H. B. 4670
(By Delegates Beane, Staton, Michael, Amores,
Trump and G. White)
(Originating in the House Select Committee on
Mitchell v. Broadnax)
[February 27, 2002]
A BILL to amend and reenact section thirty, article six, chapter
thirty-three of the code of West Virginia one thousand nine
hundred thirty-one, as amended, relating to construction of
insurance policies; setting forth legislative findings and
clarifying that specific line item premium discounts are not
required.
Be it enacted by the Legislature of West Virginia:
That section thirty, article six, chapter thirty-three of
the code of West Virginia, one thousand nine hundred thirty-one,
as amended, be amended and reenacted to read as follows:
ARTICLE 6.THE INSURANCE POLICY.
§33-6-30. Construction of policies.
(a) Every insurance contract shall be construed according to
the entirety of its terms and conditions as set forth in the
policy and as amplified, extended or modified by any rider,
endorsement or application attached to and made a part of the policy: Provided, That the word "physician" when used in any
accident and sickness policy or other contract providing for the
payment of surgical procedures shall be construed to include a
physician, dentist or chiropodist-podiatrist performing such
surgical procedure procedures or chiropractor performing other
health care services within the scope of his or her professional
license: Provided, however, That any policy of insurance or
medical or health service contract providing for payment or
reimbursement for any professional services pertaining to eye
examination, refractions or the fitting of corrective lenses
shall be construed to include payment or reimbursement for such
professional service services rendered by either a duly licensed
physician or a duly licensed optometrist, within the scope of
their respective professional licenses, and that the insured or
subscriber shall have freedom of choice to select either a
physician or an optometrist to render or perform such
professional service services.
(b) The Legislature finds:
(1) That consumers and insurers both benefit from the
legislative mandate that the insurance commissioner approve the
forms used and the rates charged by insurance companies in this
state;
(2) That certain classes of persons are seeking refunds of insurance premiums and seeking to void exclusions and other
policy provisions on the basis that insurance companies allegedly
failed to provide or demonstrate a reduction in premiums charged
in relation to certain terms or exclusions incorporated into
policies of insurance;
(3) That historically, as a prerequisite to a rate or form
being approved, neither the legislature nor the insurance
commissioner has ever required that the insurer demonstrate that
there was a specific premium deduction for certain exclusions
incorporated into policies of insurance;
(4) That the provisions of this chapter were enacted with
the intent of requiring the filing of all rates and forms with
the insurance commissioner to enable the insurance commissioner
to review and regulate rates and forms in a fair and consistent
manner;
(5) That the provisions of this chapter do not provide and
were not intended to provide the basis for monetary damages in
the form of premium refunds or partial premium refunds when the
form used and the rates charged by the insurance company have
been approved by the insurance commissioner;
(6) That actions seeking premium refunds or partial premium
refunds have a severe and negative impact upon insurers operating
in this state by imposing unexpected liabilities when insurers have relied upon the insurance commissioner's approval of the
forms used and the rates charged insureds; and
(7) That it is in the best interest of the citizens of this
state to ensure a stable insurance market.
(c) Nothing in this chapter may be construed as requiring
specific line item premium discounts or rate adjustments
corresponding to any exclusion, condition, definition, term or
limitation in any policy of insurance, including policies
incorporating statutorily mandated benefits or optional benefits
which as a matter of law must be offered. Where any insurance
policy form, including any endorsement thereto, has been approved
by the commissioner, and the corresponding rate has been approved
by the commissioner, there is a presumption that the policy forms
and rate structure are in full compliance with the requirements
of this chapter. It is the intent of the Legislature that the
amendments in this section enacted during the regular session of
two thousand and two are: (1) a clarification of existing law as
previously enacted by the Legislature, including, but not
limited, to the provisions of subsection (k), section thirty-one
of this article; and, (2) specifically intended to clarify the
law and correct a misinterpretation and misapplication of the law
that was expressed in the holding of the Supreme Court of Appeals
of West Virginia in the case of Mitchell v. Broadnax, 537 S.E.2d 882 (W.Va. 2000). These amendments are a clarification of the
existing law as previously enacted by this Legislature.