NAIC model law · NAIC model laws
Unfair Claims Settlement Practices Act
Edition and licensing notes
Publisher. National Association of Insurance Commissioners (NAIC)
Status. NAIC model, © NAIC. Brief quotations under fair use; not the enacted law of any state until adopted.
What this document is
Unfair Claims Settlement Practices Act is a naic model law published by National Association of Insurance Commissioners (NAIC). It is one of the documents that insurance license exam questions are written from, including life & health, personal lines practice questions. This page summarizes it and points to the official version, which is the text to rely on.
Sections cited in practice questions
Each practice answer shows the exact passage it comes from. These are sections of this document that questions cite, with a short excerpt from the source text.
- NAIC Model #900: Section 4 (Unfair Claims Practices Defined)
“B. Failing to acknowledge with reasonable promptness pertinent communications with respect to claims arising under its policies;”
- NAIC Model NAIC 900: Section 4.H (Settlement Below Advertised Amount)
“Attempting to settle or settling claims for less than the amount that a reasonable person would believe the insured or beneficiary was entitled by reference to written or printed advertising material accompanying or made part of an application;”
- NAIC Model NAIC 900: Section 4.G (Affirm or Deny Coverage)
“G. Failing to affirm or deny coverage of claims within a reasonable time after having completed its investigation related to such claim or claims;”
- NAIC Model NAIC 900: Section 4.L (Explanation of Denial)
“Failing in the case of claims denials or offers of compromise settlement to promptly provide a reasonable and accurate explanation of the basis for such actions;”
- NAIC Model NAIC 900: Section 4K (Duplicate Proof of Loss)
“Unreasonably delaying the investigation or payment of claims by requiring both a formal proof of loss form and subsequent verification that would result in duplication of information and verification appearing in the formal proof of loss form;”
- NAIC Model NAIC 900: Section 4A (Misrepresenting Policy Provisions)
“A. Knowingly misrepresenting to claimants and insureds relevant facts or policy provisions relating to coverages at issue;”
- NAIC Model NAIC 900: Section 4M (Providing Claim Forms)
“M. Failing to provide forms necessary to present claims within fifteen (15) calendar days of a request with reasonable explanations regarding their use;”
- NAIC Unfair Claims Settlement Practices Act § 4A (Unfair Claims Practices Defined, misrepresentation of facts or policy provisions)
“Any of the following acts by an insurer, if committed in violation of Section 3, constitutes an unfair claims practice: A. Knowingly misrepresenting to claimants and insureds relevant facts or policy provisions relating to coverages at issue;”
- NAIC Unfair Claims Settlement Practices Act (#900), Section 3
“It is an improper claims practice for a domestic, foreign or alien insurer transacting business in this state to commit an act defined in Section 4 of this Act if: A. It is committed flagrantly and in conscious disregard of this Act or any rules promulgated hereunder; or B. It has been committed...”
- NAIC Unfair Claims Settlement Practices Act (#900), Section 4.M
“M. Failing to provide forms necessary to present claims within fifteen (15) calendar days of a request with reasonable explanations regarding their use;”
- NAIC Model #900, Section 1 (Purpose)
“The purpose of this Act is to set forth standards for the investigation and disposition of claims arising under policies or certificates of insurance issued to residents of [insert state]. It is not intended to cover claims involving workers’ compensation, fidelity, suretyship or boiler and...”
- NAIC Model #900, Section 5 (Statement of Charges)
“Whenever the commissioner has reasonable cause to believe that an insurer doing business in this state is engaging in any unfair claims practice and that a proceeding in respect thereto would be in the public interest, the commissioner shall issue and serve upon the insurer a statement of the...”
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