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Life & Health · Chapter 20 · Marketing Practices

Unfair Claim Settlement Practices (Florida)

Definition
Unfair/deceptive when knowingly committed or performed with such frequency as to indicate a general business practice: settling claims based on documents altered without the insured's notice or consent; material misrepresentation made to settle on less favorable terms than the policy provides; failing to adopt claim-investigation standards; misrepresenting pertinent facts or policy provisions; failing to acknowledge communications promptly; denying claims without reasonable investigation; failing — within thirty (30) days of the insured's written request after proof-of-loss statements are complete — to affirm/deny coverage or state in writing that the claim is being investigated; failing to promptly explain a denial in writing; failing to identify needed additional information; failing to pay PIP claims within statutory periods; and failing to pay undisputed residential property benefits within ninety (90) days.
In plain English
The claims-department blacklist: stall, lowball, alter, deny-without-looking — patterns of any of it are illegal.
Exam tip
Watch the qualifier: most items require frequency indicating a general business practice — a single slip usually isn't the violation; the pattern is.
Easy to confuse with

These are what this term gets tested against — if you can't tell them apart cold, drill the contrast.

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Verified against primary sources · 2026-07-27 · see data/fragments/ch2*-terms.part.js headers