Maryland Insurance Section 27-304

Article - Insurance

§ 27-304.

      It is an unfair claim settlement practice and a violation of this subtitle for an insurer or nonprofit health service plan, 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; or

            (17)      fail to comply with the provisions of Title 15, Subtitle 10A of this article.



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