New Reporting Instructions and Forms for cases under §27-1001 of the Insurance Article and § 3-1701 of the Courts and Judical Proceedings Article

civil action proceeds through each level of adjudication and as each adjudicatory body issues a disposition. The amended Reporting Forms are designed to simplify the reporting process and are located on the Administration’s website (insurance.maryland.gov) at the following hyperlink: Insurer Good Faith Requirements . Please note, once you open the Excel spread sheet, you must save the form to your computer in Excel and then complete the form with the required information. The shaded areas (light blue in color) contained on the Excel spread sheet are areas which provide a drop down menu. Please choose the correct information from the drop down menu and that information will automatically transfer onto the Excel spread sheet. Once the Excel spread sheet is complete, please save it with the case name or case number and then submit the completed form to the Administration by attaching it to an email to Pamela Hirsch at pam.hirsch@maryland.gov. If you have questions regarding the process for submitting the §27-1001 Notice of Disposition or the §3-1701 Notice of Pending Complaint, please contact Pamela Hirsch, Maryland Insurance Administration, Phone: (410) 468-2346, Email: pam.hirsch@maryland.gov. ALFRED W. REDMER, JR. Insurance Commissioner By: Robert D. Morrow Jr., Associate Commissioner – Hearings signature on original Exhibit A Insurer Name: NAIC Number: Answer: Circuit Court Answer: District Court Answer: Federal Court Answer: Case Name: Court/Any underlying or prior dispositions List Names List Dispositions Case Number: Court/Any underlying or prior dispositions List Numbers List dispositions 27-1001 Notice of Disposition (b) The case name and number before that adjudicatory body, as well as the case name and number of any underlying or prior dispositions with respect to that Complaint: (a) What adjudicatory body issued the disposition? Select the city/county in which your court is located? Select the following adjudicatory body: Please select: Answer: Answer: Answer: Please enter amount $ ; and (ii) The amount sought as expenses and litigation costs, including attorney's fees: Type Amount Expenses $ Litigation Costs $ Attorney Fees $ Interest $ List disposition: (e) The amount sought as damages in the Complaint, itemized by: (i) The amount sought as actual damages (f) The disposition of each count of the Complaint: (g) A summary of any determinations made: (c) Whether the Complaint sought a determination as to coverage and/or alleged a failure by the Defendant Insurer to adequately value and/or pay the underlying insurance claim: Please select both first and second level: (d) The type of coverage at issue in the Complaint, such Auto UM/UIM, Homeowner’s, Commercial General Liability, Individual Disability Insurance, etc.: Please enter amount $ ; and Type Amount Expenses $ Litigation Costs $ Attorney Fees $ Interest $ An appeal filed Answer: Answer: (i) Whether any further proceedings before that body or another tribunal have been filed or are expected to be filed. (h) A listing of any amounts awarded by the adjudicatory body: If yes, where was the appeal filed (i) The amount awarded as actual damages (ii) The amount awarded as expenses and litigation costs, including attorney's fees; {00124862.DOC /} Exhibit B Insurer Name: NAIC Number: Answer: Circuit Court Answer: District Court Answer: Federal Court Answer: Case Name Case Number 3-1701 Notice of Pending Complaint (a) The court in which the Complaint was filed: (c) The parties to the complaint List Parties and Designation (Name(s), Plaintiff and Name(s), Defendant): (b) The case name and number assigned to the Complaint: Select the city/county in which your court is located? (d) The reason why the Complaint was not required to be filed with the Administration prior to being filed with the court: Answer: Please select: Answer: First Level Answer: Second Level Answer: Please enter amount $ ; and (ii) The amount sought as expenses and litigation costs, including attorney's fees: Type Amount Expenses $ Litigation Costs $ Attorney Fees $ Interest $ List disposition: (e) Whether the Complaint sought a determination as to coverage and/or alleged a failure by the Defendant Insurer to adequately value and/or pay the underlying insurance claim: (f) The type of coverage at issue in the Complaint, such Auto UM/UIM, Homeowner’s, Commercial General Liability, Individual Disablity Insurance, etc.: Please select both first and second level: (g) The amount sought as damages in the Complaint, itemized by: (i) The amount sought as actual damages (f) The disposition of each count of the Complaint: Please enter amount $ ;and Type Amount Expenses $ Litigation Costs $ Attorney Fees $ Interest $ An appeal filed Answer: Answer: (g) A summary of any determinations made: (i) Whether any further proceedings before that body or another tribunal have been filed or are expected to be filed. If yes, where was the appeal filed (h) A listing of any amounts awarded by the adjudicatory body: (i) The amount awarded as actual damages (ii) The amount awarded as expenses and litigation costs, including attorney's fees;