| 18 | | - | (NEW) (23) With respect to an insurance company, health care center, hospital service corporation, medical service corporation, fraternal benefit society or other entity that delivers, issues for delivery, renews, amends or continues an individual health insurance policy providing coverage of the types specified in section 38a-469, failing to refund any overpaid premium made by a policyholder for coverage under such policy not later than thirty days after such policy is cancelled or such company, center, corporation, society or other entity receives the refund request from the policyholder. Such company, center, corporation, society or other entity shall include, if such refund is issued more than thirty days after such cancellation or request, interest at the rate of fifteen per cent per annum. |
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| 30 | + | (6) Unfair claim settlement practices. Committing or performing with such frequency as to indicate a general business practice any of the following: (A) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue; (B) failing to acknowledge and act with reasonable promptness upon communications with respect to claims arising under insurance policies; (C) failing to adopt and implement reasonable standards for the prompt investigation of claims arising under insurance policies; (D) refusing to pay claims without conducting a reasonable investigation based upon all available information; (E) failing to affirm or deny coverage of claims within a reasonable time after proof of loss statements have been completed; (F) not attempting in good faith to effectuate prompt, fair and equitable settlements of claims in which liability has become reasonably clear; (G) (i) compelling insureds to institute litigation to recover amounts due under an insurance policy by offering substantially less than the amounts ultimately recovered in actions brought by such insureds, or (ii) offering a settlement and stating or implying that if the insured declines acceptance of such settlement, the insured must institute litigation to recover amounts due under an insurance policy; (H) attempting to settle a claim for less than the amount to which a reasonable [man] person would have believed he or she was entitled by reference to written or printed advertising material accompanying or made part of an application; (I) attempting to settle claims on the basis of an application which was altered without notice to, or knowledge or consent of the insured; (J) making claims payments to insureds or beneficiaries not accompanied by statements setting forth the coverage under which the payments are being made; (K) making known to insureds or claimants a policy of appealing from arbitration awards in favor of insureds or claimants for the purpose of compelling them to accept settlements or compromises less than the amount awarded in arbitration; (L) delaying the investigation or payment of claims by requiring an insured, claimant, or the physician of either to submit a preliminary claim report and then requiring the subsequent submission of formal proof of loss forms, both of which submissions contain substantially the same information; (M) failing to promptly settle claims, where liability has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage; (N) failing to promptly provide a reasonable explanation of the basis in the insurance policy in relation to the facts or applicable law for denial of a claim or for the offer of a compromise settlement; (O) using as a basis for cash settlement with a first party automobile insurance claimant an amount which is less than the amount which the insurer would pay if repairs were made unless such amount is agreed to by the insured or provided for by the insurance policy. |
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| 31 | + | |
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| 32 | + | Sec. 2. Section 38a-816 of the general statutes is amended by adding subdivision (23) as follows (Effective October 1, 2015): |
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| 33 | + | |
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| 34 | + | (NEW) (23) With respect to an insurance company, health care center, hospital service corporation, medical service corporation, fraternal benefit society or other entity that delivers, issues for delivery, renews, amends or continues an individual health insurance policy providing coverage of the types specified in section 38a-469, failing to refund any overpaid premium made by a policyholder for coverage under such policy not later than thirty days after such policy is cancelled or such company, center, corporation, society or other entity receives the refund request from the policyholder. Such company, center, corporation, society or other entity shall include, if such refund is issued more than thirty days after such notice or request, interest at the rate of fifteen per cent per annum. |
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