It is an unfair claim settlement practice and a violation of this subtitle for an insurer, nonprofit health service plan, or health maintenance organization, when committed with the frequency to indicate a general business practice, to:
(1)misrepresent pertinent facts or policy provisions that relate to the claim or coverage at issue;
(2)fail to acknowledge and act with reasonable promptness on communications about claims that arise under policies;
(3)fail to adopt and implement reasonable standards for the prompt investigation of claims that arise under policies;
(4)refuse to pay a claim without conducting a reasonable investigation based on all available information;
(5)fail to affirm or deny coverage of claims within a rea
Free access — add to your briefcase to read the full text and ask questions with AI
It is an unfair claim settlement practice and a violation of this subtitle for an insurer, nonprofit health service plan, or health maintenance organization, when committed with the frequency to indicate a general business practice, to:
(1) misrepresent pertinent facts or policy provisions that relate to the claim or coverage at issue;
(2) fail to acknowledge and act with reasonable promptness on communications about claims that arise under policies;
(3) fail to adopt and implement reasonable standards for the prompt investigation of claims that arise under policies;
(4) refuse to pay a claim without conducting a reasonable investigation based on all available information;
(5) fail to affirm or deny coverage of claims within a reasonable time after proof of loss statements have been completed;
(6) fail to make a prompt, fair, and equitable good faith attempt, to settle claims for which liability has become reasonably clear;
(7) compel insureds to institute litigation to recover amounts due under policies by offering substantially less than the amounts ultimately recovered in actions brought by the insureds;
(8) attempt to settle a claim for less than the amount to which a reasonable person would expect to be entitled after studying written or printed advertising material accompanying, or made part of, an application;
(9) attempt to settle a claim based on an application that is altered without notice to, or the knowledge or consent of, the insured;
(10) fail to include with each claim paid to an insured or beneficiary a statement of the coverage under which the payment is being made;
(11) make known to insureds or claimants a policy of appealing from arbitration awards in order to compel insureds or claimants to accept a settlement or compromise less than the amount awarded in arbitration;
(12) delay an investigation or payment of a claim by requiring a claimant or a claimant’s licensed health care provider to submit a preliminary claim report and subsequently to submit formal proof of loss forms that contain substantially the same information;
(13) fail to settle a claim promptly whenever liability is reasonably clear under one part of a policy, in order to influence settlements under other parts of the policy;
(14) fail to provide promptly a reasonable explanation of the basis for denial of a claim or the offer of a compromise settlement;
(15) refuse to pay a claim for an arbitrary or capricious reason based on all available information;
(16) fail to meet the requirements of Title 15, Subtitle 10B of this article for preauthorization for a health care service;
(17) fail to comply with the provisions of Title 15, Subtitle 10A of this article; or
(18) fail to act in good faith, as defined under § 27–1001 of this title, in settling a first–party claim under a policy of property and casualty insurance.