| 1 | Representative(s) Ross offered the following: |
| 2 |
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| 3 | Substitute Amendment for Amendment (611489) (with title |
| 4 | amendment) |
| 5 | Between lines 1296 and 1297, insert: |
| 6 | Section 17. (1) Upon an insurer's receiving a |
| 7 | communication with respect to a claim, the insurer shall, within |
| 8 | 14 calendar days, review and acknowledge receipt of such |
| 9 | communication unless payment is made within that period of time |
| 10 | or unless the failure to acknowledge is caused by factors beyond |
| 11 | the control of the insurer which reasonably prevent such |
| 12 | acknowledgement. If the acknowledgement is not in writing, a |
| 13 | notification indicating acknowledgement shall be made in the |
| 14 | insurer's claim file and dated. A communication made to or by an |
| 15 | agent of an insurer with respect to a claim shall constitute |
| 16 | communication to or by the insurer. As used in this subsection, |
| 17 | the term "agent" means any person to whom an insurer has granted |
| 18 | authority or responsibility to receive or make such |
| 19 | communications with respect to claims on behalf of the insurer. |
| 20 | This subsection shall not apply to claimants represented by |
| 21 | counsel beyond those communications necessary to provide forms |
| 22 | and instructions. |
| 23 | (2) Such acknowledgement shall be responsive to the |
| 24 | communication. If the communication constitutes a notification |
| 25 | of a claim, unless the acknowledgement reasonably advises the |
| 26 | claimant that the claim appears not to be covered by the |
| 27 | insurer, the acknowledgement shall provide necessary claim |
| 28 | forms, and instructions, including an appropriate telephone |
| 29 | number. |
| 30 | (3) Unless otherwise provided by the policy of insurance |
| 31 | or by law, within 10 working days after an insurer receives |
| 32 | proof of loss statements the insurer shall begin such |
| 33 | investigation as is reasonably necessary unless the failure to |
| 34 | begin such investigation is caused by factors beyond the control |
| 35 | of the insurer which reasonably prevent the commencement of such |
| 36 | investigation. |
| 37 |
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| 38 | ================ T I T L E A M E N D M E N T ============= |
| 39 | Between lines 107 and 108, insert: |
| 40 | requiring insurers to review and acknowledge receipt of certain |
| 41 | communications relating to claims; providing an exception; |
| 42 | providing a definition; providing for nonapplication to certain |
| 43 | claimants; providing procedures and requirements relating to |
| 44 | such acknowledgements; requiring an insurer to conduct certain |
| 45 | investigations under certain circumstances; |