ESSB 5726 -
By Committee on Insurance, Financial Services & Consumer Protection
ADOPTED AND ENGROSSED 04/05/2007
Strike everything after the enacting clause and insert the following:
"NEW SECTION. Sec. 1 This act may be known and cited as the
insurance fair conduct act.
Sec. 2 RCW 48.30.010 and 1997 c 409 s 107 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. "First party claimant" has the same meaning as
in section 3 of this act.
NEW SECTION. Sec. 3 A new section is added to chapter 48.30 RCW
to read as follows:
(1) Any first 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 of an
insurance contract who is the prevailing party in such an action.
(4) "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.
(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, the first party claimant may bring the action without any
further notice.
(c) The first 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."
EFFECT: The reference to insurance rules that can serve as a basis for treble damages or attorneys' fees is narrowed. The substitute bill referred to any rule adopted under the authority of RCW 48.30.010. The amendment includes five existing rules and any rules adopted as unfair claims settlement practice rules by the Insurance Commissioner that are intended to implement this act. The five existing rules address the following areas: Specific unfair claims settlement practices; misrepresentation of policy provisions; failure to acknowledge pertinent communications; standards for prompt investigation; standards for prompt, fair and equitable settlements applicable to all insurers. The provision that states that the remedies in the bill are separate from any remedies prescribed in RCW 19.86.090 of the Consumer Protection Act is removed. A court's existing ability to make any other determination regarding an unfair practice by an insurer or provide for any other remedy that is available at law is not limited by the bill.