<?xml version='1.0' encoding='utf-8'?>
<subtitle article="gin" title_number="27" subtitle_number="10" title_name="Unfair Trade Practices and Other Prohibited Practices" subtitle_name="Property and Casualty Insurance -- First-Party Claims">
  <section article="gin" article_name="Insurance" number="27-1001" title_number="27" title_name="Unfair Trade Practices and Other Prohibited Practices" subtitle_number="10" subtitle_name="Property and Casualty Insurance -- First-Party Claims">
    <level label="a">
      <text>In this section, “good faith” means an informed judgment based on honesty and diligence supported by evidence the insurer knew or should have known at the time the insurer made a decision on a claim.</text>
    </level>
    <level label="b">
      <text>This section applies only to actions under § 3–1701 of the Courts Article.</text>
    </level>
    <level label="c">
      <level label="1">
        <text>Except as provided in paragraph (2) of this subsection, a person may not bring or pursue an action under § 3–1701 of the Courts Article in a court unless the person complies with this section.</text>
      </level>
      <level label="2">
        <text>Paragraph (1) of this subsection does not apply to an action:</text>
        <level label="i">
          <text>within the small claim jurisdiction of the District Court under § 4–405 of the Courts Article;</text>
        </level>
        <level label="ii">
          <text>if the insured and the insurer agree to waive the requirement under paragraph (1) of this subsection; or</text>
        </level>
        <level label="iii">
          <text>under a commercial insurance policy on a claim with respect to which the applicable limit of liability exceeds $1,000,000.</text>
        </level>
      </level>
    </level>
    <level label="d">
      <level label="1">
        <text>A complaint stating a cause of action under § 3–1701 of the Courts Article shall first be filed with the Administration.</text>
      </level>
      <level label="2">
        <text>The complaint shall:</text>
        <level label="i">
          <text>be accompanied by each document that the insured has submitted to the insurer for proof of loss;</text>
        </level>
        <level label="ii">
          <text>specify the applicable insurance coverage and the amount of the claim under the applicable coverage; and</text>
        </level>
        <level label="iii">
          <text>state the amount of actual damages, and the claim for expenses and litigation costs described under subsection (e)(2) of this section.</text>
        </level>
      </level>
      <level label="3">
        <text>The Administration shall forward the filing to the insurer.</text>
      </level>
      <level label="4">
        <text>Within 30 days after the date the filing is forwarded to the insurer by the Administration, the insurer shall:</text>
        <level label="i">
          <text>file with the Administration, except for good cause shown, a written response together with a copy of each document from the insurer’s claim file that enables reconstruction of the insurer’s activities relative to the insured’s claim, including documentation of each pertinent communication, transaction, note, work paper, claim form, bill, and explanation of benefits form relative to the claim; and</text>
        </level>
        <level label="ii">
          <text>mail to the insured a copy of the response and, except for good cause shown, each document from the insurer’s claim file that enables reconstruction of the insurer’s activities relative to the insured’s claim, including documentation of each pertinent communication, transaction, note, work paper, claim form, bill, and explanation of benefits form relative to the claim.</text>
        </level>
      </level>
    </level>
    <level label="e">
      <level label="1">
        <level label="i">
          <text>Within 90 days after the date the filing was received by the Administration, the Administration shall issue a decision that determines:</text>
          <level label="1">
            <text>whether the insurer is obligated under the applicable policy to cover the underlying first–party claim;</text>
          </level>
          <level label="2">
            <text>the amount the insured was entitled to receive from the insurer under the applicable policy on the underlying covered first–party claim;</text>
          </level>
          <level label="3">
            <text>whether the insurer breached its obligation under the applicable policy to cover and pay the underlying covered first–party claim, as determined by the Administration;</text>
          </level>
          <level label="4">
            <text>whether an insurer that breached its obligation failed to act in good faith; and</text>
          </level>
          <level label="5">
            <text>the amount of damages, expenses, litigation costs, and interest, as applicable and as authorized under paragraph (2) of this subsection.</text>
          </level>
        </level>
        <level label="ii">
          <text>The failure of the Administration to issue a decision within the time specified in subparagraph (i) of this paragraph shall be considered a determination that the insurer did not breach any obligation to the insured.</text>
        </level>
      </level>
      <level label="2">
        <text>With respect to the determination of damages under paragraph (1)(i)5 of this subsection:</text>
        <level label="i">
          <text>if the Administration finds that the insurer breached an obligation to the insured, the Administration shall determine the obligation of the insurer to pay:</text>
          <level label="1">
            <text>actual damages, which actual damages may not exceed the limits of any applicable policy; and</text>
          </level>
          <level label="2">
            <text>interest on all actual damages incurred by the insured computed:</text>
          </level>
          <level label="A">
            <text>at the rate allowed under § 11–107(a) of the Courts Article; and</text>
          </level>
          <level label="B">
            <text>from the date on which the insured’s claim should have been paid; and</text>
          </level>
        </level>
        <level label="ii">
          <text>if the Administration also finds that the insurer failed to act in good faith, the Administration shall also determine the obligation of the insurer to pay:</text>
          <level label="1">
            <text>expenses and litigation costs incurred by the insured, including reasonable attorney’s fees, in pursuing recovery under this subtitle; and</text>
          </level>
          <level label="2">
            <text>interest on all expenses and litigation costs incurred by the insured computed:</text>
          </level>
          <level label="A">
            <text>at the rate allowed under § 11–107(a) of the Courts Article; and</text>
          </level>
          <level label="B">
            <text>from the applicable date or dates on which the insured’s expenses and costs were incurred.</text>
          </level>
        </level>
      </level>
      <level label="3">
        <text>An insurer may not be found to have failed to act in good faith under this section solely on the basis of delay in determining coverage or the extent of payment to which the insured is entitled if the insurer acted within the time period specified by statute or regulation for investigation of a claim by an insurer.</text>
      </level>
      <level label="4">
        <text>The amount of the attorney’s fees determined to be payable to an insured under paragraph (2) of this subsection may not exceed one–third of the actual damages payable to the insured.</text>
      </level>
      <level label="5">
        <text>The Administration shall serve a copy of the decision on the insured and the insurer in accordance with § 2–204(c) of this article.</text>
      </level>
    </level>
    <level label="f">
      <level label="1">
        <text>If a party receives an adverse decision, the party shall have 30 days after the date of service of the Administration’s decision to request a hearing.</text>
      </level>
      <level label="2">
        <text>All hearings requested under this section shall:</text>
        <level label="i">
          <text>be referred by the Commissioner to the Office of Administrative Hearings for a final decision under Title 10, Subtitle 2 of the State Government Article;</text>
        </level>
        <level label="ii">
          <text>be heard de novo; and</text>
        </level>
        <level label="iii">
          <text>result in a final decision that makes the determinations set forth in subsection (e) of this section.</text>
        </level>
      </level>
      <level label="3">
        <text>If no administrative hearing is requested in accordance with paragraph (1) of this subsection, the decision issued by the Administration shall become a final decision.</text>
      </level>
    </level>
    <level label="g">
      <level label="1">
        <text>If a party receives an adverse decision, the party may appeal a final decision by the Administration or an administrative law judge under this section to a circuit court in accordance with § 2–215 of this article and Title 10, Subtitle 2 of the State Government Article.</text>
      </level>
      <level label="2">
        <level label="i">
          <text>This paragraph applies only if more than one party receives an adverse decision from the Administration.</text>
        </level>
        <level label="ii">
          <text>If a party requests a hearing before the Office of Administrative Hearings and another party files an appeal to a circuit court:</text>
          <level label="1">
            <text>jurisdiction over the request for hearing is transferred to the circuit court;</text>
          </level>
          <level label="2">
            <text>the request for hearing, the Administration’s decision, and the Administration’s case file, including the complaint, response, and all documents submitted to the Administration, shall be transmitted promptly to the circuit court; and</text>
          </level>
          <level label="3">
            <text>the request for hearing shall be docketed in the circuit court and consolidated for trial with the appeal.</text>
          </level>
        </level>
      </level>
      <level label="3">
        <text>Notwithstanding any other provision of law, an appeal to a circuit court under this section shall be heard de novo.</text>
      </level>
    </level>
    <level label="h">
      <text>On or before January 1 of each year beginning in 2009, in accordance with § 2–1257 of the State Government Article, the Administration shall report to the General Assembly on the following for the prior fiscal year:</text>
      <level label="1">
        <text>the number and types of complaints under this section or § 3–1701 of the Courts Article from insureds regarding first–party insurance claims under property and casualty insurance policies;</text>
      </level>
      <level label="2">
        <text>the number and types of complaints under this section or § 3–1701 of the Courts Article from insureds regarding first–party insurance claims under individual disability insurance policies;</text>
      </level>
      <level label="3">
        <text>the administrative and judicial dispositions of the complaints described in items (1) and (2) of this subsection;</text>
      </level>
      <level label="4">
        <text>the number and types of regulatory enforcement actions instituted by the Administration for unfair claim settlement practices under § 27–303(9) or § 27–304(18) of this title; and</text>
      </level>
      <level label="5">
        <text>the administrative and judicial dispositions of the regulatory enforcement actions for unfair claim settlement practices described under item (4) of this subsection.</text>
      </level>
    </level>
  </section>
</subtitle>