reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.03 - Life Insurance Disclosure › Section 31.15.03.06 - Preneed Funeral Contracts or Prearrangements

Current through Register Vol. 51, No. 14, July 12, 2024
A. At the time an application is made for a preneed funeral contract or prearrangement that is funded by a life insurance policy, and before accepting the applicant's initial premium or deposit, the carrier shall adequately disclose to the applicant, in -writing, the following information:
(1) The fact that a life insurance policy is involved or being used to fund a prearrangement;
(2) The nature of the relationship among the soliciting insurance producer or insurance producers, the provider of the funeral or cemetery merchandise or services, the administrator, and any other individual;
(3) The relationship of the life insurance policy to the funding of the prearrangement, and the nature and existence of any guarantees relating to the prearrangement;
(4) The impact of the prearrangement on any:
(a) Changes in the life insurance policy, including but not limited to changes in the assignment, beneficiary designation, or use of the proceeds;
(b) Penalties to be incurred by the policyholder as a result of failure to make premium payments; and
(c) Penalties to be incurred by the policyholder or monies to be received as a result of cancellation, or surrender of the life insurance policy;
(5) A list of all merchandise and services which are applied or contracted for in the prearrangement and all relevant information concerning the price of the funeral services, including an indication that the purchase price is either guaranteed at the time of purchase or to be determined at the time of need;
(6) All relevant information concerning what occurs and whether any entitlements or obligations arise if there is a difference between the proceeds of the life insurance policy and the amount actually needed to fund the prearrangement;
(7) Any penalties or restrictions, including but not limited to:
(a) Geographic restrictions; or
(b) The inability of the provider to perform on the delivery of merchandise, services or the prearrangement guarantee; and
(8) If a sales commission or other form of compensation is being paid:
(a) The fact that a sales commission or other form of compensation is being paid; and
(b) The identity of the individuals or entities to whom the sales commission or other form of compensation is paid.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.03 - Life Insurance Disclosure › Section 31.15.03.07 - General Rules

Current through Register Vol. 51, No. 14, July 12, 2024
A. Each carrier shall maintain at its home office or principal office a complete file containing one copy of each document authorized by the carrier for use pursuant to this chapter.
B. The file described in §A of this regulation shall contain one copy of each authorized form for a period of 3 years following the date of its last authorized use unless otherwise provided by this chapter.
C. An insurance producer shall inform the prospective purchaser, before commencing a life insurance sales presentation, that the insurance producer is acting as a life insurance producer and shall inform the prospective purchaser of the full name of carrier which the insurance producer is representing to the buyer.
D. In sales situations in which an insurance producer is not involved, the carrier shall identify its full name.
E. Unless an insurance producer's compensation is unrelated to insurance sales, the terms "financial planner", "investment advisor", "financial consultant", "financial analyst", "financial counselor", and other similar terms may not be used by the insurance producer in such a way as to imply that the insurance producer's compensation is unrelated to insurance sales in any of the following:
(1) The name of the insurance producer's agency;
(2) Letterheads;
(3) Logos;
(4) Advertising or solicitation material; or
(5) Any sales presentation soliciting insurance.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.03 - Life Insurance Disclosure › Section 31.15.03.08 - Failure to Comply

Current through Register Vol. 51, No. 14, July 12, 2024
A. Failure of a carrier to provide or deliver a buyer's guide or a policy summary as provided in Regulation .04 of this chapter shall constitute an omission that misrepresents the benefits, advantages, conditions, or terms of an insurance policy.
B. An insurance producer shall be held accountable for any policy summary, comparison statement, or other materials which the insurance producer uses in connection with the solicitation of insurance.
C. If any material in §B of this regulation is prepared by a consulting firm, the insurance producer shall personally review and sign the material before presenting it to the insurance producer's prospect.
D. A carrier is charged with the duty of supervising every insurance producer for whom the carrier has applied for a license and shall be held accountable for the actions of the carrier's insurance producers unless the carrier proves to the satisfaction of the Commissioner that the carrier exercised appropriate supervision and the insurance producer acted contrary to the carrier's instructions.
E. If the Commissioner determines that a carrier, insurance producer, representative, officer, or employee of a carrier failed to comply with the requirements of this chapter, the Commissioner shall impose penalties as authorized under the Insurance Article, Annotated Code of Maryland, including:
(1) Suspending or revoking the license of the carrier, insurance producer, or both;
(2) Assessing a penalty of not less than $100, but not more than $125,000, on a carrier and not less than $100, but not more than $500, on an insurance producer for each offense; and
(3) Requiring the carrier or insurance producer to make restitution to an individual who has suffered financial injury or damage as a result of a violation of this chapter by the carrier or insurance producer.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.04 - Solicitation of Annuity and Deposit Fund Contracts › Section 31.15.04.01 - Unfair Trade Practice

Current through Register Vol. 51, No. 14, July 12, 2024
The solicitation or sale of annuities or deposit fund contracts not in conformity with this chapter shall be deemed an Unfair Trade Practice in violation of Insurance Article, Title 27, Annotated Code of Maryland.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.04 - Solicitation of Annuity and Deposit Fund Contracts › Section 31.15.04.02 - Purpose

Current through Register Vol. 51, No. 14, July 12, 2024
A. The purpose of this chapter is to require insurers to deliver to prospects for annuity contracts or for deposit funds accepted in conjunction with life insurance policies or annuity contracts, information which helps the prospect select an annuity or deposit fund, or both, appropriate to the prospect's needs, improves the prospect's understanding of the basic features of the plan under consideration and improves the prospect's ability to evaluate the relative benefits of similar plans.
B. This chapter does not prohibit the use of additional material which is not in violation of this chapter or any other regulation or statute.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.04 - Solicitation of Annuity and Deposit Fund Contracts › Section 31.15.04.03 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
A. To the extent provided here, this chapter shall apply to any solicitation, negotiation, or procurement of annuity contracts or deposit funds accepted in conjunction with individual life insurance policies or with annuity contracts which are subject to this chapter, occurring within this State. The chapter shall apply to an issuer of life insurance policies or annuity contracts including fraternal benefit societies.
B. This chapter shall apply to:
(1) Individual deferred annuities other than:
(a) Variable annuities,
(b) Investment annuities; and
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.04 - Solicitation of Annuity and Deposit Fund Contracts › Section 31.15.04.05 - Disclosure Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. The insurer shall provide to all prospective purchasers a contract summary before accepting the applicant's initial consideration for the annuity contract, or in the case of a deposit fund, before acceptance of the applicant's initial consideration for the associated life insurance policy or annuity contract, unless the annuity contract or associated life insurance policy for which the application is made provides for an unconditional refund period of at least 10 days or unless the contract summary contains such an unconditional refund offer, in which event the contract summary shall be delivered with or before the delivery of the annuity contract or associated life insurance policy.
B. The insurer shall provide a contract summary to a prospective purchaser upon request.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.04 - Solicitation of Annuity and Deposit Fund Contracts › Section 31.15.04.06 - General Regulations

Current through Register Vol. 51, No. 14, July 12, 2024
A. Each insurer shall maintain at its home office or principal office, a complete file containing one copy of each document authorized by the insurer for use pursuant to this chapter. This file shall contain one copy of each authorized form for a period of at least 3 years following the date of its last authorized use.
B. An agent shall inform the prospective purchaser, before commencing a sales presentation, that the agent is acting as a life insurance agent and shall inform the prospective purchaser of the full name of the insurance company which the agent is representing to the buyer. In sales situations in which an agent is not involved, the insurer shall identify its full name.
C. Terms such as "financial planner", "investment advisor", "financial consultant", "financial analyst", "financial counsellor", and the like, may not be used by the agent in the name of his agency, in letterheads, logos, or in advertising or solicitation material, or in sales presentations soliciting insurance to mislead or in any way that implies that his compensation is unrelated to insurance sales, unless this is actually the case.
D. A reference to dividends or to excess interest credits shall include a statement that these dividends or credits are not guaranteed.
E. A presentation of benefits may not display guaranteed and non-guaranteed benefits as a single sum unless guaranteed benefits are shown separately in proximity and with equal prominence.
F. Sales promotion literature and contract forms may not state or imply that annuity contracts or deposit funds are the same as savings accounts or deposits in banking or savings institutions. The use of passbooks which resemble savings bank passbooks is prohibited.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.04 - Solicitation of Annuity and Deposit Fund Contracts › Section 31.15.04.07 - Failure to Comply

Current through Register Vol. 51, No. 14, July 12, 2024
A. Failure of an insurer to provide or deliver a contract summary as provided in Regulation .05 of this chapter shall constitute an omission which misrepresents the benefits, advantages, conditions, or terms of an annuity contract or of an insurance policy.
B. An agent shall be held accountable for any contract summary or other materials which he used in connection with the solicitation. If any of these materials is prepared by a consulting computer firm, the agent shall personally review and sign it before presenting it to his prospect.
C. An insurer is charged with the duty of supervising every agent for whom it has applied for a license and shall be held accountable for the actions of its agents unless it proves to the satisfaction of the Commissioner that it exercised appropriate supervision and the agent acted contrary to its instructions.
D. Any insurer, agent, representative, officer, or employee of an insurer who fails to comply with the requirements of this chapter shall be subject to such disciplinary action and penalties as may be appropriate under Insurance Article, Annotated Code of Maryland. This action may include the suspension or revocation of the license of the insurer or of the agent or both. The Commissioner may also impose monetary fines of $100 to $50,000 on an insurer and of $25 to $500 on an agent for each offense. In addition, the Commissioner may order the insurer or the agent, or both, to make restitution to any person who has suffered financial injury or damage as a result of any violation of this chapter by the insurer or agent.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.05 - Insurer's Financial Statements › Section 31.15.05.01 - Authority

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter is deemed necessary for, and as an aid to the effectuation of, the provisions of Insurance Article, 27-203 and 27-205(a), Annotated Code of Maryland, as amended.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.05 - Insurer's Financial Statements › Section 31.15.05.02 - Purpose and Applicability

Current through Register Vol. 51, No. 14, July 12, 2024
The purpose of this chapter is to protect the public from untrue, deceptive, misleading, or false statements of financial condition of an insurer. It is applicable to all persons licensed to conduct the business of insurance in Maryland.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.06 - Filing or Service Fees in Connection with Certificates of Financial Responsibility › Section 31.15.06.01 - Prohibited Practice

Current through Register Vol. 51, No. 14, July 12, 2024
Any charge in addition to the established premium as filed with the Maryland Insurance Administration by the writing company, as a so-called filing or service fee in connection with the writing of any motor vehicle liability or property damage policy, or both, or the filing of any certificate of financial responsibility with the Motor Vehicle Administration in connection with any policy, is forbidden.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.07 - Payment of Claims Under Property and Casualty and Title Insurance Policies › Section 31.15.07.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter is applicable to all property and casualty and title insurers, but does not include reinsurance, workers' compensation, or surety.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.07 - Payment of Claims Under Property and Casualty and Title Insurance Policies › Section 31.15.07.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Application" means an initial application for the issuance of an insurance policy.
(2) "Claim" means a demand for payment or an inquiry regarding the possibility of payment for a loss incurred under one or more coverages provided by the policy.
(3) "Claimant" means either a first-party claimant or a third-party claimant and may include, in a particular case, the claimant's designated legal representative or a member of the claimant's immediate family designated by the claimant.
(4) "First-party claimant" means any person asserting a right to payment under an insurance policy pursuant to which the person is insured, which right arises out of the occurrence of a contingency or loss covered by the policy.
(5) "Investigation" means all activities of an insurer directly or indirectly related to the determination of the insurer's liabilities under coverages afforded by an insurance policy.
(6) "Licensed producer" means a person issued a license in accordance with the provisions of Insurance Article, Title 10, Subtitle 1, Annotated Code of Maryland.
(7) Notification of a claim means notification by a claimant, in writing or by other means acceptable under the terms of the insurance policy, which reasonably apprises the insurer of the facts pertinent to the claim and which is made:
(a) Directly to the insurer in the case of a title insurance policy;
(b) Directly to the Maryland Automobile Insurance Fund in the case of a policy issued by the Fund; or
(c) To an insurer or its producer who has an appointment from that insurer as defined in Insurance Article, §
											1-101(f), Annotated Code of Maryland, in all other cases.
(8) "Policy" means an individual or group policy, contract, or certificate issued by an insurer.
(9) "Producer" means any person authorized to represent an insurer with respect to a claim, or a licensed producer.
(10) "Proof of loss" means the submission to an insurer of all factual information necessary for an insurer to determine the nature of the loss, the applicable coverage, and the amount due under that applicable coverage.
(11) "Third-party claimant" means any person asserting a claim against a person insured under an insurance policy.
(12) "Unreasonable delay" means, except with respect to claims for personal injury protection benefits made pursuant to Insurance Article, §
										19-505, Annotated Code of Maryland, the failure to make payment to claimants of amounts properly due them within 15 working days after receipt of a properly completed claim form or other proof of loss unless a longer period of time is provided for in the insurance contract or unless otherwise provided for by law, when there is no significant dispute as to coverage, liability, and amount of damages.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.07 - Payment of Claims Under Property and Casualty and Title Insurance Policies › Section 31.15.07.03 - Unfair Claim Settlement Practices

Current through Register Vol. 51, No. 14, July 12, 2024
A. A prohibited unfair claim settlement practice occurs if an insurer commits one or more of the following acts:
(1) Misrepresents pertinent facts or policy provisions relating to the claim at issue. For the purposes of this regulation, misrepresentation includes, but is not limited to, the following acts:
(a) Providing incomplete or misleading disclosure of pertinent facts or policy provisions relating to the claim at issue;
(b) Concealing from a first-party claimant benefits, coverages, or other provisions of a policy when these benefits, coverages, or other provisions are pertinent to the claim at issue;
(c) Failing, upon written request, to disclose to a first-party claimant all benefits, coverages, or other provisions of an insurance policy under which a claim is presented;
(d) Except when there is a time limit specified in the policy or provided by law, making oral or written statements to any claimant that:
(i) There is a requirement that the claimant give written notice of loss or proof of loss within a specified time, and
(ii) The company is relieved of its obligations under the policy if the time limit is not complied with;
(e) Making oral or written statements to any claimant that there is a requirement that the claimant sign a release that extends beyond the subject matter that gave rise to the claim payment; or
(f) Issuing a check or draft in partial settlement of a loss or claim under a specific coverage or coverages, which check or draft contains language releasing the insurer or its insured from their total liability.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.07 - Payment of Claims Under Property and Casualty and Title Insurance Policies › Section 31.15.07.04 - Standards for Prompt Investigation of Claims

Current through Register Vol. 51, No. 14, July 12, 2024
A. Insurers shall, for at least 3 years, make available for inspection by the Maryland Insurance Administration records of denials of claims and supporting documentation.
B. If an insurer has not completed its investigation of a first party claim within 45 days of notification, the insurer shall promptly notify the first-party claimant, in writing, of the actual reason that additional time is necessary to complete the investigation. Notice shall be sent to the first-party claimant after each additional 45-day period until the insurer either affirms or denies coverage and damages.
C. In any case in which a first-party claimant is neither an attorney nor represented by an attorney, the insurer shall, upon receipt of a written claim, inform that claimant in writing that there may be an applicable statute of limitations which may bar that claimant's rights in the future.
D. An insurer that denies a claim on the grounds of a specific policy provision, condition, or exclusion shall advise the claimant as to the provision, condition, or exclusion on which the denial is based.
E. When there is a reasonable basis, supported by specific information available for review by the Commissioner, that the first-party claimant has fraudulently caused or contributed to the loss, the insurer is relieved of the requirement contained in B and C of this regulation that the insurer state the reason that more time is required.
F. If a claim is denied for reasons other than those described in §D or E of this regulation, an appropriate notation shall be made in the claim file of the insurer.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.07 - Payment of Claims Under Property and Casualty and Title Insurance Policies › Section 31.15.07.05 - Time for Filing Claim for Personal Injury Protection Benefits

Current through Register Vol. 51, No. 14, July 12, 2024
Upon receipt of written notice from an insured of the occurrence of an accident, each insurer providing benefits required under Insurance Article, §
									19-505, Annotated Code of Maryland, shall notify the insured of the latest date on which an original claim for benefits may be presented to the insurer, as provided in Insurance Article, §
									19-508(a), Annotated Code of Maryland.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.07 - Payment of Claims Under Property and Casualty and Title Insurance Policies › Section 31.15.07.06 - Payment of Interest on Personal Injury Protection Benefits

Current through Register Vol. 51, No. 14, July 12, 2024
Whenever a claim for benefits under Insurance Article, §
									19-505, Annotated Code of Maryland, is paid more than 30 days after receipt of a properly completed claim form or other proof of loss and satisfactory proof verifying the claim, the insurer shall:
A. Make a notation in the insurer's claim file stating the reason for the delay; and
B. Add to the amount otherwise payable 1-1/2 percent simple interest per month for those days in excess of the 30 days.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.07 - Payment of Claims Under Property and Casualty and Title Insurance Policies › Section 31.15.07.07 - Computation of Time

Current through Register Vol. 51, No. 14, July 12, 2024
If an insurer requires additional information in order to properly consider a claim, the number of days which elapse between the date the insurer requests 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.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.07 - Payment of Claims Under Property and Casualty and Title Insurance Policies › Section 31.15.07.08 - Claims Registers

Current through Register Vol. 51, No. 14, July 12, 2024
A. Each insurer shall maintain claims registers separately for:
(1) Private passenger automobile insurance;
(2) All other liability insurance;
(3) Homeowner's insurance;
(4) All other property insurance; and
(5) Title insurance.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.07 - Payment of Claims Under Property and Casualty and Title Insurance Policies › Section 31.15.07.09 - General Business Practices

Current through Register Vol. 51, No. 14, July 12, 2024
A. The methodology of §B of this regulation shall be used to determine whether an insurer 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. It shall be considered prima facie evidence of a general business practice of committing unfair claim settlement practices if, in any 12-month period, it is found that the number of unfair claim settlement practices with respect to claims handling by foreign insurers of claims of Maryland residents, or by domestic insurers of all claims of the insurer, equals or exceeds the following, if the total number of claims during any 12-month period is:
(1) Less than 10,000, three claims with the same unfair claim settlement practice out of a random sampling of 50 claims; or
(2) Ten thousand or more, six claims with the same unfair claim settlement practice out of a random sampling of 100 claims.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.07 - Payment of Claims Under Property and Casualty and Title Insurance Policies › Section 31.15.07.10 - Penalties

Current through Register Vol. 51, No. 14, July 12, 2024
Penalties for violations of these regulations shall be assessed in accordance with Insurance Article, §§
									4-113,  27-301,  27-305, and  27-306, Annotated Code of Maryland.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.08 - Payment of Claims Under Life and Health Policies Annuity Contracts › Section 31.15.08.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
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.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.08 - Payment of Claims Under Life and Health Policies Annuity Contracts › Section 31.15.08.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
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 or beneficiary designated by the claimant.
(3) "Insurer" means a person licensed to issue, or who issues, any insurance policy in this State, including a nonprofit health service plan, fraternal benefit society, health maintenance organization, or dental plan organization.
(4) "Investigation" means all activities of an insurer directly or indirectly related to the determination of the insurer's liabilities under coverage afforded by an insurance policy.
(5) "Licensed agent" means a person licensed in accordance with the provisions of Insurance Article, Title 8, Subtitle 4, or Title 10, Subtitle 1, Annotated Code of Maryland.
(6) "Notification of a claim" means notification by a claimant, to an insurer or its agent, in writing or by other means acceptable under the terms of the policy, which reasonably apprises the insurer of the facts pertinent to the claim.
(7) "Policy" means an individual or group policy, contract, or certificate issued by an insurer.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.08 - Payment of Claims Under Life and Health Policies Annuity Contracts › Section 31.15.08.03 - Unfair Claim Settlement Practices

Current through Register Vol. 51, No. 14, July 12, 2024
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 application which has been altered without notice to, or the knowledge or consent of, the insured;
(4) Refuses to satisfy a claim for an arbitrary or capricious reason based on all available information;
(5) Fails to include, in any claim paid to an insured or beneficiary, a statement setting forth the coverage under which the payment is made;
(6) Fails to settle a claim promptly whenever liability is reasonably clear under one portion of a policy in order to influence settlements under other portions of the policy; or
(7) Fails to promptly provide a reasonable explanation of the basis for denial of a claim when requested to do so.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.08 - Payment of Claims Under Life and Health Policies Annuity Contracts › Section 31.15.08.04 - Computation of Time

Current through Register Vol. 51, No. 14, July 12, 2024
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.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.08 - Payment of Claims Under Life and Health Policies Annuity Contracts › Section 31.15.08.05 - Claims Registers

Current through Register Vol. 51, No. 14, July 12, 2024
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.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.08 - Payment of Claims Under Life and Health Policies Annuity Contracts › Section 31.15.08.06 - General Business Practices

Current through Register Vol. 51, No. 14, July 12, 2024
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 general business practice if, in any 12-month period, it is found that the number of unfair claim settlement practices with respect to claims handling by foreign insurers of claims by Maryland residents, or by domestic insurers of all claims of the insurer, equals or exceeds the following:
(1) If the total number of annuity and life insurance claims, excluding credit life insurance claims, during any 12-month period is:
(a) Less than 100, five claims;
(b) At least 100, but less than 10,000, five claims out of a sampling of 100 claims;
(c) At least 10,000, but less than 50,000, ten claims out of a sampling of 200 claims; or
(d) 50,000 or more, 15 claims out of a sampling of 300 claims;
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.08 - Payment of Claims Under Life and Health Policies Annuity Contracts › Section 31.15.08.07 - Penalties

Current through Register Vol. 51, No. 14, July 12, 2024
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 powers afforded the Commissioner under Insurance Article, Annotated Code of Maryland.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.10 - Homeowner's Insurance and Private Passenger Motor Vehicle Insurance - Standards for Cancellation and Nonrenewal › Section 31.15.10.01 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Business purposes standard" means the standard required by Insurance Article, §
										27-501(a)(2), Annotated Code of Maryland.
(2) "Claim" means a reported loss that is covered or coverable under a policy.
(3) "Loss" means damage or injury to body, person, or property.
(4) "Remediation" means repair of the premises or dwelling of an insured or replacement of part of the premises or dwelling of an insured that:
(a) Eliminates or significantly diminishes the condition of the premises or dwelling that gave rise to a claim; and
(b) Makes it reasonably unlikely that the same type of claim will arise again.
(5) "Repair notice" means written notice that:
(a) An insurer provides to an insured pursuant to Insurance Article, §
											27-501(i)(2), Annotated Code of Maryland; and
(b) Requests the insured to make reasonable or customary repairs or replacement specific to the insured's premises or dwelling.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.10 - Homeowner's Insurance and Private Passenger Motor Vehicle Insurance - Standards for Cancellation and Nonrenewal › Section 31.15.10.02 - Homeowner's Insurance

Current through Register Vol. 51, No. 14, July 12, 2024
A. Scope. This regulation applies to homeowner's insurance.
B. Weather-Related Claims-Presumption. A claim is presumed to be a weather-related claim if the loss was caused by snow, rain, sleet, hail, lightning, freezing, thawing, change in barometric pressure, or a similar condition.
C. Weather-Related Claims-Standard for Cancellation or Nonrenewal.
(1) An insurer may not combine a weather-related claim that is excepted from the business purposes standard by Insurance Article, §
										27-501(i)(1), Annotated Code of Maryland, with any other factor for the purpose of canceling or refusing to renew coverage unless there were three or more weather-related claims within the preceding 3 years.
(2) For purposes of cancellation of, or refusal to renew, coverage based on weather-related claims pursuant to Insurance Article, §
										27-501(i)(1), Annotated Code of Maryland, an insurer may consider a weather-related claim notwithstanding any remediation by the insured that may prevent a similar weather-related claim from arising in the future.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.10 - Homeowner's Insurance and Private Passenger Motor Vehicle Insurance - Standards for Cancellation and Nonrenewal › Section 31.15.10.03 - Private Passenger Motor Vehicle Insurance

Current through Register Vol. 51, No. 14, July 12, 2024
A. Scope. This regulation applies to private passenger motor vehicle insurance.
B. Determining Number of Claims.
(1) For the purpose of determining the number of not-at-fault claims under Insurance Article, §
										27-501(k), Annotated Code of Maryland, claims under the following types of coverage shall be presumed to be not-at-fault:
(a) Uninsured motorist coverage; and
(b) Comprehensive coverage.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.10 - Homeowner's Insurance and Private Passenger Motor Vehicle Insurance - Standards for Cancellation and Nonrenewal › Section 31.15.10.04 - Action Based on Claims History

Current through Register Vol. 51, No. 14, July 12, 2024
A. Factors in Mitigation. With respect to cancellation of, or refusal to renew, coverage based on claims history, an insurer may not consider factors in mitigation of a proposed cancellation of, or refusal to renew, coverage as provided by Insurance Article, §
									27-501(n)(1), Annotated Code of Maryland, unless the:
(1) Insurer applies the factors uniformly within a given classification to each proposed cancellation of, or refusal to renew, coverage for all insureds; and
(2) Factors considered are included in the insurer's underwriting guidelines or rating plan.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.10 - Homeowner's Insurance and Private Passenger Motor Vehicle Insurance - Standards for Cancellation and Nonrenewal › Section 31.15.10.05 - Measurement of Time Periods

Current through Register Vol. 51, No. 14, July 12, 2024
For the purpose of measuring any time period within which a certain number of claims, or events giving rise to claims, shall have occurred in order to cancel or refuse to renew coverage under Insurance Article, §
									27-501, Annotated Code of Maryland, the time period is measured from the effective date of the coverage or renewal.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.10 - Homeowner's Insurance and Private Passenger Motor Vehicle Insurance - Standards for Cancellation and Nonrenewal › Section 31.15.10.06 - Prohibition on Cancellation or Nonrenewal When Filed Rate Exists

Current through Register Vol. 51, No. 14, July 12, 2024
A. Scope. This regulation does not apply to cancellation of a risk due to nonpayment of a premium.
B. Prohibition. Notwithstanding any provision of Insurance Article, §
									27-501, Annotated Code of Maryland, or of this chapter, an insurer may not cancel, or refuse to renew, a risk if the insurer has a filed rate that is applicable to that risk.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.10 - Homeowner's Insurance and Private Passenger Motor Vehicle Insurance - Standards for Cancellation and Nonrenewal › Section 31.15.10.07 - Umbrella Coverage

Current through Register Vol. 51, No. 14, July 12, 2024
Insurance Article, §
									27-501, Annotated Code of Maryland, or this chapter does not allow an insurer to cancel or refuse to renew personal umbrella or personal excess coverage without meeting the business purposes standard.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.10 - Homeowner's Insurance and Private Passenger Motor Vehicle Insurance - Standards for Cancellation and Nonrenewal › Section 31.15.10.08 - Effective Date of Standards

Current through Register Vol. 51, No. 14, July 12, 2024
A. If an insurer proposes to cancel, or refuse to renew, insurance coverage in accordance with Insurance Article, §
									27-501, Annotated Code of Maryland, and the cancellation or refusal to renew will take effect on or after October 1, 1998, the insurer shall comply with the standards of Insurance Article, §
									27-501(i)  -(n), Annotated Code of Maryland, to the extent that the standards are applicable.
B. The disclosure requirements of Regulation .04B of this chapter apply only to a policy that is issued or renewed on or after January 28, 2000.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.11 - Use of Credit History in Underwriting and Rate Making › Section 31.15.11.01 - Purpose

Current through Register Vol. 51, No. 14, July 12, 2024
A. Enactment of Legislation on Use of Credit History.
(1) During the 2002 Session, the General Assembly enacted House Bill 521 which became Ch. 580, Acts 2002.
(2) With respect to homeowner's insurance, Ch. 580, Acts of 2002 prohibits an insurer from using credit history to underwrite or rate a risk or require a particular payment plan.
(3) With respect to private passenger motor vehicle insurance, Ch. 580, Acts of 2002, prohibits an insurer from using credit history to underwrite a risk, increase a renewal premium, or require a particular payment plan and restricts the manner in which an insurer may use credit history to rate a new private passenger motor vehicle policy.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.11 - Use of Credit History in Underwriting and Rate Making › Section 31.15.11.02 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
A. In General. This chapter applies to insurers that sell or offer to sell homeowner's insurance or private passenger motor vehicle insurance.
B. Insurance Transaction Not Initiated by a Consumer.
(1) This chapter does not apply to the use of a credit report or a credit score derived from a credit report, by an insurer in an insurance transaction that:
(a) Is not initiated by a consumer; and
(b) Consists of a firm offer of insurance.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.11 - Use of Credit History in Underwriting and Rate Making › Section 31.15.11.04 - Homeowner's Insurance - Prohibition on Use of Credit History

Current through Register Vol. 51, No. 14, July 12, 2024
With respect to homeowner's insurance, an insurer may not:
A. Refuse to underwrite, cancel, or refuse to renew a risk based wholly or partly on the credit history of an applicant or insured, including the absence of or inability to determine credit history;
B. Rate a risk based wholly or partly on the credit history of an applicant or insured, including the absence of or inability to determine credit history, in any manner, including:
(1) Providing or removing a discount or imposing or removing a surcharge;
(2) Assigning the insured or applicant to a tier; or
(3) Placing an applicant or insured with an affiliated insurer; or
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.11 - Use of Credit History in Underwriting and Rate Making › Section 31.15.11.05 - Private Passenger Motor Vehicle Insurance - Uses of Credit History

Current through Register Vol. 51, No. 14, July 12, 2024
A. Prohibited Use of Credit History. With respect to private passenger motor vehicle insurance, an insurer may not:
(1) Refuse to underwrite, cancel, refuse to renew, or increase the renewal premium based wholly or partly on the credit history of the applicant or insured, including the absence of or inability to determine credit history; or
(2) Require a particular payment plan based wholly or partly on the credit history of the applicant or insured, including the absence of or inability to determine credit history.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.11 - Use of Credit History in Underwriting and Rate Making › Section 31.15.11.06 - Private Passenger Motor Vehicle Insurance - Credit History Use Disclosure - Premium Quotation

Current through Register Vol. 51, No. 14, July 12, 2024
A. Contents of Disclosure. An insurer that rates a new policy of private passenger motor vehicle insurance based wholly or partly on the credit history of an applicant shall, at the time of application, advise the applicant in writing on the application form that:
(1) The insurer uses credit history to rate new policies; and
(2) The applicant may request a premium quotation that separately identifies the portion of the premium attributable to the applicant's credit history.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.11 - Use of Credit History in Underwriting and Rate Making › Section 31.15.11.07 - Private Passenger Motor Vehicle Insurance-Obtaining Credit History

Current through Register Vol. 51, No. 14, July 12, 2024
A. In General. With respect to private passenger motor vehicle insurance, an insurer or an insurance producer of an insurer may not obtain a credit report, credit score, or other credit history for an applicant unless the insurer or insurance producer obtains a credit report, credit score, or other credit history:
(1) For each applicant of the insurer; or
(2) In accordance with a written standard for determining when to obtain a credit report, credit score, or other credit history that meets the requirements of §B of this regulation.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 15 - UNFAIR TRADE PRACTICES › Chapter 31.15.11 - Use of Credit History in Underwriting and Rate Making › Section 31.15.11.08 - Private Passenger Motor Vehicle Insurance - Inability to Obtain Credit History

Current through Register Vol. 51, No. 14, July 12, 2024
A. With respect to private passenger motor vehicle insurance, if an initial inquiry by an insurer or insurance producer fails to generate a credit report, credit score, or other credit history, the insurer or insurance producer shall:
(1) Notify the applicant or insured that the initial inquiry failed to generate a credit report, credit score, or other credit history;
(2) Verify the accuracy of:
(a) The name of the applicant or insured, to ensure that the insurer or insurance producer has the full name of the applicant or insured, including any middle initial, and that the name is spelled correctly;
(b) The address of the applicant or insured; and
(c) Any other information that the insurer or insurance producer obtained from an applicant or insured in order to obtain a credit report, credit score, or other credit history for the applicant or insured;
(3) Document in the appropriate file the notice to the applicant or insured and any response from the applicant or insured; and
(4) Retain the documentation for at least 3 years after the date that the notice was provided.