52 Pa. Code § 1025.5 - Standards for adjustment and payment of claims

Common carriers by motor vehicle, who are responsible to the public for adjustment or payment of bodily injury, property damage or cargo damage claims, or both, are prohibited from:

(1) Misrepresenting pertinent facts relating to claims at issue.

(2) Failing to acknowledge and act promptly upon written or oral communications with respect to insurance claims.

(3) Failing to adopt and implement reasonable standards for the prompt investigation of claims.

(4) Refusing to pay claims without conducting a reasonable investigation based upon available information.

(5) Failing to affirm or deny responsibility for claims within a reasonable time after proof of loss statements have been completed and communicated to the carrier or its representative.

(6) Not attempting in good faith to effectuate prompt, fair and equitable settlements of claims in which the carrier's liability has become reasonably clear.

(7) Compelling persons to institute litigation to recover amounts due by offering substantially less than the amounts due and ultimately recovered in actions brought by those persons.

(8) Making claim payments to claimants not accompanied by a statement defining which payments are being made.

(9) Making known to claimants a policy of appealing from arbitration awards in favor of claimants to induce or compel them to accept settlements or compromises less than the amount awarded in arbitration.

(10) Delaying the investigation or payment of claims by requiring a physician to submit a preliminary claim report and then requiring the subsequent submission of formal proof of loss forms, both of which submissions contain substantially the same information.

(11) Failing to promptly provide a reasonable explanation in relation to the facts or applicable law for denial of a claim or for the offer of a compromise settlement.

Notes

52 Pa. Code § 1025.5