24-A M.R.S. § 2164-D - Unfair claims practices

Cite as24-A M.R.S. § 2164-D

1. Definition. As used in this section, "insurer" means any person, reciprocal exchange, Lloyd's insurer, fraternal benefit society and any other legal entity engaged in the business of insurance, including, but not limited to, producers, adjusters and 3rd-party administrators. "Insurer" also means nonprofit hospital or medical service organizations, as described in Title 24, section 2301.

A. [ 1997, c. 634, Pt. A, §1 (RP).]

B. [ 1997, c. 634, Pt. A, §1 (RP).]

C. [ 1997, c. 634, Pt. A, §1 (RP).]

D. [ 1997, c. 634, Pt. A, §1 (RP).]

E. [ 1997, c. 634, Pt. A, §1 (RP).]

[ 1997, c. 634, Pt. A, §1 (RPR).]

2. Prohibited activities. It is an unfair claims practice for any domestic, foreign or alien insurer transacting business in this State to commit any act under subsection <codecitation statecd="ME" sessionyear="2023" datatype="S" title="24-A" catchline=""Insurance" defined">3</codecitation> if:

A. It is committed in conscious disregard of this section and any rules adopted under this section; or [ 1997, c. 634, Pt. A, §1 (NEW).]

B. It has been committed with such frequency as to indicate a general business practice to engage in that type of conduct. [ 1997, c. 634, Pt. A, §1 (NEW).]

[ 1997, c. 634, Pt. A, §1 (RPR).]

</subsect>

3. Unfair practices. Any of the following acts by an insurer, if committed in violation of subsection <codecitation statecd="ME" sessionyear="2023" datatype="S" title="24-A" catchline=""Person" defined">2</codecitation>, constitutes an unfair claims practice:

A. Knowingly misrepresenting to claimants and insureds relevant facts or policy provisions related to coverages at issue; [ 1997, c. 634, Pt. A, §1 (NEW).]

B. Failing to acknowledge with reasonable promptness pertinent written communications with respect to claims arising under its policies; [ 1997, c. 634, Pt. A, §1 (NEW).]

C. Failing to adopt and implement reasonable standards for the prompt investigation and settlement of claims arising under its policies; [ 1997, c. 634, Pt. A, §1 (NEW).]

D. Failing to develop and maintain documented claim files supporting decisions made regarding liability; [ 1997, c. 634, Pt. A, §1 (NEW).]

E. Refusing to pay claims without conducting a reasonable investigation; [ 1997, c. 634, Pt. A, §1 (NEW).]

F. Failing to affirm coverage or deny coverage, reserving any appropriate defenses, within a reasonable time after having completed its investigation related to a claim; [ 1997, c. 634, Pt. A, §1 (NEW).]

To continue reading

Request your trial

VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy. ACCEPT