<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".03" citation="COMAR 31.15.08.03" title_num="31" subtitle_num="15" chapter_num="08" heading="Unfair Claim Settlement Practices.">
  <paragraph num="A.">
    <text>A prohibited unfair claim settlement practice occurs if an insurer commits any of the following acts:</text>
    <paragraph num="(1)">
      <text>Misrepresents or provides incomplete or misleading disclosures of pertinent facts or policy provisions relating to the claim at issue;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Conceals benefits, coverages, or other provisions of a policy when those benefits, coverages, or other provisions are pertinent to a claim;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Attempts to settle a claim on the basis of an application which has been altered without notice to, or the knowledge or consent of, the insured;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Refuses to satisfy a claim for an arbitrary or capricious reason based on all available information;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Fails to include, in any claim paid to an insured or beneficiary, a statement setting forth the coverage under which the payment is made;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Fails to settle a claim promptly whenever liability is reasonably clear under one portion of a policy in order to influence settlements under other portions of the policy; or</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Fails to promptly provide a reasonable explanation of the basis for denial of a claim when requested to do so.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>A prohibited unfair claim settlement practice occurs if an insurer commits any of the following acts with such frequency as to indicate a general business practice:</text>
    <paragraph num="(1)">
      <text>Misrepresents or provides incomplete or misleading disclosure of pertinent facts or policy provisions relating to the coverages at issue;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Fails to include, in claims paid to insureds or beneficiaries, statements setting forth the coverage under which the payments are made;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Fails to promptly provide reasonable explanations of the basis for denial of claims or the offer of compromise settlements;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Fails to adopt and implement reasonable standards for the prompt investigation of claims arising under policies;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Refuses to pay claims without conducting reasonable investigations based on all available information;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Fails to make good faith attempts to settle claims promptly, fairly, and equitably once liability has become reasonably clear;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Compels claimants to institute litigation to recover amounts due them under policies by offering substantially less than the amounts ultimately recovered in actions brought by the claimants;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Attempts to settle claims 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 a part of, applications or solicitations for insurance;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Attempts to settle claims on the basis of applications which have been altered without notice to, or the knowledge or consent of, insureds;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Fails to settle claims promptly whenever liability is reasonably clear under one portion of a policy in order to influence settlements under other portions of the policy;</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Delays investigations or payments of claims by requiring claimants, or claimants' licensed health care providers, to submit formal claims reports if all necessary information has been provided to the insurer in preliminary claims reports;</text>
    </paragraph>
    <paragraph num="(12)">
      <text>Fails, within 30 days after receipt of a claim that contains all necessary information and documentation, to:</text>
      <paragraph num="(a)">
        <text>Make payment of the claim,</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Notify the claimant that reimbursement for the claim, or a portion of the claim, is refused, providing specific reasons for the refusal, or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Inform the claimant of the reason it was not reasonably practicable to process the claim within that period, stating what specific additional information is needed before a decision on the claim can be made;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(13)">
      <text>Fails, upon receipt of inquiries from state insurance departments regarding claims, to furnish the departments with adequate responses to the inquiries within 10 working days or within the time period specified by the Maryland Insurance Administration in correspondence to the insurer, whichever is greater;</text>
    </paragraph>
    <paragraph num="(14)">
      <text>Induces or requires claimants to surrender policies as a condition of paying claims if the policies would normally continue in force beyond the date of payment of the claim; or</text>
    </paragraph>
    <paragraph num="(15)">
      <text>Fails to provide claimants, within 10 working days after receiving notification of claims, with any necessary claim forms, instructions, and reasonable assistance in order that claimants can comply with the policy conditions and the insurer's reasonable requirements for filing claims.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>The provision of any necessary claim forms and reasonable assistance in order that claimants can comply with the policy provisions and the insurer's reasonable requirements for filing claims shall satisfy the requirement that insurers acknowledge receipt of notification of claims, or pay claims, within 10 working days.</text>
  </paragraph>
</regulation>