WAC 284-30-380

(1) Within fifteen working days after receipt by the insurer of fully completed and executed proofs of loss, the insurer must notify the first party claimant whether the claim has been accepted or denied. The insurer must not deny a claim on the grounds of a specific policy provision, condition, or exclusion unless reference to the specific provision, condition, or exclusion is included in the denial. The denial must be given to the claimant in writing and the claim file of the insurer must contain a copy of the denial.

(2) If a claim is denied for reasons other than those described in subsection (1) and is made by any other means than in writing, an appropriate notation must be made in the claim file of the insurer describing how, when, and to whom the notice was made.

(3) If the insurer needs more time to determine whether a first party claim should be accepted or denied, it must notify the first party claimant within fifteen working days after receipt of the proofs of loss giving the reasons more time is needed. If after that time the investigation remains incomplete, the insurer must notify the first party claimant in writing stating the reason or reasons additional time is needed for investigation. This notification must be sent within forty-five days after the date of the initial notification and, if needed, additional notice must be provided every thirty days after that date explaining why the claim remains unresolved.

(4) Insurers must not fail to settle first party claims on the basis that responsibility for payment should be assumed by others except as may otherwise be provided by policy provisions.

(5) Insurers must not continue negotiations for settlement of a claim directly with a claimant who is neither an attorney nor represented by an attorney until the claimant's rights may be affected by a statute of limitations or a policy or contract time limit, without giving the claimant written notice that the time limit may be expiring and may affect the claimant's rights. This notice must be given to first party claimants thirty days and to third party claimants sixty days before the date on which any time limit may expire.

(6) The insurer must not make statements which indicate that the rights of a third party claimant may be impaired if a form or release is not completed within a specified period of time unless the statement is given for the purpose of notifying the third party claimant of the provision of a statute of limitations.

(7) Insurers are responsible for the accuracy of evaluations to determine actual cash value.

A violation of any of the following is hereby defined as an unfair method of competition and an unfair or deceptive act or practice of the insurer in the business of insurance, specifically applicable to the settlement of claims:

(1) Within 30 calendar days after receipt by the insurer of a notification of claim, the insurer must notify the first party claimant whether the claim has been accepted or denied. This timeline does not apply to medical professional liability claims. The insurer must not deny a claim on the grounds of a specific policy provision, condition, or exclusion unless reference to the specific provision, condition, or exclusion is included in the denial. The denial must be given to the claimant in writing and the claim file of the insurer must contain a copy of the denial.

(2) If a claim is denied for reasons other than those described in subsection (1) of this section and is made by any other means than in writing, an appropriate notation must be made in the claim file of the insurer describing how, when, and to whom the notice was made.

(3) If the insurer needs more time to determine whether a first party claim should be accepted or denied, it must notify the first party claimant within 30 calendar days after a notification of claim and give all of the reasons more time is needed. If after that time the investigation remains incomplete, the insurer must notify the first party claimant in writing stating all of the reasons additional time is needed for investigation. If needed, additional notice must be provided every 30 calendar days after that date explaining why the claim remains unresolved. This subsection does not apply to medical professional liability claims.

(4) Insurers must not fail to settle first party claims on the basis that responsibility for payment should be assumed by others except as may otherwise be provided by policy provisions.

(5) Insurers must not continue negotiations for settlement of a claim directly with a claimant who is neither an attorney nor represented by an attorney until the claimant's rights may be affected by a statute of limitations or a policy or contract time limit, without giving the claimant written notice that the time limit may be expiring and may affect the claimant's rights. This notice must be given to first party claimants 30 calendar days and to third-party claimants 60 calendar days before the date on which any time limit may expire.

(6) The insurer must not make statements which indicate that the rights of a third-party claimant may be impaired if a form or release is not completed within a specified period of time unless the statement is given for the purpose of notifying the third-party claimant of the provision of a statute of limitations.

(7) Insurers are responsible for the accuracy of their evaluations including, but not limited to, evaluations made on their behalf, to determine the amounts owed under the applicable insurance policy.

(8) If an insurer uses a database, survey, estimating software, or benchmarks to account for either material pricing, labor rate, or both, and upon request of the claimant, the insurer must provide the claimant with the date the data was collected, where the data was collected from, and which businesses provided the cost data to the database, survey, estimating software, or benchmarks.