KRS 304.12-230: Unfair claims settlement practices.

It is an unfair claims settlement practice for any person to commit or perform any of the

following acts or omissions:

(1) Misrepresenting pertinent facts or insurance policy provisions relating to coverages

at issue;

(2) Failing to acknowledge and act rea sonably promptly upon communications with

respect to claims arising under insurance policies;

(3) Failing to adopt and implement reasonable standards for the prompt investigation of

claims arising under insurance policies;

(4) Refusing to pay claims withou t conducting a reasonable investigation based upon

all available information;

(5) Failing to affirm or deny coverage of claims within a reasonable time after proof of

loss statements have been completed;

(6) Not attempting in good faith to effectuate promp t, fair and equitable settlements of

claims in which liability has become reasonably clear;

(7) 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;

(8) Attempting to settle a claim for less than the amount to which a reasonable man

would have believed he was entitled by reference to written or printed advertising

material accompanying or made part of an application;

(9) Attempting to settle claims on the basis of an application which was altered without

notice to, or knowledge or consent of the insured;

(10) Making claims payments to insureds or beneficiaries not accompanied by statement

setting forth the coverage under which the payments are being made;

(11) 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;

(12) 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, bo th of which submissions

contain substantially the same information;

(13) Failing to promptly settle claims, where liability has become reasonably clear, under

one (1) portion of the insurance policy coverage in order to influence settlements

under other portions of the insurance policy coverage;

(14) 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;

(15) Failing to comply with the decision of an independent review entity to provide

coverage for a covered person as a result of an external review in accordance with

KRS 304.17A-621, 304.17A-623, and 304.17A-625;

(16) Knowingly and willfully failing to comply with the provisions of KRS 304.17A-714

when collecting claim overpayments from providers; or

(17) Knowingly and willfully failing to comply with the provisions of KRS 304.17A-708

on resolution of payment errors and retroactive denial of claims.