Ch. 348

1996 LAWS OF MARYLAND

(12) Delaying an investigation or payment of a claim by requiring a claimant
or a claimant's licensed health care provider to submit a preliminary claim report in
addition to subsequent submission of formal proof of less 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;

(14)   Failing promptly to provide a reasonable explanation for the basis for
denial of a claim or the offer of a compromise settlement; [or]

(15)   Failing to meet the requirements of Title 19, Subtitle 13 of the Health -
General Article for preauthorization for a health care service; OR

(16)   REFERRING FIRST PARTY CLAIMS TO A PEER REVIEW
ORGANIZATION.

(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 (e) 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] EXCEPT AS PROVIDED IN SUBSECTION (G) OF THIS
SECTION, THIS section provides administrative remedies only.

(ii) Appeals from orders issued by the Commissioner under this
section shall be as provided in § 40 of this article.

(2) (i) Nothing contained in this section is intended to provide or deprive
any private right or cause of action to, or on behalf of any claimant or other person in any
state, territory, or possession of the United States.

(ii) It is the specific intent of this section to provide an additional
administrative remedy to the claimant for any violation of the provisions of this section or
any regulation pertaining to this section.

(3) This section may not be construed to impair the right of any person to
seek redress in law or equity for any conduct which is otherwise actionable.

(G) (1) THIS SUBSECTION SHALL APPLY TO INSUREDS AND INSURERS
UNDER POLICIES OF PRIVATE PASSENGER AUTOMOBILE INSURANCE ONLY.

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