NAIC Unfair Claims Settlement Practices Model Act (MDL-900) and Model Regulation (MDL-902) mdl900-s4-a-l-no-misrepresentation-explanation: Do not misrepresent facts or policy provisions, and give prompt reasonable and accurate explanations of denials and compromise offers

What does mdl900-s4-a-l-no-misrepresentation-explanation require?

Among the defined unfair practices, item A is knowingly giving claimants or insureds a false picture of the facts or policy terms bearing on the coverage in question, and item L is failing to explain a denial or compromise offer promptly, reasonably and accurately. Together they require claim correspondence that states the facts and the policy terms correctly and denial letters that explain why.

Other controls in Model Act sections 3 and 4: the general business practice test and the fourteen defined unfair claims practices – NAIC Unfair Claims Settlement Practices Model Act (MDL-900) and Model Regulation (MDL-902)

mdl900-s3-general-business-practice An unfair claims practice is actionable when committed flagrantly in conscious disregard of the law, or so often as to show a general business practice
mdl900-s4-b-c-f-g-acknowledge-standards-investigate Acknowledge communications promptly, adopt standards for prompt investigation and settlement, investigate before refusing, and affirm or deny coverage within a reasonable time
mdl900-s4-d-e-good-faith-settlement-no-lowball Attempt in good faith to settle promptly, fairly and equitably once liability is reasonably clear, and never force suits by offering far less than the claim is worth
mdl900-s4-h-i-j-k-m-n-settlement-basis-payments-forms-repairs Settle on the advertised and applied-for terms, identify the coverage for each payment, avoid duplicate proofs, supply claim forms within fifteen days and stand behind required repairers

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The graph holds this control, the 0 it maps to, and the evidence behind each claim, over MCP and REST.

MCP endpoint All NAIC Unfair Claims Settlement Practices Model Act (MDL-900) and Model Regulation (MDL-902) controls