3672

VETOES

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 PERSON WOULD EXPECT TO BE ENTITLED
AFTER STUDYING WRITTEN OR PRINTED ADVERTISING MATERIAL
ACCOMPANYING, OR MADE PART OF, AN APPLICATION;

(9)  ATTEMPTING TO SETTLE A CLAIM ON THE BASIS OF AN
APPLICATION WHICH IS ALTERED WITHOUT NOTICE TO, OR THE KNOWLEDGE
OR CONSENT OF, THE INSURED;

(10)  FAILING TO INCLUDE WITH CLAIMS PAID TO INSUREDS
OR BENEFICIARIES STATEMENTS SETTING FORTH THE COVERAGE UNDER
WHICH PAYMENTS ARE BEING MADE;

(11)  MAKING KNOWN TO INSUREDS OR CLAIMANTS A POLICY
OF APPEALING FROM ARBITRATION AWARDS IN ORDER TO COMPEL INSUREDS
OR CLAIMANTS TO ACCEPT A SETTLEMENT OR COMPROMISE LESS THAN THE
AMOUNT AWARDED IN ARBITRATION;

(12)  DELAYING AN INVESTIGATION OR PAYMENT OF A CLAIM
BY REQUIRING A CLAIMANT OR A CLAIMANT'S PHYSICIAN LICENSED HEALTH
CARE PROVIDER TO SUBMIT A PRELIMINARY CLAIM REPORT IN ADDITION TO
SUBSEQUENT SUBMISSION OF FORMAL PROOF OF LOSS FORMS, CONTAINING
SUBSTANTIALLY THE SAME INFORMATION;

(13)  FAILING TO SETTLE CLAIMS PROMPTLY WHENEVER
LIABILITY IS REASONABLY CLEAR UNDER ONE PORTION OF A POLICY, IN
ORDER TO INFLUENCE SETTLEMENTS UNDER OTHER PORTIONS OF THE
POLICY; OR

(14)  FAILING PROMPTLY TO PROVIDE A REASONABLE
EXPLANATION FOR THE BASIS FOR DENIAL OF A CLAIM OR THE OFFER OF A
COMPROMISE SETTLEMENT.

(E)  (1) THE COMMISSIONER MAY IMPOSE A PENALTY OF UP TO $500
FOR EACH VIOLATION OF SUBSECTION (C) OF THIS SECTION, OR OF ANY
REGULATION PROMULGATED UNDER SUBSECTION (C) OF THIS SECTION.

(2)  THE PENALTY FOR A VIOLATION OF SUBSECTION (D) OF
THIS SECTION SHALL BE AS PROVIDED IN §§ 12, 55, 55A, AND 215 OF
THIS ARTICLE.

(3)  (I) UPON FINDING OF A VIOLATION OF THIS SECTION
THE COMMISSIONER MAY REQUIRE THAT RESTITUTION BE MADE BY AN
INSURER OR NONPROFIT HEALTH SERVICE PLAN TO ANY CLAIMANT WHO HAS
SUFFERED ACTUAL ECONOMIC DAMAGE AS A RESULT OF A VIOLATION OF
THIS SECTION.

(II) RESTITUTION SHALL BE LIMITED TO THE AMOUNT
OF ACTUAL ECONOMIC DAMAGE SUSTAINED, SUBJECT TO THE LIMITS OF ANY
APPLICABLE INSURANCE POLICY.

(F)  (1) (I) THIS SECTION PROVIDES ADMINISTRATIVE REMEDIES
ONLY.