742.005
Grounds for disapproval of policy forms. The Director of the Department of Consumer and
Business Services shall disapprove any form requiring the director’s approval:
(1) If the
director finds it does not comply with the law;
(2) If the
director finds it contains any provision, including statement of premium, or
has any label, description of its contents, title, heading, backing or other
indication of its provisions, which is unintelligible, uncertain, ambiguous or
abstruse, or likely to mislead a person to whom the policy is offered,
delivered or issued;
(3) If, in the
director’s judgment, its use would be prejudicial to the interests of the
insurer’s policyholders;
(4) If the
director finds it contains provisions which are unjust, unfair or inequitable;
(5) If the
director finds sales presentation material disapproved by the director pursuant
to ORS 742.009 is being used with respect to the form; or
(6) If, with
respect to any of the following forms, the director finds the benefits provided
therein are not reasonable in relation to the premium charged:
(a) Individual
health insurance policy forms, including benefit certificates issued by
fraternal benefit societies and individual policies issued by health care
service contractors, but excluding policies referred to in ORS 743.402 as exempt
from the application of ORS 743.405 to 743.498 and 743A.160;
(b) Small
employer group health benefit plan forms for small employers as that term is
defined in ORS 743B.005, including small employer group policies issued by
health care service contractors; or
(c) Credit life
and credit health insurance forms subject to ORS 743.371 to 743.380. [Formerly
743.009; 1991 c.182 §1; 1999 c.987 §4; 2017 c.206 §15]
Notes of Decisions
North Pac. Ins. v. Hamilton, 22 P.3d 739 (Or. 2001).
· cites it 2× “4 That approach is consistent with the standards set out in ORS 742.005 as grounds for disapproval by the Director of the Department of Consumer and Business Services of insurance forms that require approval.”
Wright v. State Farm Mut. Auto. Ins., 22 P.3d 744 (Or. 2001).
· cites it 2× “In their second assignment, plaintiffs contended that, "[b]y failing to provide a separate insurance section for underinsurance, [State Farm] Auto issued a policy which is `unintelligible, uncertain, ambiguous or abstruse, or likely to mislead a person to whom the policy is…”
Petrusich v. Unum Life Ins. Co. of Am., 984 F. Supp. 2d 1112 (D. Or. 2013).
· cites it 2× “In the alternative, Petrusich argues the Court should apply heightened scrutiny because Unum’s structural conflict of interest 1 resulted in a breach of Unum’s fiduciary duty to Petrusich.”
Kirsch v. Dep't of Consum. & Bus. Servs., 278 P.3d 104 (Or. Ct. App. 2012).
· cites it 22× “Petitioner seeks judicial review of a final order in which the director of the Department of Consumer and Business Services (the department) concluded, after a contested case hearing, that the department properly applied ORS 742.005 1 in approving an individual health insurance…”
— Or. Rev. Stat. § 742.005(2) — 1 case
North Pac. Ins. v. Hamilton, 22 P.3d 739 (Or. 2001).
“4 That approach is consistent with the standards set out in ORS 742.005 as grounds for disapproval by the Director of the Department of Consumer and Business Services of insurance forms that require approval.”
— Or. Rev. Stat. § 742.005(3) — 1 case
Kirsch v. Dep't of Consum. & Bus. Servs., 278 P.3d 104 (Or. Ct. App. 2012).
“Petitioner seeks judicial review of a final order in which the director of the Department of Consumer and Business Services (the department) concluded, after a contested case hearing, that the department properly applied ORS 742.005 1 in approving an individual health insurance…”
— Or. Rev. Stat. § 742.005(4) — 1 case
Kirsch v. Dep't of Consum. & Bus. Servs., 278 P.3d 104 (Or. Ct. App. 2012).
“Petitioner seeks judicial review of a final order in which the director of the Department of Consumer and Business Services (the department) concluded, after a contested case hearing, that the department properly applied ORS 742.005 1 in approving an individual health insurance…”
— Or. Rev. Stat. § 742.005(6) — 1 case
Kirsch v. Dep't of Consum. & Bus. Servs., 278 P.3d 104 (Or. Ct. App. 2012).
“Petitioner seeks judicial review of a final order in which the director of the Department of Consumer and Business Services (the department) concluded, after a contested case hearing, that the department properly applied ORS 742.005 1 in approving an individual health insurance…”
— Or. Rev. Stat. § 742.005(6)(a) — 1 case
Kirsch v. Dep't of Consum. & Bus. Servs., 278 P.3d 104 (Or. Ct. App. 2012).
“Petitioner seeks judicial review of a final order in which the director of the Department of Consumer and Business Services (the department) concluded, after a contested case hearing, that the department properly applied ORS 742.005 1 in approving an individual health insurance…”
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