§ 26-13-124 — Unfair claims settlement practices

Wyoming § 26-13-124

• Jurisdiction: Wyoming
• Title 26: Insurance Code
• Ch. 13: TRADE PRACTICES AND FRAUDS

Text

(a) A person is considered to be engaging in an unfair
method of competition and unfair and deceptive act or practice
in the business of insurance if that person commits or performs
with such frequency as to indicate a general business practice
any of the following unfair claims settlement practices:
(i) Misrepresenting pertinent facts or insurance
policy provisions relating to coverages at issue;
(ii) Failing to acknowledge and act reasonably
promptly upon communications with respect to claims arising
under insurance policies;
(iii) Failing to adopt and implement reasonable
standards for the prompt investigation of claims arising under
insurance policies;
(iv) Refusing to pay claims without conducting a
reasonable investigation based upon all available information;
(v) Failing to affirm or deny coverage of claims
within a reasonable time after proof of loss statements have
been completed;
(vi) Not attempting in good faith to effectuate
prompt, fair and equitable settlements of claims in which
liability has become reasonably clear;
(vii) Compelling insureds to institute litigation to
recover amounts due under an insurance policy by offering
substantially less than the amounts ultimately recovered in
actions brought by such insureds;
(viii) Attempting to settle a claim for less than the
amount to which a reasonable person would have believed he was
entitled by reference to written or printed advertising material
accompanying or made part of an application;
(ix) Attempting to settle claims on the basis of an
application which was altered without notice to, or knowledge or
consent of, the insured;
(x) Making claims payments to insureds or
beneficiaries not accompanied by a statement setting forth the
coverage under which the payments are being made;
(xi) Making known to insureds or claimants a policy
of appealing from arbitration awards in favor of insureds or
claimants for the purpose of compelling them to accept
settlements or compromises less than the amount awarded in
arbitration;
(xii) Delaying the investigation or payment of claims
by requiring an insured, claimant or the physician of either to
submit a preliminary claim report and then requiring the
subsequent submission of formal proof of loss forms, both of
which submissions contain substantially the same information;
(xiii) Failing to promptly settle claims, where
liability has become reasonably clear, under one (1) portion of
the insurance policy coverage in order to influence settlements
under other portions of the insurance policy coverage;
(xiv) Failing to promptly provide a reasonable
explanation of the basis in the insurance policy in relation to
the facts or applicable law for denial of a claim or for the
offer of a compromise settlement;
(xv) Denying or failing to timely pay disability
insurance claims for medically necessary services, procedures or
supplies as required by W.S. 26-40-201;
(xvi) Failing to comply with the external review
procedures required by W.S. 26-40-201; or
(xvii) Failing to pay a claim after an external
review organization has declared such claim to be a benefit
covered under the terms of the insurance policy.