1. A. Insurers shall, for at least 3 years, make available for inspection by the Maryland Insurance Administration records of denials of claims and supporting documentation.
2. B. If an insurer has not completed its investigation of a first party claim within 45 days of notification, the insurer shall promptly notify the first-party claimant, in writing, of the actual reason that additional time is necessary to complete the investigation. Notice shall be sent to the first-party claimant after each additional 45-day period until the insurer either affirms or denies coverage and damages.
3. C. In any case in which a first-party claimant is neither an attorney nor represented by an attorney, the insurer shall, upon receipt of a written claim, inform that claimant in writing that there may be an applicable statute of limitations which may bar that claimant's rights in the future.
4. D. An insurer that denies a claim on the grounds of a specific policy provision, condition, or exclusion shall advise the claimant as to the provision, condition, or exclusion on which the denial is based.
5. E. When there is a reasonable basis, supported by specific information available for review by the Commissioner, that the first-party claimant has fraudulently caused or contributed to the loss, the insurer is relieved of the requirement contained in §§B and C of this regulation that the insurer state the reason that more time is required.
6. F. If a claim is denied for reasons other than those described in §D or E of this regulation, an appropriate notation shall be made in the claim file of the insurer.

Authority: Insurance Article, §§1-301, 2-109, 2-205, 2-207, 4-113, 10-126, 10-410, 19-505, 19-506, 19-508, and 27-301—27-306, Annotated Code of Maryland

Effective date: July 23, 1990 (17:14 Md. R. 1758)

Regulation .04G adopted effective April 1, 1991 (18:6 Md. R. 685)

Regulation .04G repealed as an emergency provision effective April 6, 1991 (18:9 Md. R. 1004); emergency status expired August 6, 1991; repealed permanently effective August 19, 1991 (18:16 Md. R. 1811)

Chapter recodified from COMAR 09.30.75 to COMAR 31.15.07 effective September 7, 1998 (25:18 Md. R. 1439)

Regulation .02B amended effective January 14, 2010 (37:1 Md. R. 17); February 1, 2016 (43:2 Md. R. 129)

Regulation .03A, B amended effective January 26, 2009 (36:2 Md. R. 103)

Regulation .10 amended effective January 14, 2010 (37:1 Md. R. 17)