prior December 31, with figures provided for the number of closed claims under paragraph (3) (a) and the number of open and unopened claims under paragraph (3) (a). Show for each such item, the difference between the 2 valuations.
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(4) Actual incurred expenses allocated separately to
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| loss adjustment, commissions, or other acquisition costs, general office expenses, taxes, licenses and fees, and all other expenses.
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(5) Net underwriting gain or loss.
(Source: P.A. 87-1090.)
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(215 ILCS 5/155.35)
Sec. 155.35.
Insurance compliance self-evaluative privilege.
(a) To encourage insurance companies and persons conducting activities
regulated under this Code, both to conduct voluntary internal audits of their
compliance programs and management systems and to assess and improve compliance
with State and federal statutes, rules, and orders, an insurance compliance
self-evaluative privilege is recognized to protect the confidentiality of
communications relating to voluntary internal compliance audits. The General
Assembly hereby finds and declares that protection of insurance consumers is
enhanced by companies' voluntary compliance with this State's insurance and
other laws and that the public will benefit from incentives to identify and
remedy insurance and other compliance issues. It is further declared that
limited expansion of the protection against disclosure will encourage voluntary
compliance and improve insurance market conduct quality and that the voluntary
provisions of this Section will not inhibit the exercise of the regulatory
authority by those entrusted with protecting insurance consumers.
(b)(1) An insurance compliance self-evaluative audit document is privileged
information and is not admissible as evidence in any legal action in any
civil, criminal, or administrative proceeding, except as provided in
subsections (c) and (d) of this Section. Documents, communications, data,
reports, or other information created as a result of a claim involving personal
injury or workers' compensation made against an insurance policy are not
insurance compliance self-evaluative audit documents and are admissible as
evidence in civil proceedings as otherwise provided by applicable rules of
evidence or civil procedure, subject to any applicable statutory or common law
privilege, including but not limited to the work product doctrine, the
attorney-client privilege, or the subsequent remedial measures exclusion.
(2) If any company, person, or entity performs or directs the performance
of an insurance compliance audit, an officer or employee involved with the
insurance compliance audit, or any consultant who is hired for the purpose of
performing the insurance compliance audit, may not be examined in any civil,
criminal, or administrative proceeding as to the insurance compliance audit or
any insurance compliance self-evaluative audit document, as defined in this
Section. This subsection (b)(2) does not apply if the privilege set forth in
subsection (b)(1) of this Section is determined under subsection (c) or (d) not
to apply.
(3) A company may voluntarily submit, in connection with examinations
conducted under this Article, an insurance compliance self-evaluative audit
document to the Director, or his or her designee, as a confidential document
under subsection (f) of Section 132.5 of this Code without waiving the
privilege set forth in this Section to which the company would otherwise be
entitled;
provided, however, that the provisions in subsection (f) of Section 132.5
permitting the Director to make confidential documents public pursuant to
subsection (e) of Section 132.5 and access to the National Association of
Insurance Commissioners shall not apply to the insurance compliance
self-evaluative audit
document so voluntarily submitted. Nothing contained in this subsection shall
give the Director any authority to compel a company to disclose involuntarily
or otherwise provide an insurance compliance self-evaluative audit document.
(c)(1) The privilege set forth in subsection (b) of this Section does not
apply to the extent that it is expressly waived by the company that prepared
or caused to be prepared the insurance compliance self-evaluative audit
document.
(2) In a civil or administrative proceeding, a court of record may, after
an in camera review, require disclosure of material for which the privilege set
forth in subsection (b) of this Section is asserted, if the court determines
one of the following:
(A) the privilege is asserted for a fraudulent |
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(B) the material is not subject to the privilege; or
(C) even if subject to the privilege, the material
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| shows evidence of noncompliance with State and federal statutes, rules and orders and the company failed to undertake reasonable corrective action or eliminate the noncompliance within a reasonable time.
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(3) In a criminal proceeding, a court of record may, after an in camera
review, require disclosure of material for which the privilege described in
subsection (b) of this Section is asserted, if the court determines one of the
following:
(A) the privilege is asserted for a fraudulent
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(B) the material is not subject to the privilege;
(C) even if subject to the privilege, the material
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| shows evidence of noncompliance with State and federal statutes, rules and orders and the company failed to undertake reasonable corrective action or eliminate such noncompliance within a reasonable time; or
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(D) the material contains evidence relevant to
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| commission of a criminal offense under this Code, and all of the following factors are present:
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(i) the Director, State's Attorney, or Attorney
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| General has a compelling need for the information;
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(ii) the information is not otherwise available;
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(iii) the Director, State's Attorney, or Attorney
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| General is unable to obtain the substantial equivalent of the information by any means without incurring unreasonable cost and delay.
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(d)(1) Within 30 days after the Director, State's Attorney, or Attorney
General makes a written request by certified mail for disclosure of an
insurance compliance self-evaluative audit document under this subsection, the
company that
prepared or caused the document to be prepared may file with the appropriate
court a petition requesting an in camera hearing on whether the insurance
compliance self-evaluative audit document or portions of the document are
privileged under this Section or subject to disclosure. The court has
jurisdiction over a petition filed by a company under this subsection
requesting an in camera hearing on whether the insurance compliance
self-evaluative audit document or portions of the document are privileged or
subject
to disclosure. Failure by the company to file a petition waives the privilege.
(2) A company asserting the insurance compliance self-evaluative privilege
in response to a request for disclosure under this subsection shall include in
its request for an in camera hearing all of the information set forth in
subsection (d)(5) of this Section.
(3) Upon the filing of a petition under this subsection, the court shall
issue an order scheduling, within 45 days after the filing of the petition, an
in camera hearing to determine whether the insurance compliance self-evaluative
audit document or portions of the document are privileged under this Section or
subject to disclosure.
(4) The court, after an in camera review, may require disclosure of
material for which the privilege in subsection (b) of this Section is asserted
if the court determines, based upon its in camera review, that any one of the
conditions set forth in subsection (c)(2)(A) through (C) is applicable as to a
civil or administrative proceeding or that any one of the conditions set forth
in subsection (c)(3)(A) through (D) is applicable as to a criminal proceeding.
Upon making such a determination, the court may only compel the disclosure of
those portions of an insurance compliance self-evaluative audit document
relevant to issues in dispute in the underlying proceeding.
Any compelled disclosure will not be considered to be a public document or be
deemed to be a waiver of the privilege for any other civil, criminal, or
administrative proceeding. A party unsuccessfully opposing disclosure may
apply to the court for an appropriate order protecting the document from
further disclosure.
(5) A company asserting the insurance compliance self-evaluative privilege
in response to a request for disclosure under this subsection (d) shall provide
to the Director, State's Attorney, or Attorney General, as the case may be, at
the time of
filing any objection to the disclosure, all of the following information:
(A) The date of the insurance compliance
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| self-evaluative audit document.
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(B) The identity of the entity conducting the audit.
(C) The general nature of the activities covered by
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| the insurance compliance audit.
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(D) An identification of the portions of the
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| insurance compliance self-evaluative audit document for which the privilege is being asserted.
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(e) (1) A company asserting the insurance compliance self-evaluative
privilege set forth in subsection (b) of this Section has the burden of
demonstrating the applicability of the privilege. Once a company has
established the applicability of the privilege, a party
seeking disclosure under subsections (c)(2)(A) or (C) of this Section has the
burden of proving that the privilege is asserted for
a fraudulent purpose or that the company failed to
undertake reasonable corrective action or eliminate the noncompliance with a
reasonable time. The Director, State's Attorney, or Attorney General seeking
disclosure under subsection (c)(3) of this Section has the burden of proving
the elements set forth in subsection (c)(3) of this Section.
(2) The parties may at any time stipulate in proceedings under subsections
(c) or (d) of this Section to entry of an order directing that specific
information contained in an insurance compliance self-evaluative audit document
is or is not subject to the privilege provided under subsection (b) of this
Section.
(f) The privilege set forth in subsection (b) of this Section shall not
extend to any of the following:
(1) documents, communications, data, reports, or
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| other information required to be collected, developed, maintained, reported, or otherwise made available to a regulatory agency pursuant to this Code, or other federal or State law, rule, or order;
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(2) information obtained by observation or monitoring
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| by any regulatory agency; or
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(3) information obtained from a source independent of
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| the insurance compliance audit.
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(g) As used in this Section:
(1) "Insurance compliance audit" means a voluntary,
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| internal evaluation, review, assessment, or audit not otherwise expressly required by law of a company or an activity regulated under this Code, or other State or federal law applicable to a company, or of management systems related to the company or activity, that is designed to identify and prevent noncompliance and to improve compliance with those statutes, rules, or orders. An insurance compliance audit may be conducted by the company, its employees, or by independent contractors.
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(2) "Insurance compliance self-evaluative audit
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| document" means documents prepared as a result of or in connection with and not prior to an insurance compliance audit. An insurance compliance self-evaluation audit document may include a written response to the findings of an insurance compliance audit. An insurance compliance self-evaluative audit document may include, but is not limited to, as applicable, field notes and records of observations, findings, opinions, suggestions, conclusions, drafts, memoranda, drawings, photographs, computer-generated or electronically recorded information, phone records, maps, charts, graphs, and surveys, provided this supporting information is collected or developed for the primary purpose and in the course of an insurance compliance audit. An insurance compliance self-evaluative audit document may also include any of the following:
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(A) an insurance compliance audit report prepared
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| by an auditor, who may be an employee of the company or an independent contractor, which may include the scope of the audit, the information gained in the audit, and conclusions and recommendations, with exhibits and appendices;
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(B) memoranda and documents analyzing portions or
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| all of the insurance compliance audit report and discussing potential implementation issues;
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(C) an implementation plan that addresses
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| correcting past noncompliance, improving current compliance, and preventing future noncompliance; or
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(D) analytic data generated in the course of
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| conducting the insurance compliance audit.
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(3) "Company" has the same meaning as provided in
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(h) Nothing in this Section shall limit, waive, or abrogate the scope or
nature of any statutory or common law privilege including, but not limited to,
the work product doctrine, the attorney-client privilege, or the subsequent
remedial measures exclusion.
(Source: P.A. 90-499, eff. 8-19-97; 90-655, eff. 7-30-98.)
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