West Virginia Code § 33-6-30

Construction of policies
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(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 physiecian, dentist or
chiropodist-podiatrist performing surgical procedures or chiropractor performing other
health care services within the scope of his or her professional license:r 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
professional services rendered by either a duly licensed phystician or a duly licensed
optometrist, within the scope of their respective professional licenses, and that the insured
or subscriber have freedom of choice to select either a physician or an optometrist to render
or perform professional services.
(b) The Legislature finds: s
(1) That consumers and insurers both benefit from the legislative mandate that the
Insurance Commissioner approve thge 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
thaWt there was a specific premium reduction 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 commissiouner, 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 amendmetnts in this section enacted
during the regular session of two thousand 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 Wsest 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.

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