2021 Maryland Statutes
Insurance
Title 27 - Unfair Trade Practices and Other Prohibited Practices
Subtitle 3 - Unfair Claim Settlement Practices
Section 27-304 - Unfair Claim Settlement Practices -- General Business Practice

    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.

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