(1) Any person aggrieved by
any rate charged, rating plan, rating system, underwriting rule, policy form,
certificate, or contract of insurance or rider followed or adopted by an insurer,
advisory organization, or rating organization may request the insurer, advisory
organization, or rating organization to review the manner in which the rate, plan,
system, rule, form, certificate, or contract or rider has been applied with respect to
insurance afforded him. Such request may be made by his authorized
representative and shall be written. If the request is not granted within thirty days
after it is made, it may be treated as rejected. Any person aggrieved by the action of
an insurer, advisory organization, or rating organization in refusing the review
requested or in failing or refusing to grant all or part of the relief requested may file
a written complaint and request for hearing with the commissioner, specifying the
grounds relied upon. If the commissioner finds that probable cause for the
complaint does not exist or that the complaint is not made in good faith, he shall
deny the hearing; however, if he finds that the complaint charges a violation of this
title and that the complainant would be aggrieved if the violation is proven, he shall
proceed as provided in subsection (2) of this section.
(2) (a) If, after examination or inspection of an insurer, rating organization,
advisory organization, or group, association, or other organization of insurers which
engages in joint underwriting or joint reinsurance, or upon the basis of other
information, or upon sufficient complaint as provided in subsection (1) of this
section, the commissioner has good cause to believe that such insurer, organization,
group, or association, or any rate, rating plan, rating system, underwriting rule,
policy form, certificate, contract of insurance or rider, made or used by any such
insurer, advisory organization, or rating organization, or proposals thereof made by
advisory or rating organizations does not comply with the applicable requirements
and standards of this title, he shall, unless he has good cause to believe that such
noncompliance is willful, give notice in writing to such insurer, organization, group,
or association, stating therein in what manner and to what extent such
noncompliance is alleged to exist and specifying therein a reasonable time, not less
than ten days thereafter, in which such noncompliance shall be corrected. Notices
and filings of underwriting rules required under this section shall be confidential as
between the commissioner and the parties.
(b) The commissioner shall not find that a policy form, certificate, or contract
of insurance or rider does not comply with the applicable requirements and
standards of this title on the ground that it excludes coverage of claims made by a
member of a household against another member of the same household. Such
exclusions are in conformity with the public policy of this state.
(c) Repealed.
(3) (a) If the commissioner has good cause to believe that such
noncompliance is willful or if, within the period prescribed by the commissioner in
the notice required by subsection (2) of this section, the insurer, organization,
group, or association does not make such changes as may be necessary to correct
the noncompliance specified by the commissioner or establish to the satisfaction of
the commissioner that such specified noncompliance does not exist, the
commissioner may hold a public hearing in connection therewith. Within a
reasonable period of time, not less than ten days before the date of such hearing,
he shall mail a written notice of the hearing to such insurer, organization, group, or
association. The notice given under this subsection (3) shall state in what manner
and to what extent noncompliance is alleged to exist and the matters to be
considered at such hearing. The hearing shall not include subjects not specified in
the notice. The hearing shall be conducted in accordance with section 24-4-105,
C.R.S., and the commissioner shall have all the powers granted in said section.
(b) Any insurer, rating organization, advisory organization, or group,
association, or other organization of insurers which engages in joint underwriting or
joint reinsurance aggrieved by an order or decision of the commissioner made
without a hearing may, within thirty days after notice of the order or decision to the
corporation, make written application to the commissioner for a hearing thereon.
The commissioner shall hold a hearing as provided in the applicable provisions of
article 4 of title 24, C.R.S. Within fourteen days after such hearing, the
commissioner shall affirm, reverse, or modify his previous action, specifying his
reasons therefor.
(4) If, after a hearing pursuant to subsection (3) of this section, the
commissioner finds:
(a) That any rate, rating plan, or rating system violates the provisions of this
title applicable to it, the commissioner may issue an order to the insurer or rating
organization which has been the subject of the hearing, specifying in what respects
such violation exists and stating when, within a reasonable period of time, the
further use of such rate or rating system by such insurer or rating organization in
contracts of insurance made thereafter shall be prohibited. In such order the
commissioner may require the excess premium plus a maximum of eighteen
percent interest to be refunded to the policyholder. The amount of the refund, plus
interest, shall be computed from the effective date of the rate used on the
individual policyholder contract to the commencement date of the hearing on the
rate. Interest shall be computed as simple interest per annum.
(b) That an insurer, rating organization, advisory organization, or group,
association, or other organization of insurers which engages in joint underwriting or
joint reinsurance is in violation of the provisions of this title applicable to it, other
than the provisions dealing with rates, rating plans, or rating systems, he may issue
an order to such insurer, organization, group, or association which has been the
subject of the hearing, specifying in what respects such violation exists and
requiring compliance within a specified time thereafter;
(c) That any policy form, policy, certificate, contract of insurance or rider, or
any portion or any proposal thereof made by advisory or rating organizations
contains any provision or style of presentation which is deceptive or misleading or
renders its use hazardous to the public or the policyholders or otherwise does not
comply with the requirements of law, he may issue an order to such insurer,
organization, group, or association which has been the subject of the hearing,
prohibiting the further use of any such form in this state;
(d) That the violation of any of the provisions of this title applicable to it by
any insurer or rating organization which has been the subject of hearing was willful,
he may suspend or revoke, in whole or in part, the certificate of authority of such
insurer or the license of such rating organization with respect to the class of
insurance which has been the subject matter of the hearing;
(e) That any rating organization has willfully engaged in any fraudulent or
dishonest act or practice, he may suspend or revoke, in whole or in part, the license
of such organization in addition to any other penalty provided in this title.
(5) In addition to other remedies or penalties provided by law:
(a) The commissioner may suspend or revoke, in whole or in part, the license
of any rating organization or the certificate of authority of any insurer which fails to
comply with an order of the commissioner within the time limited by such order. The
commissioner shall not suspend or revoke the license or certificate of authority for
failure to comply with an order until the time prescribed for an appeal therefrom
has expired or, if an appeal has been taken, until such order has been affirmed. The
commissioner may determine when a suspension or revocation of license or
certificate of authority shall become effective. An order of suspension shall remain
in effect for the period fixed by the commissioner, unless he modifies or rescinds
such suspension or until the order upon which such suspension is based is modified,
rescinded, or reversed. No license shall be suspended or revoked except upon a
written order of the commissioner, stating his findings, made after a hearing held
upon not less than ten days' written notice to such person or organization
specifying the alleged violation.
(b) If a failure to comply with an order of the commissioner within the time
limited by such order is willful, the rating organization or insurer shall be liable to
the state in an amount not exceeding five thousand dollars for such failure. The
commissioner shall collect the amount so payable and may bring a civil action in the
name of the people of the state of Colorado to enforce collection. Such penalty may
be in addition to the remedy provided in paragraph (a) of this subsection (5). All
moneys collected by the commissioner under this paragraph (b) shall be paid into
the general fund of the state of Colorado.
(6) Any findings, determination, rule, ruling, or order made by the
commissioner shall be subject to judicial review by the court of appeals, and
proceedings on review shall be in accordance with the provisions of section 24-4-106 (11), C.R.S.
(7) This section shall apply to insurers providing coverage for exempt
commercial policyholders, as defined pursuant to section 10-4-1402 and rules
adopted by the commissioner pursuant to that section, that the commissioner
determines to be anticompetitive, as described in section 10-4-415.