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§ 27-304. Unfair claim settlement practices committed with frequency to indicate general busine...

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, § 27-304
§ 27-304. Unfair claim settlement practices committed with frequency to indicate 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.


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. 112, § 2, eff. Jan. 1, 1999; Acts 1999, c. 71, § 1, eff. June 1, 1999; Acts 2007, c. 150, § 1, eff. Oct. 1, 2007; Acts 2014, c. 355, § 2, eff. June 1, 2014.
Formerly Art. 48A, § 230A.
MD Code, Insurance, § 27-304, MD INSURANCE § 27-304
Current through all legislation from the 2022 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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