OAR 836-080-0235
Standards for Prompt and Fair Settlements — Generally


(1)

An insurer shall, not later than the 30th day after its receipt of properly executed proofs of loss from a first party claimant, advise the claimant of the acceptance or denial of the claim. An insurer shall not deny a claim on the grounds of a specific policy provision, condition or exclusion unless the denial includes reference to the provision, condition or exclusion. A claim denial must be in writing, with either a copy or the capability of reproducing its text included in the insurer’s claim file.

(2)

If a claim is made on a health insurance policy and the claim involves a coordination of benefits issue to which OAR 836-020-0700 to 836-020-0765 apply, the time allowed in 836-020-0740 to an insurer for applying a coordination of benefit provision shall be added to the time period provided in section (1) of this rule.

(3)

If a claim is denied for reasons other than those described in section (1) of this rule and is made by any other means than in writing, an appropriate notation shall be made in the insurer’s claim file.

(4)

If an insurer needs more time to determine whether the claim of a first party claimant should be accepted or denied, it shall so notify the claimant not later than the 30th day after receipt of the proofs of loss, giving the reason more time is needed. Forty-five days from the date of such initial notification and every 45 days thereafter while the investigation remains incomplete, the insurer shall notify the claimant in writing of the reason additional time is needed for investigation.

(5)

An insurer shall not fail to settle claims of first party claimants on the grounds that responsibility for payment should be assumed by others, except as may be provided otherwise by the provisions of the insurance policy issued by the insurer.

(6)

If an insurer continues 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 policy time limit, the insurer shall give the claimant written notice that the time limit may be expiring and may affect the claimant’s rights. The notice shall be given to first party claimants not less than 30 days before, and to third party claimants not less than 60 days before, the date on which the insurer believes the time limit may expire.

(7)

An insurer shall not make a statement that indicates that the rights of a third party claimant may be impaired if a form or release is not completed within a given period of time, unless the statement is given for the purpose of notifying the third party claimant of the provision of a relevant statute of limitations.

(8)

Notwithstanding section (4) of this rule, for title insurance:

(a)

The requirements in section (4) of this rule are suspended from the date the insurer arranges or agrees to legal representation of the insured, for the term of that representation, with respect to:

(A)

A matter for which the insurer accepts a tender of defense; or

(B)

A matter for which the insurer prosecutes an action or proceeding or does, or causes to be done, any other act to establish the title as insured or to prevent or reduce loss or damage to the insured.

(b)

When an insurer initially notifies the claimant that more time is needed, the insurer:

(A)

May specify a date later than 45 days but not later than 90 days for the next and any successive notification; and

(B)

Shall notify the claimant in writing by the date specified whether additional time is needed and give the reason additional time is needed.

Source: Rule 836-080-0235 — Standards for Prompt and Fair Settlements — Generally, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=836-080-0235.

836–080–0001
Statutory Authority
836–080–0005
Definitions
836–080–0014
Duties of Agent
836–080–0022
Duties of Insurers that Use Agents Insurance Producers
836–080–0029
Duties of Replacing Insurers that Use Agents
836–080–0034
Duties of the Existing Insurer
836–080–0039
Duties of Insurers with Respect to Direct Response Solicitations
836–080–0043
Violations and Penalties
836–080–0050
Authority
836–080–0055
Unfair Discrimination Identified
836–080–0080
Definition, Claims Handling Services
836–080–0085
Annual Report
836–080–0090
Suitability in the Sale of Life Insurance
836–080–0105
Statutory Authority
836–080–0110
Applicability
836–080–0115
Definitions
836–080–0120
Statement as to Participation Required Upon Request Before Delivery of Policy
836–080–0125
Prohibited Representations Regarding Participation Rights
836–080–0130
Dividend Statement Permitted
836–080–0135
Dividend Rights Accrue Upon Declaration of Dividends
836–080–0140
Unfair Discrimination in Allocation of Dividends Prohibited
836–080–0145
Unfair Forfeiture of Dividend for Failure to Renew Prohibited
836–080–0150
Policyholder Dividend Rights of Group Members and Dividend Group Policyholders
836–080–0155
False or Deceptive Publications by Insurer Prohibited
836–080–0160
Use of Special Certifications and Professional Designations by Insurance Producers
836–080–0165
Notice of Insurance Division Assistance
836–080–0170
Statutory Authority
836–080–0172
Applicability
836–080–0175
Exemptions
836–080–0178
Definitions
836–080–0180
Duties of Insurers and of Insurance Producers
836–080–0183
Insurance Producer Training
836–080–0185
Compliance Mitigation
836–080–0188
Recordkeeping
836–080–0190
Annuity Sales
836–080–0193
Effective Date and Operative Date
836–080–0200
Electronic Payment of Claims
836–080–0205
Statutory Authority, Purpose, and Applicability
836–080–0210
Definitions
836–080–0215
Claim Files
836–080–0220
Misrepresentation and Other Prohibited Claim Practices
836–080–0225
Required Claim Communication Practices
836–080–0230
Standard for Prompt Claim Investigation
836–080–0235
Standards for Prompt and Fair Settlements — Generally
836–080–0240
Standards for Prompt and Fair Total Loss Settlements — Automobile Insurance
836–080–0250
Workers’ Compensation Insurance Unfair Claim Settlement Practices Standards
836–080–0305
Statutory Authority
836–080–0310
Definitions
836–080–0315
Providing Things of Value to Intermediaries Generally Prohibited
836–080–0320
Miscellaneous Things of Value
836–080–0325
Business Development Activities
836–080–0335
Gifts
836–080–0337
Real Property Information
836–080–0340
Assistance in Qualifying a Subdivision
836–080–0345
Automatic Change in Monetary Limits
836–080–0355
Title Insurer Responsible for Violations by Agent
836–080–0360
Use by Title Company of an Intermediary’s Office
836–080–0365
Filing Escrow Rates Required
836–080–0370
Instruction of Title Company Employees About Rules Required
836–080–0425
Applicability
836–080–0430
Disclosure of Use of Credit History or Insurance Scores
836–080–0435
Policies Governing Credit Histories and Insurance Scores
836–080–0436
Absence of or Inability to Determine Credit History
836–080–0438
Definition of Adverse Underwriting Decision
836–080–0440
Unfair Insurance Trade Practice
836–080–0501
Authority
836–080–0506
Definitions and Examples
836–080–0511
Application of Notice Requirements
836–080–0516
Initial Notice to Consumers
836–080–0519
Information to be Included in Initial Privacy Notice
836–080–0523
Annual Notice
836–080–0526
Information to be Included in Annual Notice
836–080–0531
Revised Privacy Notices
836–080–0536
Delivery
836–080–0541
Opt in Notice
836–080–0546
Limits on Sharing Account Number Information for Marketing Purposes
836–080–0551
Authorization Request Delivery
836–080–0600
Authority
836–080–0610
Definitions and Examples
836–080–0615
Personal Information Notice
836–080–0620
Notice of Personal Financial Information Practices
836–080–0625
Alternative Procedures
836–080–0630
Application of Notice Requirements
836–080–0635
Initial Notice to Consumers
836–080–0640
Information to Be Included in Initial Privacy Notice
836–080–0645
Annual Notice
836–080–0650
Information to Be Included in Annual Notice
836–080–0655
Revised Privacy Notices
836–080–0660
Delivery
836–080–0665
Authorization
836–080–0670
Authorization Exemptions
836–080–0675
Disclosure Without Authorization
836–080–0680
Opt in Notice
836–080–0685
Limits on Sharing Account Number Information for Marketing Purposes
836–080–0690
Authorization Request Delivery
836–080–0695
Access to Recorded Personal Information
836–080–0700
Correction, Amendment or Deletion of Recorded Personal Information
836–080–0750
Purpose
836–080–0755
Application of OAR 836-080-0750 to 836-080-0775
836–080–0760
Definitions for OAR 836-080-0750 to 836-080-0775
836–080–0765
Practices Declared False, Misleading, Deceptive or Unfair on a Military Installation
836–080–0770
Practices Declared False, Misleading, Deceptive or Unfair, Regardless of Location
836–080–0775
Severability
836–080–0800
Definitions
836–080–0805
Statutory Authority, Purpose, and Applicability
836–080–0810
Provision of Commercial Loss Runs
Last Updated

Jun. 8, 2021

Rule 836-080-0235’s source at or​.us