Section 230-RICR-20-40-2.7 - Standards for Prompt, Fair and Equitable Settlements Applicable to All InsurersA. Within twenty-one (21) days after receipt by the insurer of properly executed proofs of loss, the first party claimant shall be advised of the acceptance or denial of the claim by the Insurer. No insurer shall deny a claim on the grounds of a specific provision, condition, or exclusion unless reference to such provision, condition, or exclusion is included in the denial. The denial must be given to the first party claimant in writing and the claim file of the insurer shall contain such documentation of the denial as required by § 2.4 of this Part. 1. Where there is a reasonable basis supported by specific information available for review by the Department that the first party claimant has fraudulently caused or contributed to the loss, the insurer is relieved from the requirements of this subsection; provided, however, that the first party claimant shall be advised of the acceptance or denial of the claim within a reasonable time for full investigation after receipt by the insurer of a properly executed proof of loss.B. If the Insurer needs more time to determine whether a first party claim should be accepted or denied, it shall notify the first party claimant within twenty-one (21) days after receipt of the proofs of loss, giving the reasons more time is needed. If the investigation remains incomplete, the insurer shall, forty-five (45) days from the initial notification and every forty-five (45) days thereafter, send to the first party claimant a letter setting forth the reasons additional time is needed for Investigation. 1. Where there is a reasonable basis supported by specific information for suspecting that the first party claimant has fraudulently caused or contributed to the loss, the first party claimant shall be advised of the acceptance or denial of the claim by the insurer within a reasonable time for full investigation after receipt by the insurer of a properly executed proof of loss.C. Insurers shall not fail to settle a first party claims on the basis that responsibility for payment should be assumed by others except as may otherwise be provided by policy provisions.D. No insurer shall commence or continue negotiations for settlement of a claim if the claimants rights may be affected by a statute of limitations, unless the insurer has given the claimant written notice of such limitation. Notice shall be given to first party claimants at least thirty (30) days and to third party claimants at least sixty (60) days before the date on which any such statute of limitations may expire.E. No insurer shall make statements indicating 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 statute of limitations.F. The insurer shall affirm or deny liability within a reasonable time and shall tender payment of all claims in which damages are not in dispute within thirty (30) days of affirmation of liability. In claims where multiple coverages are involved payments which are not in dispute and where the payee is known should be tendered within thirty (30) days if such payment would terminate the insurer's known liability under that individual coverage.G. No insurer shall request or require any first party claimant to submit to a polygraph examination unless authorized under the applicable insurance contract and state law.H. If, after an insurer denies a claim, the claimant objects to such denial, the insurer shall notify the Claimant in writing that he or she may have the matter reviewed by the Rhode Island Department of Business Regulation, Division of Insurance, via the contact information for the Department promulgated in a Bulletin for this specific purpose.230 R.I. Code R. § 230-RICR-20-40-2.7
Amended effective 6/11/2019
Amended effective 12/24/2019