Md. Code Regs. 31.15.08.06

Current through Register Vol. 51, No. 21, October 18, 2024

Section 31.15.08.06 - General Business Practices

A. The methodology of §B of this regulation shall be used to determine whether an insurer, nonprofit health service plan, or health maintenance organization has engaged in unfair claim settlement practices with such frequency as to constitute a general business practice within the meaning of Insurance Article, § 27-304, Annotated Code of Maryland.

B. Engaging in unfair claim settlement practices shall be regarded as prima facie evidence of a general business practice if, in any 12-month period, it is found that the number of unfair claim settlement practices with respect to claims handling by foreign insurers of claims by Maryland residents, or by domestic insurers of all claims of the insurer, equals or exceeds the following:

(1) If the total number of annuity and life insurance claims, excluding credit life insurance claims, during any 12-month period is:

(a) Less than 100, five claims;

(b) At least 100, but less than 10,000, five claims out of a sampling of 100 claims;

(c) At least 10,000, but less than 50,000, ten claims out of a sampling of 200 claims; or

(d) 50,000 or more, 15 claims out of a sampling of 300 claims;

(2) If the total number of health insurance claims, excluding credit health insurance claims, during any 12-month period is:

(a) Less than 100, ten claims;

(b) At least 100, but less than 10,000, ten claims out of a sampling of 100 claims;

(c) At least 10,000, but less than 50,000, 15 claims out of a sampling of 200 claims; or

(d) 50,000 or more, 20 claims out of a sampling of 300 claims.

Md. Code Regs. 31.15.08.06

Regulation .06 amended effective 41:20 Md. R. 1114, eff.10/13/2014