Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › THE UNFAIR CLAIMS SETTLEMENT PRACTICES REGULATION › Section 284-30-380 - Settlement standards applicable to all insurers

Current through Register Vol. 24-14, July 15, 2024
(1) Within fifteen working days after receipt
				by the insurer of fully completed and executed proofs of loss, the insurer must
				notify the first party claimant whether the claim has been accepted or denied.
				The insurer must not deny a claim on the grounds of a specific policy
				provision, condition, or exclusion unless reference to the specific 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 must contain a copy
				of the denial.
(2) If a claim is
				denied for reasons other than those described in subsection (1) and is made by
				any other means than in writing, an appropriate notation must be made in the
				claim file of the insurer describing how, when, and to whom the notice was
				made.
(3) If the insurer needs more
				time to determine whether a first party claim should be accepted or denied, it
				must notify the first party claimant within fifteen working days after receipt
				of the proofs of loss giving the reasons more time is needed. If after that
				time the investigation remains incomplete, the insurer must notify the first
				party claimant in writing stating the reason or reasons additional time is
				needed for investigation. This notification must be sent within forty-five days
				after the date of the initial notification and, if needed, additional notice
				must be provided every thirty days after that date explaining why the claim
				remains unresolved.
(4) Insurers
				must 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) Insurers
				must not continue 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 a policy or
				contract time limit, without giving the claimant written notice that the time
				limit may be expiring and may affect the claimant's rights. This notice must be
				given to first party claimants thirty days and to third party claimants sixty
				days before the date on which any time limit may expire.
(6) The insurer must not make statements
				which indicate that the rights of a third party claimant may be impaired if a
				form or release is not completed within a specified 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.
(7) Insurers are responsible for the accuracy
				of evaluations to determine actual cash value.
Statutory Authority:
					 RCW
					 48.02.060 and
					 48.30.010. 09-11-129 (Matter No. R
					 2007-08), §
											284-30-380, filed 5/20/09,
					 effective 8/21/09; 78-08-082 (Order R 78-3), §
											284-30-380, filed 7/27/78,
					 effective 9/1/78.