31A-22-1102 - Policy and certificate forms.
31A-22-1102. Policy and certificate forms.
(1) Legal expense insurance may be written as individual, group, blanket, or franchiseinsurance. Each contractual obligation for legal expense insurance shall be evidenced by a policy. Each person insured under a group policy shall be issued a certificate of coverage.
(2) Policies and certificates of legal expense insurance are subject to Section31A-21-201.
(3) The commissioner may not approve any form that does not meet all of the followingrequirements:
(a) Policies shall contain a list and description of the legal services promised or the legalmatters for which expenses are to be reimbursed, and any limits on the amounts to be reimbursed.
(b) Certificates issued under group policies shall contain a full statement of the benefitsprovided, but may summarize the other terms of the master policy.
(c) Policies promising legal services to be provided by a limited number of attorneys whohave concluded provider contracts with the insurer, whether the attorney in an individual case isto be selected by the insured or by the insurer, shall provide for alternative benefits in case theinsured is unable to find a participating attorney willing to perform the promised services or theattorney selected by the insurer is disqualified or otherwise unable to perform the promisedservices. The alternative benefit may consist of furnishing the services of an attorney selected andpaid by the insurer or paying the fee of an attorney selected by the insured. The policy shall alsoprovide a procedure that includes impartial review for settling disagreements about the groundsfor demanding an alternative benefit.
(d) No policy, except one issued by a mutual insurance company, may provide forassessments on policyholders or for reductions of benefits to maintain the insurer's solvency.
(4) The commissioner may disapprove a policy or certificate form if he finds that it:
(a) is unfair, unfairly discriminatory, misleading, or encourages misrepresentation ormisunderstanding of the contract;
(b) provides coverage or benefits or contains other provisions that would endanger thesolidity of the insurer; or
(c) is contrary to law.
(5) The commissioner may require the submission of relevant information he considers tobe reasonably necessary in determining whether to approve or disapprove a filing.
Amended by Chapter 261, 1989 General Session