Rules for Appropriate Insurance Company Conduct
Insurance companies MUST follow the following rules:
- PROMPTLY accept a claim when the need is reasonably clear.
- Acknowledge receipt of a claim, begin an investigation, and request all items, including the statements and forms they need. In most circumstances, this must be done within fifteen (15) days.
- Notify you in writing of the acceptance or rejection of the claim within fifteen (15) business days after they receive all information from you. If they feel they cannot comply with this time period, they must notify you why they need additional time and accept or reject the claim within 45 days of their request for more time.
- Pay the claim within five (5) business days of their acceptance of all or part of the claim, in most circumstances.
- Confirm whether the need is clear with a REASONABLE investigation.
- Reasonably clear needs must be covered first, and questioned later, when such questioning is actually necessary. This helps to ensure the best chance for recovery, protection of families, and a prompt return to normal life.
- Honor the provisions of their policy. If they promise to pay replacement value, that is what they must pay.
- Treat their insured as “innocent until proven guilty.” Insurance companies may not act as an adversary or obstacle.
- Hire reasonable, above-board, and unbiased reviewers and investigators to inspect your home and property
- Have a reasonable, good faith basis to deny a claim. They cannot fake or exaggerate reasons for denying claims.
- Take a reasonable “Yes” for an answer. Insurance companies may not search for excuses to deny claims.
Knowing the rules will help you get through the
OBSTACLE COURSE of the insurance claims process.