NAIC Unfair Claims Settlement Practices Model Act (MDL-900) and Model Regulation (MDL-902) mdl902-s7a-b-accept-deny-21-days: Accept or deny a first party claim within twenty-one days of proof of loss, deny in writing citing the provision, and send delay letters every forty-five days

What does mdl902-s7a-b-accept-deny-21-days require?

Within twenty-one days of receiving a properly executed proof of loss the insurer must tell the first party claimant whether the claim is accepted or denied. A denial that rests on a particular provision, condition or exclusion must name it, must be in writing and must be documented on the file. If more time is needed the insurer must say so within the same twenty-one days with the reasons, and while the investigation remains open must write to the claimant every forty-five days explaining why more time is needed. Where specific information available for regulatory review gives reasonable grounds to suspect the claimant caused or contributed to the loss by fraud, these timetables fall away, but the insurer must still accept or deny within whatever time a full investigation reasonably takes.