14VAC5-400-70: Claims settlement standards applicable to all insurers

A. Any denial of a claim shall be given to a claimant in writing and the claim file of the insurer shall contain a copy of the denial.

B. An insurer shall provide a reasonable written explanation of the basis for any claim denial. The written explanation shall provide a specific reference to a policy provision, condition, or exclusion, if any.

C. An insurer shall not deny a first party claim on the basis that responsibility for payment should be assumed by others except as may otherwise be provided by policy provisions.

D. In any case where there is no dispute as to coverage or liability, an insurer shall offer to a first party claimant an amount that is fair and reasonable as shown by the investigation of the claim, provided the amount so offered is within policy limits and in accordance with policy provisions.

E. An insurer shall not unreasonably refuse to pay any claim in accordance with the provisions of the policy.