ch 5 claims filing

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

Formal statement that gives the company sufficient information converning the loss to enable it to determine its liability under the policy

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

Insurer is responsible for providing a thorough investigation of the claim and to keep adequate documentation of the investigation

State law requires the claim be handled promptly.

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

Insurers will provide acknowledgement within a specified time period of the receipt of a claim

When an insurer receives a claim inquiry, they will provide a response to the inquiry within a specified # of days

Insurer will reply within a certain # of days to all other pertinent communications from a claimant that reasonably suggest that a response is expected

Insurers will promptly provide necessary forms, instructions and assistance so claimants can comply with policy conditions

Insurer shall establish procedures to commence an investigation of any claim and provide notification to claimants and representatives

If coverage or liability is undisputed, insurer must offer amounts that are fair and reasonable as shown by its investigation of the claim

No insurer shall deny a claim unless reference to such provision, condition or exclusion is included in the denial. Must be in writing

Denial of a claim is made in writing or appropriate notation

Insurer will notify claimant in writing if more time is needed for a claim investigation

Insurer will not fail to settle claims on the basis that responsibility for payment should be assumed by others

No insurer shall deny a claim for failure to exhibit the insured property without proof of demand and refusal

Payments will be made without prejudice to either party if there is no dispute as to one or more elements of a claim

Insurer shall pay any amount agreed upon in settlement promptly

No representative of the insurer shall negotiate for settlement with a claimant without written notice that their rights may be affected

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

No personal shall require a claimant to travel unreasonably.