375.1007. Improper claims practices.

416 words·~2 min read·/mo/chapter-375/375-1007

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

375.1007. Improper claims practices. — Any of the following acts by an insurer, if committed in violation of section 375.1005 , constitutes an improper claims practice:

(1)Misrepresenting to claimants and insureds relevant facts or policy provisions relating to coverages at issue;

(2)Failing to acknowledge with reasonable promptness pertinent communications with respect to claims arising under its policies;

(3)Failing to adopt and implement reasonable standards for the prompt investigation and settlement of claims arising under its policies;

(4)Not attempting in good faith to effectuate prompt, fair and equitable settlement of claims submitted in which liability has become reasonably clear;

(5)Compelling insureds or beneficiaries to institute suits to recover amounts due under its policies by offering substantially less than the amounts ultimately recovered in suits brought by them;

(6)Refusing to pay claims without conducting a reasonable investigation;

(7)Failing to affirm or deny coverage of claims within a reasonable time after proof of loss statements have been completed and communicated to the insurer;

(8)Attempting to settle a claim for less than the amount to which a reasonable person would believe the insured or beneficiary was entitled by reference to written or printed advertising material accompanying or made part of an application;

(9)Attempting to settle claims on the basis of an application which was materially altered without notice to, or knowledge or consent of, the insured;

(10)Making a claims payment to an insured or beneficiary without indicating the coverage under which each payment is being made;

(11)Unreasonably delaying the investigation or payment of claims by requiring both a formal proof of loss form and subsequent verification that would result in duplication of information and verification appearing in the formal proof of loss form;

(12)Failing in the case of claims denial or offers of a compromise settlement to promptly provide a reasonable and accurate explanation of the basis for such actions;

(13)Failing to provide forms necessary to present claims within fifteen calendar days of a request with reasonable explanations regarding their use;

(14)Failing to adopt and implement reasonable standards to assure that the repairs of a repairer owned by or required to be used by the insurer are performed in a workmanlike manner;

(15)Failing to promptly settle claims where liability has become reasonably clear under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.

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(L. 1991 S.B. 53 § 5, A.L. 1993 H.B. 709)