Administrative Code

Creating a Report: Check the sections you'd like to appear in the report, then use the "Create Report" button at the bottom of the page to generate your report. Once the report is generated you'll then have the option to download it as a pdf, print or email the report.

Virginia Administrative Code
Title 14. Insurance
Agency 5. State Corporation Commission, Bureau of Insurance
Chapter 400. Rules Governing Unfair Claim Settlement Practices
10/24/2020

14VAC5-400-40. Misrepresentation of Policy Provisions.

A. No insurer shall fail to fully disclose to a first party claimant all pertinent benefits, coverages, or other provisions of an insurance policy under which a claim is presented and document the claim file accordingly.

B. No person shall misrepresent benefits, coverages, or other provisions of any insurance policy when such benefits, coverages, or other provisions are pertinent to a claim.

C. No insurer shall deny a claim for failure of a first party claimant to submit to physical examination or for failure of the first party claimant to exhibit property unless there is documentation of breach of the policy provisions in the claim file.

D. No insurer shall deny a claim based on the failure of a claimant to give written notice of loss or give notice of loss within a specified period of time unless either or both requirements are policy conditions. If a policy requires a demonstration of prejudice for a claimant's failure to comply with a notice condition, an insurer shall not be relieved of its obligations under the policy unless the failure to comply with the notice condition prejudices the insurer's rights.

E. No insurer shall request a first party claimant to sign a release that extends beyond the subject matter that gave rise to the claim. An insurer shall not include with any payment or in any accompanying correspondence an indication that payment is "final" or "a release" of any claim unless the policy limit has been paid or a compromise settlement has been agreed to by the first party claimant.

F. No insurer shall issue a payment in partial settlement of a loss or claim for a specific coverage that contains language purporting to release the insurer or its insured from total liability.

Statutory Authority

§§ 12.1-13, 38.2-223, and 38.2-510 of the Code of Virginia.

Historical Notes

Derived from Regulation 12, Case No. 19961, § 5, eff. September 15, 1978; amended, Volume 33, Issue 22, eff. January 1, 2018.

Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation.

As a service to the public, the Virginia Administrative Code is provided online by the Virginia General Assembly. We are unable to answer legal questions or respond to requests for legal advice, including application of law to specific fact. To understand and protect your legal rights, you should consult an attorney.