South Dakota Codified Laws 58-12-34. Acts constituting unfair claims practices
Any of the following acts by an insurer, if committed in violation of § 58-12-33, is an unfair claims practice:
(1) Knowingly misrepresents to a claimant or an insured a relevant fact or policy provision relating to coverages at issue;
Terms Used In South Dakota Codified Laws 58-12-34
- Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
- Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. Source: U.S. Courts
- Person: includes natural persons, partnerships, associations, cooperative corporations, limited liability companies, and corporations. See South Dakota Codified Laws 2-14-2
- Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
- written: include typewriting and typewritten, printing and printed, except in the case of signatures, and where the words are used by way of contrast to typewriting and printing. See South Dakota Codified Laws 2-14-2
(2) Fails to acknowledge with reasonable promptness pertinent communications with respect to claims arising under its policies;
(3) Fails to adopt and implement reasonable standards to promptly complete claim investigations and settlement of claims arising under its policies;
(4) Fails to make a good faith attempt to effectuate prompt, fair, and equitable settlement of claims submitted in which liability coverage, and causation of claims have become reasonably clear;
(5) Compels an insured or beneficiary to institute a suit to recover an amount due under its policies by offering substantially less than the amount ultimately recovered in a suit brought by the insured or beneficiary;
(6) Refuses to pay claims without conducting a reasonable claim investigation;
(7) Fails to affirm or deny coverage of claims within a reasonable time after having completed a claim investigation related to the claim;
(8) Attempts to settle a claim for less than the amount that a reasonable person would believe the insured or beneficiary is entitled by reference to written or printed advertising material accompanying or made part of an application;
(9) Attempts to settle a claim on the basis of an application that was materially altered without notice to, or knowledge or consent of, the insured;
(10) Makes a claim payment to an insured or beneficiary without indicating the coverage under which each payment is being made;
(11) Unreasonably delays a claim investigation or payment of a claim by requiring both a formal proof of loss form and subsequent verification that would result in duplication of information and verification appearing in the formal proof of loss form;
(12) Fails, in the case of a claim denial or offer of compromise settlement, to promptly provide a reasonable and accurate explanation of the basis for such action; or
(13) Fails to provide forms necessary to present a claim within fifteen days of a request with reasonable explanations regarding their use.
Source: SL 2014, ch 235, § 4.