A. In
this chapter, the following terms have the meanings indicated.
B. Terms
Defined.
(1)
"Business purposes standard" means the standard required by Insurance
Article, §27-501(a)(2), Annotated Code of Maryland.
(2)
"Claim" means a reported loss that is covered or coverable under a
policy.
(3)
"Loss" means damage or injury to body, person, or property.
(4)
"Remediation" means repair of the premises or dwelling of an insured
or replacement of part of the premises or dwelling of an insured that:
(a)
Eliminates or significantly diminishes the condition of the premises or dwelling
that gave rise to a claim; and
(b) Makes
it reasonably unlikely that the same type of claim will arise again.
(5)
"Repair notice" means written notice that:
(a) An
insurer provides to an insured pursuant to Insurance Article, §27-501(i)(2),
Annotated Code of Maryland; and
(b)
Requests the insured to make reasonable or customary repairs or replacement
specific to the insured's premises or dwelling.
A. Scope.
This regulation applies to homeowner's insurance.
B.
Weather-Related Claims—Presumption. A claim is presumed to be a
weather-related claim if the loss was caused by snow, rain, sleet, hail,
lightning, freezing, thawing, change in barometric pressure, or a similar
condition.
C.
Weather-Related Claims—Standard for Cancellation or Nonrenewal.
(1) An
insurer may not combine a weather-related claim that is excepted from the
business purposes standard by Insurance Article, §27-501(i)(1), Annotated Code
of Maryland, with any other factor for the purpose of canceling or refusing to
renew coverage unless there were three or more weather-related claims within the
preceding 3 years.
(2) For
purposes of cancellation of, or refusal to renew, coverage based on
weather-related claims pursuant to Insurance Article, §27-501(i)(1), Annotated
Code of Maryland, an insurer may consider a weather-related claim
notwithstanding any remediation by the insured that may prevent a similar
weather-related claim from arising in the future.
D.
Weather-Related Claims—Repair Notice.
(1) An
insurer may consider claims for weather-related events for the purpose of
canceling, or refusing to renew, coverage after providing a repair notice to an
insured pursuant to Insurance Article §27-501(i)(2), Annotated Code of
Maryland, only if the repair was sent following:
(a) An
inspection of the insured's premises or dwelling; or
(b) The
filing of a claim by the insured where the insurer's adjuster recognized the
need for the repair after inspecting the premises or dwelling where the claim
arose.
(2) An
insurer that provides a repair notice to an insured may satisfy the requirements
of Insurance Article, §27-501(i)(2), Annotated Code of Maryland, by sending the
repair notice to the insured by first class mail, in accordance with the
insurer's regular business practices.
(3) An
insurer may not consider a weather-related claim for the purpose of canceling,
or refusing to renew, coverage due to the insured's failure to make repairs or
replacement after mailing of a repair notice unless the repair notice was mailed
at least 60 days before the weather-related event that gave rise to the loss for
which a claim was made.
(4)
Insurance Article, §27-501(i)(2), Annotated Code of Maryland, does not allow an
insurer to cancel, or refuse to renew, coverage based wholly or partly on an
insured's failure to make repair or replacement after mailing of a repair notice
unless the insurer meets the business purposes standard, which may be met by
meeting one of the standards listed in Insurance Article, §27-501(j), Annotated
Code of Maryland.
E.
Material Misrepresentation.
(1) For
purposes of Insurance Article, §27-501(j)(1)(i), Annotated Code of Maryland, a
material misrepresentation is a misrepresentation but for which an insurer
would:
(a) Not
have provided coverage; or
(b) Have
denied a claim or any part of a claim.
(2) For
purposes of Insurance Article, §27-501(j)(1)(i), Annotated Code of Maryland, a
material misrepresentation does not include a good faith representation of the
value of a claim or any part of a claim.
31.15.10.03
A. Scope.
This regulation applies to private passenger motor vehicle insurance.
B.
Determining Number of Claims.
(1) For
the purpose of determining the number of not-at-fault claims under Insurance
Article, §27-501(k), Annotated Code of Maryland, claims under the following
types of coverage shall be presumed to be not-at-fault:
(a)
Uninsured motorist coverage; and
(b)
Comprehensive coverage.
(2) The
presumption in §B(1) of this regulation may be overcome if the carrier
demonstrates that the claim was an at-fault claim.
C.
Complaint Proceeding Based on Accident—Determination of Fault.
(1) In a
consumer complaint proceeding for cancellation or refusal to renew coverage
under Insurance Article, §27-501(k) or (l)(iv), Annotated Code of Maryland,
based wholly or partly on an accident, the Insurance Administration may:
(a)
Review the insurer's determination of fault for the accident; and
(b)
Decide whether the insurer's determination of fault was arbitrary or capricious.
(2)
Payment of a settlement by an insurer for an accident is evidence of the
insured's fault for the accident, but is not conclusive proof of fault.
D.
Material Misrepresentation.
(1) For
purposes of Insurance Article, §27-501(l)(1)(i), Annotated Code of Maryland, a
material misrepresentation is a misrepresentation:
(a) About
an insured's driving record made on an initial or underwriting renewal
application; or
(b) But
for which an insurer would:
(i) Not
have provided coverage; or
(ii) Have
denied a claim or any part of a claim.
(2) For
purposes of Insurance Article, §27-501(l)(1)(i), Annotated Code of Maryland, a
material misrepresentation does not include a good faith representation of the
value of a claim or any part of a claim.
E. Action
Based on Criminal Conduct.
(1) In
the case of private passenger motor vehicle insurance, standards that meet the
business purposes standard and do not require statistical validation include a
standard that allows cancellation or nonrenewal of coverage if the named insured
or a covered driver under the policy is convicted of:
(a)
Operating the motor vehicle while intoxicated, or impaired by drugs;
(b)
Committing homicide, reckless endangerment, or criminal negligence arising out
of the operation of the motor vehicle; or
(c) Using
the motor vehicle to participate in a felony.
(2) If a
named insured or covered driver is found guilty of a crime listed in §E(1) of
this regulation, and the guilty finding subsequently is struck, and the final
disposition of the matter is probation before judgment, the guilty finding:
(a) May
be used as evidence that the named insured or covered driver committed the
conduct listed in §E(1) of this regulation; but
(b) Is
not conclusive proof that the named insured or covered driver committed the
conduct listed in §E(1) of this regulation and may be rebutted by evidence
showing that the insured or covered driver did not commit the conduct.
A.
Factors in Mitigation. With respect to cancellation of, or refusal to renew,
coverage based on claims history, an insurer may not consider factors in
mitigation of a proposed cancellation of, or refusal to renew, coverage as
provided by Insurance Article, §27-501(n)(1), Annotated Code of Maryland,
unless the:
(1)
Insurer applies the factors uniformly within a given classification to each
proposed cancellation of, or refusal to renew, coverage for all insureds; and
(2)
Factors considered are included in the insurer's underwriting guidelines or
rating plan.
B.
Disclosure of Practice of Considering Claims History. An insurer that is
required by Insurance Article, §27-501(n)(2), Annotated Code of Maryland, to
disclose the practice of considering claims history for purposes of canceling,
or refusing to renew, coverage shall provide notice to the insured at the
issuance of the policy and at each renewal by using the following language, or
substantially similar language, in a least 12-point type: (Name of Insurer) will
consider your claims history for purposes of determining whether to cancel or
refuse to renew your policy.
C.
Providing Disclosure Notice at Inception of Policy. An insurer shall provide the
disclosure notice required by §B of this regulation to an insured at the
inception of a policy by:
(1)
Including the disclosure notice in a conspicuous location on a binder, the
policy, or another form; and
(2)
Mailing or delivering the binder, policy, or other form to the insured.
D.
Providing Disclosure Notice at Renewal. An insurer shall provide the disclosure
notice required by §B of this regulation to an insured at each renewal of a
policy by including the disclosure notice in a conspicuous location on the
notice of renewal premium required by Insurance Article, §27-607, Annotated
Code of Maryland