W. Va. Code R. § 114-76-4

Current through Register Vol. XLI, No. 49, December 6, 2024

Section 114-76-4 - Filing of an Administrative Complaint

4.1. Time within which complaint must be filed. -- A written administrative complaint must be received by the commissioner no later than one (1) year following the actual or implied discovery of the alleged unfair claims settlement practice.

4.2. Receipt of complaint. -- For purposes of the time limit imposed by W. Va. Code § 33-11-4 a(b) and subsection 4.1 of this section, a complaint shall be deemed to have been received on the date on which a written document describing acts that could reasonably be construed as an unfair claims settlement practice is received by the commissioner, regardless of whether such document is on a form as described in subsection 4.3 of this section.

4.3. Complaint form. --

a. A complaint shall be on a form provided by the commissioner and shall state with specificity the following:

1. The statutory provision, if known, which the person allegedly violated;

2. The facts and circumstances giving rise to the violation;

3. The name of any individual or other entity involved in the violation;

4. Reference to specific policy language that is relevant to the violation, if known; and

5. Any other information the commissioner may require.

b. If the complaint does not provide sufficient information, the commissioner shall contact the claimant within fifteen (15) days of receipt of the complaint advising that the complaint does not provide sufficient information. The claimant may amend, within an additional fifteen (15) days from the date of contact, the original complaint to clarify it, add and/or delete parties, and make any other necessary changes. If the claimant fails to provide information for a sufficiently complete complaint within fifteen (15) days from contact by the Commission, no further action will be taken on the complaint.

c. Upon receipt of a sufficiently complete complaint, the commissioner must, within five (5) working days thereafter, mail or by electronic means provide a copy to the respondent(s).

4.4. Reporting status of negotiations. -- Within forty-five (45) days after receiving a complaint, the respondent must advise the commissioner in writing of the status of negotiations with the claimant unless the complaint has been resolved and the commissioner has been so advised or the respondent has advised the commissioner that he or she does not intend to take any further action to resolve the complaint.

W. Va. Code R. § 114-76-4