<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 31.15.07.04" title_num="31" subtitle_num="15" chapter_num="07" heading="Standards for Prompt Investigation of Claims.">
  <paragraph num="A.">
    <text>Insurers shall, for at least 3 years, make available for inspection by the Maryland Insurance Administration records of denials of claims and supporting documentation.</text>
  </paragraph>
  <paragraph num="B.">
    <text>If an insurer has not completed its investigation of a first party claim within 45 days of notification, the insurer shall promptly notify the first-party claimant, in writing, of the actual reason that additional time is necessary to complete the investigation. Notice shall be sent to the first-party claimant after each additional 45-day period until the insurer either affirms or denies coverage and damages.</text>
  </paragraph>
  <paragraph num="C.">
    <text>In any case in which a first-party claimant is neither an attorney nor represented by an attorney, the insurer shall, upon receipt of a written claim, inform that claimant in writing that there may be an applicable statute of limitations which may bar that claimant's rights in the future.</text>
  </paragraph>
  <paragraph num="D.">
    <text>An insurer that denies a claim on the grounds of a specific policy provision, condition, or exclusion shall advise the claimant as to the provision, condition, or exclusion on which the denial is based.</text>
  </paragraph>
  <paragraph num="E.">
    <text>When there is a reasonable basis, supported by specific information available for review by the Commissioner, that the first-party claimant has fraudulently caused or contributed to the loss, the insurer is relieved of the requirement contained in §§B and C of this regulation that the insurer state the reason that more time is required.</text>
  </paragraph>
  <paragraph num="F.">
    <text>If a claim is denied for reasons other than those described in §D or E of this regulation, an appropriate notation shall be made in the claim file of the insurer.</text>
  </paragraph>
</regulation>