Iowa Administrative Code › Agency 191 - Insurance Division › Unfair Trade Practices › Chapter 15 - Unfair Trade Practices › Rule 191-15.41 - Claims Settlement Guidelines for Property and Casualty Insurance

Current through Register Vol. 47, No. 3, July 24, 2024
For purposes of this rule, "insurer" means property and
				  casualty insurers.
(1) An insurer
				shall fully disclose to first-party claimants all pertinent benefits, coverages
				or other provisions of a policy or contract under which a claim is
				presented.
(2) Within 30 days after
				receipt by the insurer of properly executed proofs of loss, the first-party
				property claimant shall be advised of the acceptance or denial of the claim by
				the insurer. No insurer shall deny a claim on the grounds of a specific policy
				provision, condition or exclusion unless reference to such provision,
				condition, or exclusion is included in the denial. The denial must be given to
				the claimant in writing, and the claim file of the insurer shall contain
				documentation of the denial.
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 from the requirements of this subrule. However, the claimant shall be
				  advised of the acceptance or denial of the claim within a reasonable time for
				  full investigation after receipt by the insurer of a properly executed proof of
				  loss.
(3) If the insurer
				needs more time to determine whether a first-party claim should be accepted or
				denied, the insurer shall so notify the first-party claimant within 30 days
				after receipt of the proof of loss and give the reasons more time is needed. If
				the investigation remains incomplete, the insurer shall, 45 days from the
				initial notification and every 45 days thereafter, send to the claimant a
				letter setting forth the reasons additional time is needed for investigation.
When there is a reasonable basis supported by specific
				  information available for review by the commissioner for suspecting that the
				  first-party claimant has fraudulently caused or contributed to the loss, the
				  insurer is relieved from the requirements of this subrule. However, the
				  claimant shall be advised of the acceptance or denial of the claim by the
				  insurer within a reasonable time for full investigation after receipt by the
				  insurer of a properly executed proof of loss.
(4) Insurers shall not fail to settle
				first-party claims on the basis that responsibility for payment should be
				assumed by others except as may otherwise be provided by policy
				provisions.
(5) No insurer shall
				make statements indicating that the rights of a third-party claimant may be
				impaired if a form or release, other than a release to obtain medical records,
				is not completed within a given period of time unless the statement is given
				for the purpose of notifying the third-party claimant of the provision of a
				statute of limitations.
(6) The
				insurer shall affirm or deny liability on claims within a reasonable time and
				shall tender payment within 30 days of affirmation of liability, if the amount
				of the claim is determined and not in dispute. In claims where multiple
				coverages are involved, payments that are not in dispute under one of the
				coverages and where the payee is known should be tendered within 30 days if
				such payment would terminate the insurer's known liability under that
				coverage.
(7) No producer shall
				conceal from a first-party claimant benefits, coverages or other provisions of
				any insurance policy or insurance contract when such benefits, coverages or
				other provisions are pertinent to a claim.
(8) A claim shall not be denied on the basis
				of failure to exhibit property unless there is documentation of breach of the
				policy provisions to exhibit or cooperate in the claim investigation.
(9) No insurer shall deny a claim based upon
				the failure of a first-party claimant to give written notice of loss within a
				specified time limit unless the written notice is a written policy condition.
				An insurer may deny a claim if the claimant's failure to give written notice
				after being requested to do so is so unreasonable as to constitute a breach of
				the claimant's duty to cooperate with the insurer.
(10) No insurer shall indicate to a
				first-party claimant on a payment draft, check or in any accompanying letter
				that said payment is "final" or "a release" of any claim unless the policy
				limit has been paid or there has been a compromise settlement agreed to by the
				first-party claimant and the insurer as to coverage and amount payable under
				the contract.
(11) No insurer shall
				request or require any insured to submit to a polygraph examination unless
				authorized under the applicable insurance contracts and state
				law.