631.83 Annotation
The failure of policyholders to give notice to an underinsurer of a settlement between the insured and the tortfeasor did not bar underinsured motorist coverage in the absence of prejudice to the insurer. There is a rebuttable presumption of prejudice when there is a lack of notice, with the burden on the insured to prove by the greater weight of the evidence that the insurer was not prejudiced. Ranes v. American Family Mutual Insurance Co.
219 Wis. 2d 49,
580 N.W.2d 197 (1998).
631.85
631.85
Appraisal or arbitration. An insurance policy may contain provision for independent appraisal and compulsory arbitration, subject to the provisions of
s. 631.20. If an approved policy provides for application to a court of record for the appointment of a disinterested appraiser, arbitrator or umpire, any court of record of this state except the court of appeals or the supreme court may be requested to make an appointment. Upon appropriate request, the court shall make the appointment promptly.
631.85 History
History: 1975 c. 375;
1977 c. 187.
631.85 Annotation
Although s. 631.20 generally refers to forms, its procedure for approval of of forms is applicable to arbitration clauses under this section. An arbitration clause not approved under this section is per se invalid. Appleton Papers, Inc. v. Home Indemnity Co. 2000 WI App 104,
235 Wis. 2d 39,
612 N.W.2d 760.
631.89
631.89
Restrictions on use of genetic test results. 631.89(1)(1) In this section, "genetic test" means a test using deoxyribonucleic acid extracted from an individual's cells in order to determine the presence of a genetic disease or disorder or the individual's predisposition for a particular genetic disease or disorder.
631.89(2)
(2) An insurer, the state with respect to a self-insured health plan, or a county, city, village or school board that provides health care services for individuals on a self-insured basis, may not do any of the following:
631.89(2)(a)
(a) Require or request directly or indirectly any individual or a member of the individual's family to obtain a genetic test.
631.89(2)(b)
(b) Require or request directly or indirectly any individual to reveal whether the individual or a member of the individual's family has obtained a genetic test or what the results of the test, if obtained by the individual or a member of the individual's family, were.
631.89(2)(bm)
(bm) Require or request directly or indirectly a health care provider, as defined in
s. 146.81 (1), who is or may be providing or who has or may have provided health care services to an individual to reveal whether the individual or a member of the individual's family has obtained a genetic test or what the results of the test, if obtained by the individual or a member of the individual's family, were.
631.89(2)(c)
(c) Condition the provision of insurance coverage or health care benefits on whether an individual or a member of the individual's family has obtained a genetic test or what the results of the test, if obtained by the individual or a member of the individual's family, were.
631.89(2)(d)
(d) Consider in the determination of rates or any other aspect of insurance coverage or health care benefits provided to an individual whether an individual or a member of the individual's family has obtained a genetic test or what the results of the test, if obtained by the individual or a member of the individual's family, were.
631.89(3)(a)(a) Subsection (2) does not apply to an insurer writing life insurance coverage or income continuation insurance coverage.
631.89(3)(b)
(b) An insurer writing life insurance coverage or income continuation insurance coverage that obtains information under
sub. (2) (a) or
(b) may not do any of the following:
631.89(3)(b)1.
1. Use the information contrary to
sub. (2) (c) or
(d) in writing a type of insurance coverage other than life or income continuation for the individual or a member of the individual's family.
631.89(3)(b)2.
2. Provide for rates or any other aspect of coverage that is not reasonably related to the risk involved.
631.89 History
History: 1991 a. 269;
1997 a. 74.
631.90
631.90
Restrictions on use of tests for HIV. 631.90(1)
(1) In this section, "HIV" means any strain of human immunodeficiency virus, which causes acquired immunodeficiency syndrome.
631.90(2)
(2) With regard to policies issued or renewed on and after July 20, 1985, an insurer may not do any of the following:
631.90(2)(a)
(a) Require or request directly or indirectly any individual to reveal whether the individual has obtained a test for the presence of HIV, antigen or nonantigenic products of HIV or an antibody to HIV or what the results of this test, if obtained by the individual, were.
631.90(2)(b)
(b) Condition the provision of insurance coverage on whether an individual has obtained a test for the presence of HIV, antigen or nonantigenic products of HIV or an antibody to HIV or what the results of this test, if obtained by the individual, were.
631.90(2)(c)
(c) Consider in the determination of rates or any other aspect of insurance coverage provided to an individual whether an individual has obtained a test for the presence of HIV, antigen or nonantigenic products of HIV or an antibody to HIV or what the results of this test, if obtained by the individual, were.
631.90(3)(a)(a) Subsection (2) does not apply with regard to any test or series of tests for use in the underwriting of individual life, accident and health insurance policies that the person designated by the secretary of health and family services as the state epidemiologist finds medically significant and sufficiently reliable for the presence of HIV, antigen or nonantigenic products of HIV or an antibody to HIV and that the commissioner finds and designates by rule as sufficiently reliable for use in the underwriting of individual life, accident and health insurance policies.
631.90(3)(b)
(b) Paragraph (a) does not authorize the use of any test or series of tests for the presence of HIV, antigen or nonantigenic products of HIV or an antibody to HIV to discriminate in violation of
s. 628.34 (3).
631.90 Cross-reference
Cross Reference: See also s.
Ins 3.53, Wis. adm. code.
631.93
631.93
Prohibited provisions concerning HIV infection. 631.93(1)(1)
Definitions. In this section, "HIV infection" means the pathological state produced by a human body in response to the presence of HIV, as defined in
s. 631.90 (1).
631.93(2)
(2) Accident and health insurance. An accident or health insurance policy may not contain exclusions or limitations, including deductibles or copayments, for coverage of the treatment of HIV infection or any illness or medical condition arising from or related to HIV infection, unless the exclusions or limitations apply generally to other illnesses or medical conditions covered by the policy.
631.93(3)
(3) Life insurance. A life insurance policy may not deny or limit benefits solely because the insured's death is caused, directly or indirectly, by HIV infection or any illness or medical condition arising from or related to HIV infection.
631.93 History
History: 1989 a. 201.
631.95
631.95
Restrictions on insurance practices; domestic abuse. 631.95(2)
(2) General prohibitions. Except as provided in
sub. (3), an insurer may not do any of the following:
631.95(2)(a)
(a) Refuse to provide or renew coverage to a person, or cancel a person's coverage, under an individual or group insurance policy or a certificate of group insurance on the basis that the person has been, or the insurer has reason to believe that the person is, a victim of abuse or domestic abuse or that a member of the person's family has been, or the insurer has reason to believe that a member of the person's family is, a victim of abuse or domestic abuse.
631.95(2)(b)
(b) Refuse to provide or renew coverage to an employer or other group, or cancel an employer's or other group's coverage, under a group insurance policy on the basis that an employee or other group member has been, or the insurer has reason to believe that an employee or other group member is, a victim of abuse or domestic abuse or that a member of an employee's or other group member's family has been, or the insurer has reason to believe that a member of an employee's or other group member's family is, a victim of abuse or domestic abuse.
631.95(2)(c)
(c) Use as a factor in the determination of rates or any other aspect of insurance coverage under an individual or group insurance policy or a certificate of group insurance the knowledge or suspicion that a person or an employee or other group member has been or is a victim of abuse or domestic abuse or that a member of the person's or an employee's or other group member's family has been or is a victim of abuse or domestic abuse.
631.95(2)(d)
(d) Under an individual or group disability insurance policy or a certificate of group disability insurance, exclude or limit coverage of, or deny a claim for, health care services or items related to the treatment of injury or disease resulting from abuse or domestic abuse on the basis that a person or an employee or other group member has been, or the insurer has reason to believe that a person or an employee or other group member is, a victim of abuse or domestic abuse or that a member of the person's or an employee's or other group member's family has been, or the insurer has reason to believe that a member of the person's or an employee's or other group member's family is, a victim of abuse or domestic abuse.
631.95(2)(e)
(e) Under an individual or group life insurance policy or a certificate of group life insurance, deny or limit benefits in the event that the death of the person whose life is insured results from abuse or domestic abuse on the basis that the person whose life is insured has been, or the insurer has reason to believe that the person whose life is insured is, a victim of abuse or domestic abuse or that a member of the family of the person whose life is insured has been, or the insurer has reason to believe that a member of the family of the person whose life is insured is, a victim of abuse or domestic abuse.
631.95(2)(f)
(f) Under property insurance coverage that excludes coverage for loss or damage to property resulting from intentional acts, deny payment to an insured for a claim based on property loss or damage resulting from an act, or pattern, of abuse or domestic abuse if that insured did not cooperate in or contribute to the creation of the loss or damage and if the person who committed the act or acts that caused the loss or damage is criminally prosecuted for the act or acts. Payment to the innocent insured may be limited in accordance with his or her ownership interest in the property or reduced by payments to a mortgagee or other holder of a secured interest.
631.95(3)
(3) Exceptions and qualifications related to prohibitions. 631.95(3)(a)(a)
Disability insurance. In establishing premiums for an individual or group disability insurance policy or a certificate of group disability insurance, an insurer may inquire about a person's existing medical condition and, based on the opinion of a qualified actuary, as defined in
s. 623.06 (1c), use information related to a person's existing medical condition, regardless of whether that condition is or may have been caused by abuse or domestic abuse.
631.95(3)(b)
(b)
Life insurance. With respect to an individual or group life insurance policy or a certificate of group life insurance, an insurer may, on the basis of information in medical, law enforcement or court records, or on the basis of information provided by the insured, policyholder or applicant for insurance, do any of the following:
631.95(3)(b)1.
1. Deny or limit benefits under such a policy or certificate to a beneficiary who is the perpetrator of abuse or domestic abuse that results in the death of the insured.
631.95(3)(b)2.
2. Refuse to issue such a policy or certificate that names as a beneficiary a person who is or was, or who the insurer has reason to believe is or was, a perpetrator of abuse or domestic abuse against the person who is to be the insured under the policy.
631.95(3)(b)3.
3. Refuse to name as a beneficiary under such a policy or certificate a person who is or was, or who the insurer has reason to believe is or was, a perpetrator of abuse or domestic abuse against the insured under the policy.
631.95(3)(b)4.
4. Refuse to issue such a policy or certificate to a person who is or was, or who the insurer has reason to believe is or was, a perpetrator of abuse or domestic abuse against the person who is to be the insured under the policy.
631.95(3)(b)5.
5. Refuse to issue such a policy or certificate to a person who lacks an insurable interest in the person who is to be the insured under the policy.
631.95(3)(b)6.
6. For purposes of underwriting; administering a claim under; or determining a person's eligibility for coverage, a benefit or payment under; such a policy or certificate; or for purposes of servicing such a policy or certificate or an application for such a policy or certificate; inquire about and use information related to a person's medical history or existing medical condition, regardless of whether that condition is or may have been caused by abuse or domestic abuse. Any adverse underwriting decision based on a person's medical history or medical condition must be made in conformity with sound actuarial principles or otherwise supported by actual or reasonably anticipated experience.
631.95(3)(c)
(c)
Disability income or long-term care insurance. With respect to an individual or group disability income or long-term care insurance policy or a certificate of group disability income or long-term care insurance, an insurer may, on the basis of information in medical, law enforcement or court records, or on the basis of information provided by the insured, policyholder or applicant for insurance, do any of the following:
631.95(3)(c)1.
1. Refuse to name as a beneficiary under such a policy or certificate a person who is or was, or who the insurer has reason to believe is or was, a perpetrator of abuse or domestic abuse against the insured under the policy.
631.95(3)(c)2.
2. Refuse to issue such a policy or certificate to a person who is or was, or who the insurer has reason to believe is or was, a perpetrator of abuse or domestic abuse against the person who is to be the insured under the policy.
631.95(3)(c)3.
3. Refuse to issue such a policy or certificate to a person who lacks an insurable interest in the person who is to be the insured under the policy.
631.95(3)(c)4.
4. For purposes of underwriting; administering a claim under; or determining a person's eligibility for coverage, a benefit or payment under; such a policy or certificate; or for purposes of servicing such a policy or certificate or an application for such a policy or certificate; inquire about and use information related to a person's medical history or existing medical condition, regardless of whether that condition is or may have been caused by abuse or domestic abuse. Any adverse underwriting decision based on a person's medical history or medical condition must be made in conformity with sound actuarial principles or otherwise supported by actual or reasonably anticipated experience.
631.95(4)
(4) Immunity for insurers. An insurer is immune from any civil or criminal liability for any action taken under
sub. (3) or for the death of, or injury to, an insured that results from abuse or domestic abuse.
631.95(5)
(5) Use and disclosure of abuse information. 631.95(5)(a)(a) Except as provided in
pars. (c) and
(d) and
sub. (3), no person employed by or contracting with an insurer may use, disclose or transfer information related to any of the following:
631.95(5)(a)1.
1. Whether an insured or applicant for insurance or a member of the insured's or applicant's family, or whether an employee or other group member of an insured or applicant for insurance or a member of the employee's or other group member's family, is or has been, or is with reason believed by the person employed by or contracting with the insurer to be or to have been, a victim of abuse or domestic abuse.
631.95(5)(a)2.
2. Whether an insured or applicant for insurance, or whether an employee or other group member of an insured or applicant for insurance, is a family member or associate of, or in a relationship with, a person who is or has been, or who the person employed by or contracting with the insurer has reason to believe is or has been, a victim of abuse or domestic abuse.
631.95(5)(a)3.
3. Whether an insured or an applicant for insurance employs a person who is or has been, or who the person employed by or contracting with the insurer has reason to believe is or has been, a victim of abuse or domestic abuse.
631.95(5)(b)
(b) Except as provided in
pars. (c) and
(d), a person employed by or contracting with an insurer may not disclose or transfer information related to the telephone number or address or other location of any of the following individuals, if the person knows that the individual is or has been, or has reason to believe that the individual is or has been, a victim of abuse or domestic abuse:
631.95(5)(b)3.
3. An employee of an insured or of an applicant for insurance.
631.95(5)(b)4.
4. A group member of an insured or of an applicant for insurance.
631.95(5)(b)5.
5. A member of the family of any of the individuals listed in
subds. 1. to
4.
631.95(5)(c)
(c) Paragraphs (a) and
(b) do not apply if the use, disclosure or transfer of the information is made with the consent of the individual to whom the information relates or if the use, disclosure or transfer satisfies any of the following:
631.95(5)(c)1.
1. Is for a purpose related to the direct provision of health care services.
631.95(5)(c)2.
2. Is for a valid business purpose, including the disclosure or transfer of the information to any of the following:
631.95(5)(c)2.b.
b. A party to a proposed or consummated sale, transfer, merger or consolidation of all or part of the business of the insurer.
631.95(5)(c)2.c.
c. Medical, underwriting or claims personnel under contract or affiliated with the insurer.
631.95(5)(c)2.e.
e. The policyholder or policyholder's assignee as a result of delivery of the policy.
631.95(5)(c)4.
4. Is required by a court order or an order of an entity with authority to regulate insurance, or is otherwise required by law.
631.95(5)(c)5.
5. Is required or authorized by the commissioner by rule.
631.95(5)(d)
(d) Nothing in this subsection limits or precludes an insured or an applicant for insurance, or an employee or other group member of an insured or applicant for insurance, from obtaining his or her own insurance records from an insurer.
631.95 History
History: 1999 a. 95.
