N.Y. Insurance Law § 2319: Information to be furnished insureds; aggrieved person

§ 2319. Information to be furnished insureds; aggrieved person. (a)

Every insurer and rate service organization shall within a reasonable

time after receiving written request therefor, and upon payment of a

reasonable charge, furnish to any insured affected by a rate made by it,

or to the authorized representative of the insured, all pertinent

information as to the rate.

(b) Except as provided in subsection (c) of this section, every

insurer or rate service organization shall provide within this state

reasonable means whereby any person aggrieved by the application of its

rating system may be heard, in person or by an authorized

representative, on written request to review the manner in which such

rating system has been applied in connection with the insurance afforded

or offered. If the insurer or rate service organization fails to grant

or reject the request within thirty days, applicant may proceed in the

same manner as if the application had been rejected. Any party affected

by the action of the insurer or rate service organization on the request

may within thirty days after written notice of such action appeal to the

superintendent, who, after a hearing held upon not less than ten days

written notice to the appellant and to the insurer or rate service

organization, may affirm, modify or reverse such action.

(c) (1) Subject to the regulations of the superintendent, every

workers' compensation rate service organization shall establish and

implement procedures for the review of its determination to make a

rating classification, relating to insurance authorized pursuant to

paragraph fifteen of subsection (a) of section one thousand one hundred

thirteen of this chapter, which has been filed with and approved by the

superintendent. Such procedures for review shall (A) ensure that such

organization shall, within a reasonable period of time after receiving

written request therefor, furnish any insured affected by a rating

classification made by the organization, or to the authorized

representative of the insured, any information pertaining to the

insured's file and any information, upon request, pertaining to the

application of the classification, and (B) require an insured aggrieved

by such determination to submit a written request for review of the

rating classification. The failure of such rate service organization to

respond in writing to a written request submitted pursuant to this

subsection within sixty days, shall authorize the applicant for review

to proceed as though the classification challenged was disapproved by

the rate service organization. If the workers' compensation rate service

organization cannot, within such sixty day period, make such

determination or advise the insured that an inspection, audit or study

is required, the organization shall submit a written request to the

superintendent, within the sixty day period, requesting a reasonable

extension of the time period in which to make such determination.

(2) Any insured adversely affected by a review, completed pursuant to

paragraph one of this subsection, may, within thirty days of receiving

written notice of the results of the review, appeal such review in

writing to the superintendent. Such appeal shall specify the grounds to

be relied upon by the appellant. The superintendent shall make a

determination and notify the insured within sixty days of receipt of the

request for an appeal as to whether he or she finds that the application

is made in good faith, that the applicant would be so aggrieved if his

grounds are established, and that such grounds otherwise justify holding

such a hearing. If the superintendent determines that such criteria have

been met by the insured's application, then the superintendent shall

hold a hearing on such matter within sixty days of receipt of the

request for an appeal, but upon no less than ten days written notice to

the parties of the hearing. The superintendent may affirm, modify or

reverse the review of the rate service organization.

(3) Any determination by the superintendent, pursuant to paragraph two

of this subsection, shall be reviewable pursuant to article

seventy-eight of the civil practice law and rules.