(1)
Any person aggrieved by any rate charged, underwriting rule, policy form,
certificate, contract of insurance, or rider followed or adopted by a health insurer
may request the insurer to review the manner in which the rate, underwriting rule,
policy form, certificate, contract of insurance, or rider has been applied with
respect to insurance afforded to any such person. Such request may be made by an
authorized representative of any such person and shall be written. If the request is
not granted within thirty days after it is made, the request may be treated as
rejected. Any person aggrieved by the action of an insurer in refusing the review
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, the commissioner shall deny the hearing; however, if the commissioner
finds that the complaint charges a violation of any provision of this article and that
the complainant would be aggrieved if the violation is proven, the commissioner
shall proceed as provided in subsection (2) of this section.
(2) If after examination or inspection of an insurer, 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, or any rate,
underwriting rule, policy form, certificate, contract of insurance, or rider made or
used by any such insurer does not comply with the applicable requirements and
standards, the commissioner shall, unless the commissioner has good cause to
believe such noncompliance is willful, give notice in writing to such insurer, 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.
(3) (a) If the commissioner has good cause to believe that noncompliance
with the applicable requirements and standards as specified in subsection (2) of
this section is willful or if, within the period prescribed by the commissioner in the
notice required by subsection (2) of this section, the insurer 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, the commissioner shall mail a written
notice of the hearing to such insurer. The notice given under this subsection (3)
shall state in what manner and to what extent noncompliance is alleged to exist
and the matter 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 set
forth in said section.
(b) Any insurer aggrieved by an order or decision of the commissioner made
without a hearing may, within thirty days after notice of the order or decision, 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 the commissioner's previous action, specifying the reasons
therefor.
(4) If, after a hearing pursuant to subsection (3) of this section, the
commissioner finds:
(a) That any rate violates the provisions of this title applicable to it, the
commissioner may issue an order to the insurer 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 by such insurer in contracts
of insurance made thereafter shall be prohibited. In such order the commissioner
shall require the excess premium plus eight 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 policyholder contract to the date of the order
by the commissioner pursuant to this section. Interest shall be computed as simple
interest per annum.
(b) That an insurer is in violation of the provisions of this title applicable to it,
other than the provisions dealing with rates, the commissioner may issue an order
to such insurer which has been the subject of the hearing, specifying in what
respect such violation exists and requiring compliance within a specified time
thereafter;
(c) That any policy form, certificate, contract of insurance, or rider 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, the commissioner may issue an order to such insurer which
has been the subject of the hearing, prohibiting the further use of such form in this
state;
(d) That the violation of any of the provisions of this title applicable to it by
any insurer which is the subject of a hearing is willful, the commissioner may
suspend or revoke, in whole or in part, the certificate of authority of such insurer
with respect to the class of insurance which has been the subject matter of the
hearing.
(5) In addition to any other remedies or penalties provided by law:
(a) The commissioner may suspend or revoke, in whole or in part, the
certificate of authority of any insurer which fails to comply with an order of the
commissioner within the time limit contained in any such order. The commissioner
shall not suspend or revoke the 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 any certificate of authority shall
become effective. An order of suspension shall remain in effect for the period fixed
by the commissioner unless the commissioner modifies or rescinds such suspension
or until the order upon which such suspension is based is modified, rescinded, or
reversed. No certificate of authority shall be suspended or revoked except upon a
written order of the commissioner, stating findings made after a hearing held upon
not less than ten days' written notice to such person or organization specifying the
alleged violations.
(b) If a failure to comply with an order of the commissioner within the time
limit specified in any such order is willful, the insurer shall be liable to the state in
an amount not exceeding five thousand dollars for any 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 such 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 transmitted to the state treasurer who shall credit the same to the general
fund of the state.
(6) Any finding, determination, rule, ruling, or order made by the
commissioner pursuant to this section shall be subject to judicial review by the
court of appeals pursuant to section 24-4-106 (11), C.R.S.