Standards for prompt, fair, and equitable settlements applicable to insurers
Arkansas Code § 23-61-108; Arkansas Code § 23-66-207; Arkansas Code § 23-76-125
(a) The provisions of this section shall not apply to:
- (1) Persons that are defined as health carriers under 23 CAR § 15-103(b)(8);
- (2) Surety and fidelity insurance;
- (3) Mortgage guaranty; or
- (4) Other forms of insurance offering protection against investment risks.
(b)
(1)
- (A) Within fifteen (15) working 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.
- (B) No insurer shall deny a claim on the grounds of a specific policy provision, condition, or exclusion unless reference to such provision, condition, or exclusion is included in the denial.
- (C) The denial must be given to the claimant in writing, and the claim file of the insurer shall contain a copy of the denial.
(2)
- (A) If the insurer needs more time to determine whether a first-party claim should be accepted or denied, it shall so notify the first-party claimant in writing within fifteen (15) working days after receipt of the proofs of loss, stating the reasons more time is needed.
- (B) If the investigation remains incomplete, the insurer shall, within forty-five (45) calendar days from the date of the initial notification and not more than every forty-five (45) calendar days thereafter, send to such claimant a letter setting forth the reasons additional time is needed for investigation.
(c)
- (1) Where there is a reasonable basis supported by specific information available for review by the State Insurance Department that the first-party claimant has fraudulently caused or contributed to the loss by arson, the insurer is relieved from the requirements of subdivision (b)(1) of this section.
- (2) The claimant shall be advised of the acceptance or denial of the claim within a reasonable time following a full investigation after receipt by the insurer of a properly executed proof of loss.
- (3) The insurer shall comply with the provisions of the Arson Reporting-Immunity Act, Arkansas Code §§ 12-13-301 – 12-13-305.
- (d) Insurers shall not refuse to settle first-party claims on the basis that responsibility for payment should be assumed by others, except as may otherwise be provided by policy provisions.
(e)
- (1) Insurers shall not continue or prolong negotiations for settlement of a claim directly with a claimant who is neither an attorney nor represented by an attorney until the claimant's rights may be affected by a statute of limitations or a policy or contract time limit, without giving the claimant written notice that the time limit may be expiring and may affect the claimant's rights.
- (2) Such notice shall be given to first-party claimants at least thirty (30) working days and to third-party claimants at least sixty (60) calendar days before the date on which such time limit may expire.
- (f) No insurer shall make statements which indicate 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 applicable provision of a statute of limitations, as provided in subsection (e) of this section.
(g) Insurers shall mail or deliver claim checks or drafts to claimants within ten (10) working days after:
- (1) The claims are processed;
- (2) All claim investigations are completed; and
- (3) Said claim files are closed and ready for payment.
- (h) No insurer or its agents and representatives shall fail to disclose fully to first-party claimants all pertinent benefits, coverages, or other provisions of an insurance policy or contract under which a claim is presented.
- (i) No agent shall conceal from first-party claimants benefits, coverages, or other provisions of any insurance policy or insurance contract when such benefits, coverages, or other provisions are pertinent to a claim.
(j) No insurer shall:
(1) Deny a claim for a claimant's failure to exhibit the damaged property without proof of:
- (A) Demand; and
- (B) An unfounded refusal by the claimant to do so;
- (2) Except where there is a time limit specified in the policy, make statements, written or otherwise, requiring a claimant to give written notice of loss or proof of loss within a specified time and which seek to relieve the company of its obligations if such a time limit is not complied with, unless the failure to comply with such time limit prejudices the insurer's rights;
- (3) Request a first-party claimant to sign a release that extends beyond the subject matter that gave rise to the claim payment;
- (4) Issue checks or drafts in partial settlement of a loss or claim under a specific coverage which contains language which releases the insurer or its insured from total liability; or
- (5) Delay payment of any claim under specific coverages under a contract in an attempt to settle all or a portion of the claims under other coverages provided by the policy.