Missouri Code of State Regulations
Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE
Division 100 - Insurer Conduct
Chapter 1 - Improper or Unfair Claims Settlement Practices
Section 20 CSR 100-1.030 - Failure to Acknowledge Pertinent Communication

Universal Citation: 20 MO Code of State Regs 100-1.030

Current through Register Vol. 49, No. 18, September 16, 2024

PURPOSE: This amendment restructures the rule to provide greater clarity in interpreting the provisions of section 375.1007(2), RSMo regarding the handling and processing of claims.

(1) The following conduct by an insurer is deemed to be the type of conduct set forth in section 375.1007(2).

(A) Failing to acknowledge the receipt of a notification of claim from a first party claimant. For the purposes of this subsection, acknowledgment of receipt by an insurer may be made by either:
1. Making payment within ten (10) working days of receipt;

2. Sending the first party claimant a written acknowledgment within ten (10) working days of receipt and maintaining a copy of the written acknowledgment in the claim file of the insurer; or

3. Providing the first party claimant with an oral acknowledgment within ten (10) working days of receipt and making an appropriate notation of the date of this acknowledgment in the claim file of the insurer.

(B) Failing to provide an appropriate reply within ten (10) working days on all communications from any claimant that reasonably suggests a response is expected.

(2) For the purposes of subsection (1)(A), notification to any agent of the insurer, including a producer representing the insurer, constitutes notification to the insurer.

(3) Provision of necessary claim forms, instructions and reasonable assistance to first-party claimants within ten (10) working days of notification of a claim constitutes compliance with subsection (1)(A) of this rule.

*Original authority: 374.045, RSMo 1967, amended 1993, 1995; 375.1000-375.1018 see Missouri Revised Statutes 1994.

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