Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0235 - Standards for Prompt and Fair Settlements - Generally

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An insurer shall, not later than the 30th
			 day after its receipt of properly executed proofs of loss from a first party
			 claimant, advise the claimant of the acceptance or denial of the claim. An
			 insurer shall not deny a claim on the grounds of a specific policy provision,
			 condition or exclusion unless the denial includes reference to the provision,
			 condition or exclusion. A claim denial must be in writing, with either a copy
			 or the capability of reproducing its text included in the insurer's claim
			 file.
(2) If a claim is made on a
			 health insurance policy and the claim involves a coordination of benefits issue
			 to which OAR 836-020-0700 to 836-020-0765 apply, the time allowed in
			 836-020-0740 to an insurer for applying a coordination of benefit provision
			 shall be added to the time period provided in section (1) of this
			 rule.
(3) If a claim is denied for
			 reasons other than those described in section (1) of this rule and is made by
			 any other means than in writing, an appropriate notation shall be made in the
			 insurer's claim file.
(4) If an
			 insurer needs more time to determine whether the claim of a first party
			 claimant should be accepted or denied, it shall so notify the claimant not
			 later than the 30th day after receipt of the proofs of loss, giving the reason
			 more time is needed. Forty-five days from the date of such initial notification
			 and every 45 days thereafter while the investigation remains incomplete, the
			 insurer shall notify the claimant in writing of the reason additional time is
			 needed for investigation.
(5) An
			 insurer shall not fail to settle claims of first party claimants on the grounds
			 that responsibility for payment should be assumed by others, except as may be
			 provided otherwise by the provisions of the insurance policy issued by the
			 insurer.
(6) If an insurer
			 continues negotiations for settlement of a claim directly with a claimant who
			 is neither an attorney nor represented by an attorney until the claimant's
			 rights may be affected by a statute of limitations or policy time limit, the
			 insurer shall give the claimant written notice that the time limit may be
			 expiring and may affect the claimant's rights. The notice shall be given to
			 first party claimants not less than 30 days before, and to third party
			 claimants not less than 60 days before, the date on which the insurer believes
			 the time limit may expire.
(7) An
			 insurer shall not make a statement that indicates that the rights of a third
			 party claimant may be impaired if a form or release 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 relevant statute of
			 limitations.
(8) Notwithstanding
			 section (4) of this rule, for title insurance:
(a) The requirements in section (4) of this
			 rule are suspended from the date the insurer arranges or agrees to legal
			 representation of the insured, for the term of that representation, with
			 respect to:
(A) A matter for which the insurer
			 accepts a tender of defense; or
(B)
			 A matter for which the insurer prosecutes an action or proceeding or does, or
			 causes to be done, any other act to establish the title as insured or to
			 prevent or reduce loss or damage to the insured.