Utah Admin. Code R590-191-5 - Unfair Claims Settlement Practices

Current through Bulletin No. 2021-18, September 15, 2021

The commissioner, pursuant to 31A-26-303(4), hereby finds the following acts or failure to perform required acts to be misleading, deceptive, unfairly discriminatory, or overreaching in the settlement of claims:

(1) concealing from or failing to fully disclose to a claimant any benefits, limitations, exclusions, coverages, or other relevant provisions of an insurance policy or insurance contract under which a claim is presented;
(2) denying or threatening the denial of a claim for any reason which is not clearly described in the policy;
(3) refusing to settle claims without conducting a reasonable and complete investigation;
(4) refusing to provide a written basis for the denial of a claim upon demand of the claimant;
(5) failing to provide the claimant with a written explanation of the evidence of any investigation or file materials giving rise to the denial of a claim based on misrepresentation or fraud on an insurance application, when such misrepresentation is the basis for the denial;
(6) compensating employees, agents or contractors of any amounts which are based on savings to the insurer as a result of reducing or denying claims;
(7) making a claim settlement to the claimant not accompanied by a statement or explanation of benefits setting forth the coverage under which the settlement is being made and how the settlement amount was calculated;
(8) failing to settle a claim following receipt of proof of loss when liability is reasonably clear in order to influence other claim settlements under other portions of the insurance policy coverage or under other policies of insurance;
(9) advising a claimant not to obtain the services of an attorney or other advocate or suggesting the claimant will receive less money if an attorney is used to pursue or advise on the merits of a claim;
(10) misleading a claimant as to the applicable statute of limitations;
(11) issuing a check or draft in partial settlement of a loss or a claim under a specified coverage when such check or draft contains language which purports to release the insurer from total liability;
(a) for policies issued prior to May 5, 2008, failing to pay interest at the legal rate, as provided in Title 15 of the Utah Code upon amounts that are overdue under these rules. A claim shall be considered overdue if not settled within 15 days of completion of the investigation; or
(b) for policies issued on or after May 5, 2008, failing to pay interest in accordance with Section 31A-22-428; and
(13) failing to deliver a copy of the insurer's guidelines for prompt investigation of claims to the Insurance Department when requested to do so.


Utah Admin. Code R590-191-5

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