§ 2319 — Information to be furnished insureds; aggrieved person

§ 2319. Information to be furnished insureds; aggrieved person. (a)\nEvery insurer and rate service organization shall within a reasonable\ntime after receiving written request therefor, and upon payment of a\nreasonable charge, furnish to any insured affected by a rate made by it,\nor to the authorized representative of the insured, all pertinent\ninformation as to the rate.\n (b) Except as provided in subsection (c) of this section, every\ninsurer or rate service organization shall provide within this state\nreasonable means whereby any person aggrieved by the application of its\nrating system may be heard, in person or by an authorized\nrepresentative, on written request to review the manner in which such\nrating system has been applied in connection with the insurance afforded\nor offered. If the insurer or rate service organization fails to grant\nor reject the request within thirty days, applicant may proceed in the\nsame manner as if the application had been rejected. Any party affected\nby the action of the insurer or rate service organization on the request\nmay within thirty days after written notice of such action appeal to the\nsuperintendent, who, after a hearing held upon not less than ten days\nwritten notice to the appellant and to the insurer or rate service\norganization, may affirm, modify or reverse such action.\n (c) (1) Subject to the regulations of the superintendent, every\nworkers' compensation rate service organization shall establish and\nimplement procedures for the review of its determination to make a\nrating classification, relating to insurance authorized pursuant to\nparagraph fifteen of subsection (a) of section one thousand one hundred\nthirteen of this chapter, which has been filed with and approved by the\nsuperintendent. Such procedures for review shall (A) ensure that such\norganization shall, within a reasonable period of time after receiving\nwritten request therefor, furnish any insured affected by a rating\nclassification made by the organization, or to the authorized\nrepresentative of the insured, any information pertaining to the\ninsured's file and any information, upon request, pertaining to the\napplication of the classification, and (B) require an insured aggrieved\nby such determination to submit a written request for review of the\nrating classification. The failure of such rate service organization to\nrespond in writing to a written request submitted pursuant to this\nsubsection within sixty days, shall authorize the applicant for review\nto proceed as though the classification challenged was disapproved by\nthe rate service organization. If the workers' compensation rate service\norganization cannot, within such sixty day period, make such\ndetermination or advise the insured that an inspection, audit or study\nis required, the organization shall submit a written request to the\nsuperintendent, within the sixty day period, requesting a reasonable\nextension of the time period in which to make such determination.\n (2) Any insured adversely affected by a review, completed pursuant to\nparagraph one of this subsection, may, within thirty days of receiving\nwritten notice of the results of the review, appeal such review in\nwriting to the superintendent. Such appeal shall specify the grounds to\nbe relied upon by the appellant. The superintendent shall make a\ndetermination and notify the insured within sixty days of receipt of the\nrequest for an appeal as to whether he or she finds that the application\nis made in good faith, that the applicant would be so aggrieved if his\ngrounds are established, and that such grounds otherwise justify holding\nsuch a hearing. If the superintendent determines that such criteria have\nbeen met by the insured's application, then the superintendent shall\nhold a hearing on such matter within sixty days of receipt of the\nrequest for an appeal, but upon no less than ten days written notice to\nthe parties of the hearing. The superintendent may affirm, modify or\nreverse the review of the rate service organization.\n (3) Any determination by the superintendent, pursuant to paragraph two\nof this subsection, shall be reviewable pursuant to article\nseventy-eight of the civil practice law and rules.\n