14 Va. Admin. Code § 5-71-93

Current through Register Vol. 40, No. 22, June 17, 2024

Section 14VAC5-71-93 - Insurance company practices

A. Life insurance companies authorized to do business in this Commonwealth shall respond to a request for verification of coverage from a viatical settlement provider or a viatical settlement broker within 30 calendar days of the date a request is received. The insurer shall complete and issue the verification of coverage to the viatical settlement provider or, in its response, indicate whether, based on the medical evidence and documents provided, the insurer intends to pursue an investigation at this time regarding possible fraud or the validity of the contract, subject to the following conditions:

1. A current authorization consistent with applicable law, signed by the policy owner or certificate holder, accompanies the request.

2. In the case of an individual policy, submission of a verification of coverage form that is substantially similar to a form developed and adopted by the NAIC for such purpose or approved for such purpose by the commission, which has been completed by the viatical settlement provider or the viatical settlement broker in accordance with the instructions on the form.

3. In the case of group insurance coverage:

a. Submission of a verification of coverage form that is substantially similar to a form developed and adopted by the NAIC for such purpose or approved for such purpose by the commission, which has been completed by the viatical settlement provider or viatical settlement broker in accordance with the instructions on the form, and

b. Which has previously been referred to the group policyholder and completed to the extent the information is available to the group policyholder.

B. Nothing in this section shall prohibit a life insurance company and a viatical settlement provider or a viatical settlement broker from using another verification of coverage form that has been mutually agreed upon in writing in advance of submission of the request.

C. A life insurance company may not charge a fee for responding to a request for information from a viatical settlement provider or viatical settlement broker in compliance with this section in excess of any usual and customary charges to contract holders, certificate holders or insureds for similar services.

D. The life insurance company may send an acknowledgment of receipt of the request for verification of coverage to the policy owner or certificate holder and, where the policy owner or certificate holder is other than the insured, to the insured. The acknowledgment may contain a general description of any accelerated death benefit that is available under a provision of or rider to the life insurance contract.

14 Va. Admin. Code § 5-71-93

Derived from Virginia Register Volume 20, Issue 5, eff. November 1, 2003.

Statutory Authority

§§ 12.1-13 and 38.2-223 of the Code of Virginia.