Home Table of Contents

§ 27-303. Unfair claim settlement practices of insurers or nonprofit health service plans

West's Annotated Code of MarylandInsuranceEffective: June 1, 2014

West's Annotated Code of Maryland
Insurance (Refs & Annos)
Title 27. Unfair Trade Practices and Other Prohibited Practices (Refs & Annos)
Subtitle 3. Unfair Claim Settlement Practices (Refs & Annos)
Effective: June 1, 2014
MD Code, Insurance, § 27-303
§ 27-303. Unfair claim settlement practices of insurers or nonprofit health service plans
It is an unfair claim settlement practice and a violation of this subtitle for an insurer, nonprofit health service plan, or health maintenance organization to:
(1) misrepresent pertinent facts or policy provisions that relate to the claim or coverage at issue;
(2) refuse to pay a claim for an arbitrary or capricious reason based on all available information;
(3) attempt to settle a claim based on an application that is altered without notice to, or the knowledge or consent of, the insured;
(4) fail to include with each claim paid to an insured or beneficiary a statement of the coverage under which payment is being made;
(5) 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;
(6) fail to provide promptly on request a reasonable explanation of the basis for a denial of a claim;
(7) fail to meet the requirements of Title 15, Subtitle 10B of this article for preauthorization for a health care service;
(8) fail to comply with the provisions of Title 15, Subtitle 10A of this article;
(9) 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; or
(10) fail to comply with the provisions of § 16-118 of this article.

Credits

Added by Acts 1997, c. 35, § 2, eff. Oct. 1, 1997. Amended by Acts 1998, c. 111, § 2, eff. Jan. 1, 1999; Acts 1998, c. 111, § 2, eff. Jan. 1, 1999; Acts 2007, c. 150, § 1, eff. Oct. 1, 2007; Acts 2012, c. 171, § 1, eff. Oct. 1, 2013; Acts 2014, c. 355, § 2, eff. June 1, 2014.
Formerly Art. 48A, § 230A.
MD Code, Insurance, § 27-303, MD INSURANCE § 27-303
Current through all legislation from the 2022 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
End of Document