23 CAR § 83-111 – Claims and review procedure

(a)
1. (1) The insurance company shall:
  1. (A) Be responsible for the settlement, adjustment, and payment of all claims; and
  2. (B) Establish and maintain adequate claim files, which may be reviewed and examined by the Insurance Commissioner.
2. (2) All claims shall be:
  1. (A) Promptly reported to the insurance company or its designated claim representative; and
  2. (B) Settled as soon as possible and in accordance with the terms of the insurance contract.
(b) All claims shall be paid either by draft drawn upon the insurance company or by check of the insurance company to the order of the claimant to whom payment of the claim is due pursuant to the policy provisions or upon direction of such claimant to the one specified.
(c)
1. (1) No plan or arrangement shall be used whereby any person, firm, or corporation other than the insurer or its designated claim representative shall be authorized to settle or adjust claims.
2. (2) The creditor shall not be designated as claim representative for the insurer in settling or adjusting claims provided that a group policyholder may, by arrangement with the group insurer, draw drafts or checks in payment of claims due to the group policyholder subject to audit and review by the insurer.
3. (3) However, nothing herein shall be construed to relieve the insurance company from the responsibility for the proper settlement, adjustment, and payment of all claims in accordance with the terms of the insurance contract.
(d) It shall be the responsibility of the insurer to:
1. (1) Review each lender's account at least annually verifying the accuracy of premium payments or other identifiable insurance charges, premium refunds, and claims incurred; and
2. (2) Be prepared to exhibit the results of such review upon request of the commissioner.