ch 5 claims filing

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  1. Duties of the Insured
    Insured is required by the policy provisions to report a claim to the company as soon as practical. Insured reports claim to agent who provides forms and assists with completion. Insured must also preserve undamaged property to avoid additional losses
  2. Proof of loss
    Formal statement that gives the company sufficient information converning the loss to enable it to determine its liability under the policy
  3. Special Requirements/Productions of Books & Records/ Abandonment
    Insured must cooperate with the insurance company by offerign testimony or other evidence including the production of books and records. Damaged property must be separated from undamaged property and the insured cannot abandon the property to the insurance company
  4. Duties of the Insurer
    Insurer is responsible for providing a thorough investigation of the claim and to keep adequate documentation of the investigation
  5. Claims Investigation
    State law requires the claim be handled promptly.
  6. Claim File Documentation of Events
    Records must be kept in such a form to present to an insurance examiner should the occasion arise. Include all notes and paperwork pertaining to the claim in detail
  7. Acknowledgement of Notices of Claim
    Insurers will provide acknowledgement within a specified time period of the receipt of a claim
  8. Answer of inquiries from insurance department
    When an insurer receives a claim inquiry, they will provide a response to the inquiry within a specified # of days
  9. Replies to other pertinent communications
    Insurer will reply within a certain # of days to all other pertinent communications from a claimant that reasonably suggest that a response is expected
  10. Provisions of assistance to first party claimants
    Insurers will promptly provide necessary forms, instructions and assistance so claimants can comply with policy conditions
  11. Investigation of claims
    Insurer shall establish procedures to commence an investigation of any claim and provide notification to claimants and representatives
  12. Offers of settlement
    If coverage or liability is undisputed, insurer must offer amounts that are fair and reasonable as shown by its investigation of the claim
  13. Denial of claims
    No insurer shall deny a claim unless reference to such provision, condition or exclusion is included in the denial. Must be in writing
  14. Records of all claims that have been denied
    Denial of a claim is made in writing or appropriate notation
  15. Notice of necessary delay in investigating claims
    Insurer will notify claimant in writing if more time is needed for a claim investigation
  16. Liability of other
    Insurer will not fail to settle claims on the basis that responsibility for payment should be assumed by others
  17. Denial of claims for failure to exhibit property
    No insurer shall deny a claim for failure to exhibit the insured property without proof of demand and refusal
  18. Separation of claims
    Payments will be made without prejudice to either party if there is no dispute as to one or more elements of a claim
  19. Time for payment of claims
    Insurer shall pay any amount agreed upon in settlement promptly
  20. Notice of applicable time limitations
    No representative of the insurer shall negotiate for settlement with a claimant without written notice that their rights may be affected
  21. Avoidance of payment
    No person shall recommend that third party claimants make claim under their own policies solely to avoid paying claims under an insurer's insurance policy
  22. Unreasonable travel
    No personal shall require a claimant to travel unreasonably.
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ch 5 claims filing
Chapter 5 - The Claims Filing Process
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