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31.15.08.00.htm 31.15.08.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 15 UNFAIR TRADE PRACTICES Chapter 08 Payment of Claims Under Life and Health Policies and Annuity Contracts Authority: Health-General Article, §19-706(g) Insurance Article, §1-301, 2-109, 2-205, 2-207, 4-113, 4-114, 10-102, 10-103, 10-126, 10-131, 10-401―10-406, 10-410, 14-112, 14-407, 14-408, 14-409, 15-1005, 27-102, Title 15, Subtitle 7, and Title 27, Subtitle 3, Annotated Code of Maryland
31.15.08.01.htm 31.15.08.01. 01 Scope.. These regulations are applicable to all life, health, and annuity insurers, including nonprofit health service plans, fraternal benefit societies, health maintenance organizations, and dental plan organizations, issuing life and health policies and annuity contracts.
31.15.08.02.htm 31.15.08.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Agent" means any person authorized to represent an insurer with respect to a claim, and includes a licensed agent.2) "Claimant" means the insured or a beneficiary under an insurance policy or contract, or an assignee of the insured or the beneficiary, and includes the claimant's designated legal representative and members of the immediate family of the insured o
31.15.08.03.htm 31.15.08.03. 03 Unfair Claim Settlement Practices.. A. A prohibited unfair claim settlement practice occurs if an insurer commits any of the following acts:1) Misrepresents or provides incomplete or misleading disclosures of pertinent facts or policy provisions relating to the claim at issue;2) Conceals benefits, coverages, or other provisions of a policy when those benefits, coverages, or other provisions are pertinent to a claim;3) Attempts to settle a claim on the basis of an a
31.15.08.04.htm 31.15.08.04. 04 Computation of Time.. If an insurer requires additional information in order to properly consider a claim, the number of days which elapse between the date the insurer mails a request for additional information and the date the insurer receives a response to the request may not be counted whenever these regulations require action by an insurer within a stated period of time.
31.15.08.05.htm 31.15.08.05. 05 Claims Registers.. A. Each insurer shall maintain claims registers separated for:. 1) Annuity contracts and life insurance policies, excluding credit life insurance;. 2) Health insurance policies, excluding credit health insurance; and. 3) Credit life insurance and credit health insurance policies.. B. Claims registers may be maintained manually or on computer-generated tapes from which hard copy can be supplied.C. Claims registers shall list each claim received, showing the:.
31.15.08.06.htm 31.15.08.06. 06 General Business Practices.. A. The methodology of §B of this regulation shall be used to determine whether an insurer, nonprofit health service plan, or health maintenance organization has engaged in unfair claim settlement practices with such frequency as to constitute a general business practice within the meaning of Insurance Article, §27-304, Annotated Code of Maryland.B. Engaging in unfair claim settlement practices shall be regarded as prima facie evidence of a gene
31.15.08.07.htm 31.15.08.07. 07 Penalties.. A. For each violation of Regulation .03A of this chapter, the Commissioner may impose a penalty of up to $500.B. For each violation of Regulation .03B of this chapter, the Commissioner may impose a penalty, or require restitution, as provided in Insurance Article, §1-301, 4-113, 4-114, or 27-103, Annotated Code of Maryland, as may be appropriate under the circumstances.C. The penalties prescribed in these regulations are not exclusive, and are in addition to any other
31.15.08.9999.htm 31.15.08.9999. Administrative History Effective date: September 4, 1989 (16:17 Md. R. 1884). Regulation .03B amended effective September 13, 1993 (20:18 Md. R. 1429) ―. Chapter recodified from COMAR 09.30.76 to COMAR 31.15.08, July 1998. Regulation .01 amended effective October 1, 2012 (39:19 Md. R. 1238). Regulation .02B amended effective October 1, 2012 (39:19 Md. R. 1238). Regulation .03B amended effective January 26, 2009 (36:2 Md. R. 103).
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