BILL REQ. #:  H-1472.1 

Prefiled 05/01/13. Read first time 05/13/13.   Referred to Committee on Business & Financial Services.

     AN ACT Relating to third party claims under the fair conduct act; and amending RCW 48.30.010 and 48.30.015.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1   RCW 48.30.010 and 2007 c 498 s 2 are each amended to read as follows:
     (1) No person engaged in the business of insurance shall engage in unfair methods of competition or in unfair or deceptive acts or practices in the conduct of such business as such methods, acts, or practices are defined pursuant to subsection (2) of this section.
     (2) In addition to such unfair methods and unfair or deceptive acts or practices as are expressly defined and prohibited by this code, the commissioner may from time to time by regulation promulgated pursuant to chapter 34.05 RCW, define other methods of competition and other acts and practices in the conduct of such business reasonably found by the commissioner to be unfair or deceptive after a review of all comments received during the notice and comment rule-making period.
     (3)(a) In defining other methods of competition and other acts and practices in the conduct of such business to be unfair or deceptive, and after reviewing all comments and documents received during the notice and comment rule-making period, the commissioner shall identify his or her reasons for defining the method of competition or other act or practice in the conduct of insurance to be unfair or deceptive and shall include a statement outlining these reasons as part of the adopted rule.
     (b) The commissioner shall include a detailed description of facts upon which he or she relied and of facts upon which he or she failed to rely, in defining the method of competition or other act or practice in the conduct of insurance to be unfair or deceptive, in the concise explanatory statement prepared under RCW 34.05.325(6).
     (c) Upon appeal the superior court shall review the findings of fact upon which the regulation is based de novo on the record.
     (4) No such regulation shall be made effective prior to the expiration of thirty days after the date of the order by which it is promulgated.
     (5) If the commissioner has cause to believe that any person is violating any such regulation, the commissioner may order such person to cease and desist therefrom. The commissioner shall deliver such order to such person direct or mail it to the person by registered mail with return receipt requested. If the person violates the order after expiration of ten days after the cease and desist order has been received by him or her, he or she may be fined by the commissioner a sum not to exceed two hundred and fifty dollars for each violation committed thereafter.
     (6) If any such regulation is violated, the commissioner may take such other or additional action as is permitted under the insurance code for violation of a regulation.
     (7) An insurer engaged in the business of insurance may not unreasonably deny a claim for coverage or payment of benefits to any first party claimant or third party claimant.
     (a) "First party claimant" has the same meaning as in RCW 48.30.015.
     (b) "Third party claimant" has the same meaning as in RCW 48.30.015.

Sec. 2   RCW 48.30.015 and 2007 c 498 s 3 are each amended to read as follows:
     (1) Any first party claimant or third party claimant to a policy of insurance who is unreasonably denied a claim for coverage or payment of benefits by an insurer may bring an action in the superior court of this state to recover the actual damages sustained, together with the costs of the action, including reasonable attorneys' fees and litigation costs, as set forth in subsection (3) of this section.
     (2) The superior court may, after finding that an insurer has acted unreasonably in denying a claim for coverage or payment of benefits or has violated a rule in subsection (5) of this section, increase the total award of damages to an amount not to exceed three times the actual damages.
     (3) The superior court shall, after a finding of unreasonable denial of a claim for coverage or payment of benefits, or after a finding of a violation of a rule in subsection (5) of this section, award reasonable attorneys' fees and actual and statutory litigation costs, including expert witness fees, to the first party claimant or third party claimant of an insurance contract who is the prevailing party in such an action.
     (4)(a) "First party claimant" means an individual, corporation, association, partnership, or other legal entity asserting a right to payment as a covered person under an insurance policy or insurance contract arising out of the occurrence of the contingency or loss covered by such a policy or contract.
     (b) "Third party claimant" means any individual, corporation, association, partnership, or other legal entity asserting a claim against any individual, corporation, association, partnership, or other legal entity insured under an insurance policy or insurance contract of the insurer.
     (5) A violation of any of the following is a violation for the purposes of subsections (2) and (3) of this section:
     (a) WAC 284-30-330, captioned "specific unfair claims settlement practices defined";
     (b) WAC 284-30-350, captioned "misrepresentation of policy provisions";
     (c) WAC 284-30-360, captioned "failure to acknowledge pertinent communications";
     (d) WAC 284-30-370, captioned "standards for prompt investigation of claims";
     (e) WAC 284-30-380, captioned "standards for prompt, fair and equitable settlements applicable to all insurers"; or
     (f) An unfair claims settlement practice rule adopted under RCW 48.30.010 by the insurance commissioner intending to implement this section. The rule must be codified in chapter 284-30 of the Washington Administrative Code.
     (6) This section does not limit a court's existing ability to make any other determination regarding an action for an unfair or deceptive practice of an insurer or provide for any other remedy that is available at law.
     (7) This section does not apply to a health plan offered by a health carrier. "Health plan" has the same meaning as in RCW 48.43.005. "Health carrier" has the same meaning as in RCW 48.43.005.
     (8)(a) Twenty days prior to filing an action based on this section, a first party claimant must provide written notice of the basis for the cause of action to the insurer and office of the insurance commissioner. Notice may be provided by regular mail, registered mail, or certified mail with return receipt requested. Proof of notice by mail may be made in the same manner as prescribed by court rule or statute for proof of service by mail. The insurer and insurance commissioner are deemed to have received notice three business days after the notice is mailed.
     (b) If the insurer fails to resolve the basis for the action within the twenty-day period after the written notice by the first party claimant or third party claimant, the first party claimant or third party claimant may bring the action without any further notice.
     (c) The first party claimant or third party claimant may bring an action after the required period of time in (a) of this subsection has elapsed.
     (d) If a written notice of claim is served under (a) of this subsection within the time prescribed for the filing of an action under this section, the statute of limitations for the action is tolled during the twenty-day period of time in (a) of this subsection.