Bill Text: OR SB514 | 2013 | Regular Session | Introduced
Bill Title: Relating to private actions to redress unfair claim settlement practices; declaring an emergency.
Spectrum: Committee Bill
Status: (Failed) 2013-07-08 - In committee upon adjournment. [SB514 Detail]
Download: Oregon-2013-SB514-Introduced.html
77th OREGON LEGISLATIVE ASSEMBLY--2013 Regular Session
NOTE: Matter within { + braces and plus signs + } in an
amended section is new. Matter within { - braces and minus
signs - } is existing law to be omitted. New sections are within
{ + braces and plus signs + } .
LC 808
Senate Bill 514
Sponsored by COMMITTEE ON GENERAL GOVERNMENT, CONSUMER AND SMALL
BUSINESS PROTECTION
SUMMARY
The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure as
introduced.
Establishes private right of action for insurer's or another
person's alleged unfair claim settlement practice. Establishes
conditions under which aggrieved person may bring action.
Declares emergency, effective on passage.
A BILL FOR AN ACT
Relating to private actions to redress unfair claim settlement
practices; creating new provisions; amending ORS 746.230; and
declaring an emergency.
Be It Enacted by the People of the State of Oregon:
SECTION 1. ORS 746.230 is amended to read:
746.230. (1) { - No - } { + An + } insurer or
{ - other - } { + another + } person
{ - shall - } { + may not + } commit or perform any of the
following unfair claim settlement practices:
(a) Misrepresenting facts or policy provisions in settling
claims;
(b) Failing to acknowledge and act promptly upon communications
relating to claims;
(c) Failing to adopt and implement reasonable standards for
{ - the prompt investigation of - } { + promptly
investigating + } claims;
(d) Refusing to pay claims without conducting a reasonable
investigation based on all available information;
(e) Failing to affirm or deny coverage of claims within a
reasonable time after { + receiving + } completed proof of loss
statements
{ - have been submitted - } ;
(f) Not attempting, in good faith, to promptly and equitably
settle claims in which liability has become reasonably clear;
(g) Compelling claimants to initiate litigation to recover
amounts due by offering substantially less than amounts
ultimately recovered in actions { - brought by such - } { +
the + } claimants { + bring + };
(h) Attempting to settle claims for less than the amount to
which a reasonable person would believe a reasonable person was
entitled after referring to written or printed advertising
material accompanying or made part of an application;
(i) Attempting to settle claims on the basis of an application
altered without notice to or consent of the applicant;
(j) Failing, after { - payment of - } { + paying + } a
claim, to { - inform - } { + respond to requests by + }
insureds or beneficiaries { - , upon request by them, of - }
{ + with information about + } the coverage under which { +
the insurer or the other person made the + } payment { - has
been made - } ;
(k) Delaying investigation or payment of claims by requiring a
claimant or the physician of the claimant to submit a preliminary
claim report and then requiring { - subsequent submission
of - } { + the claimant or the physician to submit + } loss
forms when both { + the report and the loss forms + } require
essentially the same information;
(L) Failing to promptly settle claims under one coverage of a
policy where liability has become reasonably clear in order to
influence settlements under other coverages of the policy; or
(m) Failing to promptly provide the proper explanation of the
basis { + the insurer or other person + } relied on in the
insurance policy in relation to the facts or applicable law
{ - for the denial of - } { + to deny + } a claim.
{ + (2)(a) A person that suffers an ascertainable loss of
money or property, real or personal, as a result of an insurer's
or another person's act or omission that violates subsection (1)
of this section may bring an individual action in an appropriate
court to recover actual damages or statutory damages of $200,
whichever is greater. The court or the jury may award punitive
damages and the court may provide equitable relief that the court
considers necessary and proper.
(b) A person must bring an action under this subsection within
two years after discovering the unlawful act or omission.
(c) A person may maintain an action under this subsection as a
class action. In a class action under this subsection:
(A) Plaintiffs in the action may recover statutory damages on
behalf of class members only if the plaintiffs establish that the
class members have suffered an ascertainable loss of money or
property, real or personal, as a result of an act or omission of
the defendants that violated subsection (1) of this section;
(B) The trier of fact may award punitive damages; and
(C) The court may award equitable relief.
(d) The court may award reasonable attorney fees and costs at
trial and on appeal to a prevailing plaintiff in an action under
this subsection. The court may award reasonable attorney fees and
costs at trial and on appeal to a prevailing defendant only if
the court finds that an objectively reasonable basis for bringing
the action or asserting the ground for appeal did not exist. The
court may not award attorney fees to a prevailing defendant under
the provisions of this paragraph if the plaintiff maintains the
action under this paragraph as a class action in accordance with
ORCP 32. + }
{ - (2) - } { + (3)(a) + } { - No - } { + An + }
insurer { - shall - } { + may not + } refuse, without just
cause, to pay or settle claims { - arising - } { + that
arise + } under coverages provided by { - its - } { + the
insurer's + } policies with such frequency as to indicate a
general business practice in this state, which general business
practice is evidenced by:
{ - (a) - } { + (A) + } A substantial increase in the
number of complaints
{ - against the insurer received by - } the Department of
Consumer and Business Services { + receives against the
insurer + };
{ - (b) - } { + (B) + } A substantial increase in the
number of lawsuits
{ - filed - } { + claimants file + } against the insurer or
{ - its - } { + the insurer's + } insureds { - by
claimants - } ; or
{ - (c) - } { + (C) + } Other relevant evidence.
{ + (b) Evidence of practices described in paragraph (a) of
this subsection may be admitted, in accordance with applicable
rules of evidence, in an action that a person brings under
subsection (2) of this section. + }
{ - (3)(a) - } { + (4)(a) + } { - No - } { + A + }
health maintenance organization, as defined in ORS 750.005,
{ - shall - } { + may not + } unreasonably withhold
{ - the - } granting { - of - } participating provider
status { - from - } { + to + } a class of statutorily
authorized health care providers for services { + the health
care providers + } rendered within the lawful scope of practice
if the health care providers are licensed as { - such - }
{ + health care providers + } and reimbursement is for services
mandated by statute.
(b) Any health maintenance organization that fails to comply
with paragraph (a) of this subsection { - shall be - } { +
is + } subject to discipline under ORS 746.015.
(c) This subsection does not apply to group practice health
maintenance organizations that are federally qualified
{ - pursuant to - } { + under + } Title XIII of the Health
Maintenance Organization Act.
SECTION 2. { + The amendments to ORS 746.230 by section 1 of
this 2013 Act apply to unfair claim settlement practices that an
insurer or other person allegedly commits on or after the
effective date of this 2013 Act. + }
SECTION 3. { + This 2013 Act being necessary for the immediate
preservation of the public peace, health and safety, an emergency
is declared to exist, and this 2013 Act takes effect on its
passage. + }
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