• An insurer or agent may not fail to fully disclose to first party claimants,
pertinent benefits, coverage’s or other provisions of an insurance policy or
insurance contract under which a claim is
presented.
• An insurer may not deny a claim for failure of the insured to exhibit the damage
property without showing proof of the demand and the refusal by the insured to
comply with a said demand.
• An insurer may not, except where there is a time limit specified in the policy,
make statements, written or otherwise requiring a claimant to give written notice
of loss or proof of loss within a specified time limit and which seeks to relieve
the company of its obligations if a time limit is not complied with unless the
failure to comply with the time limit prejudices the right of the insurer.
• Every time insurer, upon receiving notification of a claim, shall within 10
working days, acknowledge the receipt of the notice unless payment is made
within that period of time.
• Every time insurer, upon receipt of an inquiry from the Insurance Department,
with respect to a claim, shall, within 15 working days of receipt of the inquiry,
furnish the Insurance Department with an
adequate response to the inquiry.
• Every insurer, upon receiving notification, shall provide, within 10 working days
necessary claim forms, instructions and reasonable assistance so that the firstparty
claimants can comply with the policy conditions and reasonable
requirements of the insurer.
• Every insurer shall complete investigation of a claim within 30 days after
notification of a claim, unless the investigation cannot be reasonably completed
within that time. if the investigation cannot be completed within 30 days, and 45
days thereafter, the insurer shall provide the claimant with a reasonable written
explanation for the delay and state when a decision of the claim may be
expected.
• Within 15 working days after receipt by the insurer of a properly executed proof
of loss, the first-party claimant shall be advised of the acceptance or denial of the
claim by the insurer. An insurer may not deny a claim on the grounds of a
specific policy provisions, conditions or exclusions unless reference to the
provisions, conditions or exclusions are included in the denial letter.
• Insurers may not fail to settle first-party claims on the basis that responsibility for
payment should be assumed by others except as may otherwise be provided by
policy provisions.
• Insurers may not continue negotiations for settlement of a claim directly with a
claimant who is neither an attorney nor represented by an attorney until the rights
of a claimant that may be affected by a statue of limitations or contract time limit,
without written notice that the time limit may be expiring and may affect the
rights of the claimant. The notice shall be given to the first-party claimant 30
days before the date the time expires.
