Right to Good Faith and Ethical
Claims Handling
Consumers have the right to be
treated fairly and honestly when they make a claim. Florida’s Unfair Insurance
Trade Practices Act defines and prohibits Unfair Claim Settlement Practices.
These practices are:
1. Attempting to settle claims on the basis of a document that was
altered without notice to, or knowledge or consent of, the insured;
2. Making a material misrepresentation for the purpose of settling
a claim on less favorable terms than those provided in the policy;
3. Failing to adopt and implement standards for the proper
investigation of claims;
4. Misrepresenting pertinent facts or insurance policy provisions
relating to coverages at issue;
5. Failing to acknowledge and act promptly upon communications with
respect to claims;
6. Denying claims without conducting reasonable investigations
based upon available information;
7. Failing to affirm or deny coverage of claims, the dollar amount
or extent of coverage, or to provide a written statement that the claim is
being investigated, upon the written request of the insured within 30 days
after proof-of-loss statements have been completed;
8. Failing to promptly provide a reasonable explanation in writing
to the insured of the basis for denial of a claim or for the offer of a
compromise settlement;
9. Failing to promptly notify the insured of any additional
information necessary for the processing of a claim;
10. Failing to clearly explain the nature of the requested
information and the reasons why such information is necessary; and
11. Failing to pay undisputed amounts
owed to the insured within 90 days after an insurer receives notice of a
residential property insurance claim and determine the amount owed for a
covered loss. [Note: there are
some exceptions for situations in which it would be impossible for some reason
for the company to pay on time].
Reference: Section 626.9541(1)(i), Florida Statues [Note:
the provisions set forth above may not track the statutory language word for
word. Some changes have been made for ease of reading and understanding].
