Essential Protections in the Claims Process

 

The protection and security that an insurance policy provides must be guaranteed by a fair and efficient claims process. The Essential Protections require insurance companies to provide information to insureds about the claims process and to implement reasonable standards for processing, investigating, evaluating, and paying claims.

 

Insurance companies must provide policyholders with essential information about the claims process

  • After a claim has been initiated, insurance companies must provide policyholders with information about the claim process and policyholder rights and, upon request, with a copy of the claim file.

Insurance companies must observe reasonable time limits in the claims process.

  • Policyholders should have reasonable time limits for filing claims and, in case of a dispute, for filing litigation against the insurance company.

Insurance companies must observe reasonable standards in the claim process.

  • Insurance companies must promptly, fairly, and objectively process, investigate, evaluate, and resolve claims.
  • Insurance companies must observe reasonable standards for determining the amount of loss.
  • Policyholders should have access to efficient, effective means of dispute resolution.
  • Insurance companies must not unreasonably pressure policyholders to settle claims.

Policyholders must have effective remedies if insurance companies act unreasonably.

  • If an insurance company acts unreasonably, a policyholder should be able to sue and recover damages, including attorneys’ fees, that are adequate to fully compensate for its loss and to deter wrongful behavior by insurance companies.

​Read more about the Claims Process