Misrepresentation of Policy Provisions in Claims Settlement

PURPOSE: This rule effectuates or aids in the interpretation of section 375.1007(1), RSMo. (1) An insurer who engaged in one or more of the following acts or practices shall be deemed to be engaged in “misrepresenting policy provisions” as used in section 375.1007(1), RSMo. This rule is not intended to be all inclusive and acts or practices not enumerated in this rule may also be deemed misrepresentation. (A) No insurer shall fail to fully disclose to first-party claimants all pertinent benefits, coverages or other provisions of an insurance policy under which a claim is presented. (B) No insurance producer shall conceal from any first-party claimant the benefits, coverages or other provisions of any insurance policy when these benefits, coverages or other provisions are pertinent to a claim. (C) No insurer shall deny any claim for failure to exhibit the property without proof of demand and unfounded refusal by a claimant to do so. (D) No insurer shall deny any claim based upon the insured’s failure to submit a written notice of loss within a specified time following any loss, unless this failure operates to prejudice the rights of the insurer. (E) No insurer shall request a first-party claimant to sign a release that extends beyond the subject matter that gave rise to the claim payment. (F) No insurer shall issue any draft in partial settlement of a claim under a specific coverage, when endorsement of the draft would totally release the insurer or its insured from liability. AUTHORITY: section 374.045, RSMo 2000 and sections 375.1000–375.1018, RSMo 2000 and RSMo Supp. 2007.* This rule was previously filed as 4 CSR 190-10.060(3). Original rule filed Aug. 5, 1974, effective Aug. 15, 1974. Rescinded and readopted: Filed Aug. 16, 1978, effective Dec. 11, 1978. Amended: Filed Sept. 11, 1980, effective Feb. 16, 1981. Amended: Filed Sept. 14, 1981, effective Jan. 15, 1982. Amended: Filed Aug. 4, 1986, effective Jan. 1, 1987. Amended: Filed Jan. 5, 1987, effective June 1, 1987. Amended: Filed Aug. 4, 1987, effective Dec. 24, 1987. Amended: Filed Dec. 9, 1988, effective April 28, 1989. Amended: Filed Nov. 2, 1989, effective Feb. 15, 1990. Emergency amendment filed Feb. 21, 1990, effective March 5, 1990, expired June 2, 1990. Amended: Filed Feb. 26, 1990, effective June 11, 1990. Amended: Filed Dec. 12, 1990, effective June 10, 1991. Amended: Filed Oct. 1, 1996, effective June 30, 1997. Amended: Filed July 12, 2002, effective Jan. 30, 2003. Amended: Filed Nov. 1, 2007, effective July 30, 2008. *Original authority: 374.045, RSMo 1967, amended 1993, 1995 and 375.1000–375.1018, see RSMo 2000 and RSMo Supp. 2007.