PURPOSE OF THIS NOTICE
Title V of the Gramm-Leach-Bliley Act (GLBA) and the laws of North Carolina,
generally prohibit us from sharing nonpublic personal information about you with a third party
unless we provide you with this notice of our privacy policies and practices describing the type of
information that we collect about you and the categories of persons or entities to whom that
information may be disclosed. In compliance with the GLBA and the laws of this state, we are
providing you with this information, which notifies you of the privacy policies and practices of
Patton, Morgan & Clark.
The laws of this state further require that we inform you that we may not share your
personal information with a non-affiliated third party for any purpose that is not specifically
authorized by law unless we obtain your affirmative permission.
OUR PRIVACY POLICIES AND PRACTICES
1. Information we collect:
A. Categories of Information Collected and Sources From Which We Collect It:
• Information we receive from you on applications or other forms.
• Information about your transactions with us, our affiliates or others.
• Information we receive from a consumer-reporting agency.
• Information we receive from medical records or medical professionals.
additional information will be collected about you.
B. Persons From Whom Information is Collected:
We may collect nonpublic personal information from individuals other than
those proposed for coverage.
2. Information we may disclose to third parties:
In the course of our general business practices, we may disclose the information that we
collect (as described above) about you or others without your permission to the following
types of institutions for the reasons described:
• To a third party if the disclosure will enable that party to perform a business,
professional or insurance function for us.
• To an insurance institution, agent, or credit reporting agency in order to
detect or prevent criminal activity, fraud or misrepresentation in connection
with an insurance transaction.
• To an insurance institution, agent or credit reporting agency for either this
agency or the entity to whom we disclose the information to perform a
function in connection with an insurance transaction involving you.
• To a medical care institution or medical professional in order to verify
coverage or benefits, inform you of a medical problem of which you may not
be aware, or conduct an audit that would enable us to verify treatment.
• To an insurance regulatory authority, law enforcement, or other governmental
authority in order to protect our interests in preventing or prosecuting fraud, or
if we believe that you have conducted illegal activities.
• To a group policyholder for the purpose of reporting claims experience or
conducting an audit of our operations or services.
In addition to those circumstances listed above, and unless you tell us not to by
completing an Opt Out Form, we may disclose certain information about you to third parties
whose only use of the information will be for the purpose of marketing a product or service.
Under no circumstances will we disclose for marketing purposes: (1) any medical information;
(2) information relating to a claim for a benefit or a civil or criminal proceeding involving you; or
(3) personal information relating to your character, personal habits, mode of living or general
3. Your Right to Access and Amend Your Personal Information:
You have the right to request access to the personal information that we record about you.
Your right includes the right know the source of the information and the identity of the persons,
institutions or types of institutions to whom we have disclosed such information within two (2)
years prior to your request. Your right includes the right to view such information and copy it in
person, or request that a copy of it be sent to you by mail (for which we may charge you a
reasonable fee to cover our costs). Your right also includes the right to request corrections,
amendments or deletions of any information in our possession. The procedures that you must
follow to request access to or an amendment of your information are as follows:
To obtain access to your information: You should submit a request in writing to Patton,
Morgan & Clark. Such request will be forwarded to the service representative of your
policy. The request should include your name, address, social security number, telephone
number, and the recorded information to which you would like access. The Request should state
whether you would like access in person or a copy of the information sent to you by mail. Upon
receipt of your request, we will contact you within 30 business days to arrange providing you
with access in person or the copies that you have requested.
To correct, amend, or delete any of your information: You should submit a request in
wiring to Patton, Morgan & Clark. Such request will be forwarded to the service representative
of your policy. The request should include your name, address, social security number, telephone
number, the specific information in dispute, and the identity of the document or record that contains
the disputed information. Upon receipt of your request, we will contact you within 30 business days
to notify you either that we have made the correction, amendment or deletion, or that we refuse to
do so and the reasons for the refusal, which you will have the opportunity to challenge.
4. Our Practices Regarding Information Confidentiality and Security:
We restrict access to nonpublic personal information about you to those employees who
need to know that information in order to provide products or services to you. We maintain
physical, electronic, and organizational safeguards to protect information about you.
The Independent Insurance Agents of America, Inc.