Unfair Claims Practice

Unfair Claims Practice

The practice by an insurer to refuse to pay claims it is contractually obliged to pay. An insurer may engage in unfair claims practices to reduce its costs; however, it is illegal in many jurisdictions.
References in periodicals archive ?
Every state has unfair claims practice statutes, for example, to establish administrative remedies for consumers to pursue with state insurance departments.
Worried that the practice may result in unfair settlement offers, the Rhode Island Senate has drafted a bill to make claim settlements based solely on computer-generated information an unfair claims practice.
The CDI examinations reportedly uncovered evidence of numerous unfair claims practices, which included wrongful denials for life-saving treatment for people battling serious illness and claim payment denials for providers and hospitals.
A settlement by the Unfair Claims Practices Acts, must be "fair and equitable" when liability is "reasonably clear." It must be fair to both sides, the insurer and the insured or third-party claimant.
According to a spokesperson for the Minnesota Department of Commerce, annuity suitability provisions were previously covered under two separate statues: one governing producers and the other defining unfair claims practices law.
The original model law was inconsistent with unclaimed property laws and unfair claims practices law; adopting the methodology for doing DMF matches required by the New York Department of Financial Services in its July request for information, the lawyer said.
Some complaints are about marketing or sales techniques, premiums and rates, unfair claims practices and underwriting.
This year's biggest highlight will be an in-depth breakdown of a challenging case study that will include property insurance coverage analysis, claims management, business interruption, expert witness use and unfair claims practices. The National Forum is also now approved for state, RPA and CPCU credits.
Arguing that a self-insurer was nonetheless an insurer that had failed to settle a claim in good faith, the plaintiff then argued that the retailer was liable for damages under the state's unfair claims practices statute.
Surprisingly, most insurance codes limit unfair claims practices penalties to direct claims.
Early this year, the family won a $79 million judgment against Humana for "intentional infliction of emotional distress, breach of contract, fraud, unfair claims practices, and promissory estoppel." The jury's whopping punitive damage award was calculated to equal the savings Humana had reportedly realized from the medical director's cost-driven winnowing of the case management rolls.
In 1972 the California legislature enacted an Unfair Practices Act, derived from the Model Unfair Claims Practices Act of the National Association of Insurance Commissioners, as part of the California Insurance Code.