No plan shall be approved unless it contains each of the
following provisions:
(1)
Payment to the claimant: The insurer shall offer to
pay every claimant for the loss of or damage to the insured motor vehicle under
collision coverage, limited collision coverage or comprehensive coverage the
full amount, less any applicable deductible, of the cost of repair of the
damage as described in an appraisal made by a licensed automobile damage
appraiser employed or designated by the insurer, subject to the terms and
conditions of the applicable insurance policy. In the case of property damage
liability claims, the insurer may make such offer to the person to whom such
liability payments are owed.
Unless such direct payment is refused by the claimant, the
insurer shall make such payment at the time of, or within five business days
after, the preparation of said appraisal. In no event shall payment be made
prior to provision of a copy of the appraisal to the claimant. Nothing in 108
CMR 123.05 be construed to affect the right of any insurer to delay payment for
a period of time reasonably necessary to investigate any claim before
authorizing repair work or making payment on such claim.
If the claimant refuses such direct payment, the insurer shall
comply with applicable laws and regulations relating to such payments without
regard to the plan.
(2)
Form of Payment: The payments described in 211 CMR
123.05(1) shall be in cash or a negotiable instrument payable to the claimant,
and the lienholder, if applicable.
(3)
Repair
certification: Each claimant shall receive, with the appraisal and
direct payment check, a repair certification form, the form for which shall be
included as part of the filed plan. The repair certification form shall at a
minimum contain the following:
(a) An
explanation of the claimant's rights and obligations with respect
thereto.
(b) Certification that the
repair work has been completed.
(c)
Identification of the repair shop or individual who performed the repair
work.
(d) An agreement that the
claimant will permit the insurer to reinspect the repaired vehicle within a
reasonable period of time after the return of the repair certification form.
The claimant shall return the repair certification form to the
insurer upon completion of the repairs. If the claimant elects not to repair
the vehicle or if the repair certification form is not returned to the insurer,
the actual cash value of the insured vehicle will be reduced by the amount of
the claim payment plus any applicable deductible, unless and until such time as
the insurer or any successor insurer receives a repair certification
form.
(4)
Resolution of Consumer Disputes: If the claimant
disputes the accuracy of the appraisal or the amount of the payment based
thereon, the insurer shall resolve such dispute as follows:
(a) The claimant, or the claimant's
representative or repair shop at the direction of the claimant, must notify the
insurer by telephone or in writing if the cost of repairs is expected to exceed
the amount of the payment plus any applicable deductible and the claimant is
seeking to have the insurer pay any part of the difference. Such notice must be
prior to, or in the course of, the repair work.
(b) The insurer shall promptly evaluate the
source of any differences between the insurer's appraisal and the cost of
repairs and either authorize or deny a supplemental payment within three
business days after the notification of such difference and inspection of the
vehicle. During such three-day period, the insurer may inspect the vehicle, and
if it so requests, the claimant or repair shop shall make the vehicle available
for inspection by the insurer. The insurer shall not delay such inspection for
more than three days without the consent of the claimant. If the insurer makes
a timely request for inspection the insurer will either authorize or deny a
supplemental payment within three business days after the inspection. The
claimant may direct the insurer to make any supplemental payment to the repair
shop, provided the repair shop is registered under M. G.L. c. 100A. Otherwise,
any supplemental payment must be made directly to the claimant.
(c) If the claimant and the insurer are
unable to reach agreement as to any dispute a s to the amount of the payment by
the insurer, either party may demand arbitration of the dispute. The demand for
arbitration must be in writing and it must include an appraisal of the cost of
the repair prepared by a licensed automobile damage appraiser and an itemized
bill for the actual cost of the repair, if the repair has been completed. The
arbitration will be conducted pursuant to General Provision Section 11 of the
Massachusetts Standard Automobile Insurance Policy and the applicable
provisions of M.G.L. c. 175, § 191A. Notwithstanding this provision, the
claimant may, without prejudice, pursue any other remedy which may be
available.
(d) If the repair is
made at a registered repair shop which is an insurer referral shop as provided
in
211 CMR
123.06, neither the repair shop nor the
insurer shall require the claimant to pay more than the amount of the direct
payment plus the amount of any applicable deductible to have the repair work
completed, and any dispute as to the amount of the appraised damage shall be
resolved between the referral repair shop and the insurer.
(5)
Repair Shop
Referral: The plan must provide for referral insurer referral
repair shops as provided in
211 CMR
123.06.
(6)
Disclosures to
Consumers: The plan must provide for full and accurate disclosures
to consumers as provided in
211 CMR
123.07.
