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State law provides different rights to people making claims against insurance companies – either your own or the negligent party that injured you. These laws create duties for the insurer and govern how the insurer makes a decision about whether or not to settle a claim. Because these laws are from each state’s department of insurance, they can vary a bit from state to state. In Illinois, insurance providers have the following statutory duties:

  • Within 21 days of notification of loss, make a bona fide effort to communicate with all insureds and claimants where liability is reasonably clear and maintain evidence of effort to communicate in the claim file. Admin. Code tit. 50, § 919.40; see also 215 Ill. Comp. Stat. 5/154.6(c)
  • Within 15 days from receipt of communication, acknowledge pertinent communications from a claimant or insured with respect to claims arising under the policy. Admin. Code tit. 50, § 919.40(c); see also 215 Ill. Comp. Stat. 5/154.6(b)
  • Within 15 days of a request, provide forms necessary to present claims with explanation of effective use of forms. 215 Ill. Comp. Stat. 5/154.6(o)
  • Within a reasonable time, affirm or deny liability on claims. Admin. Code tit. 50, § 919.50(a); see also 215 Ill. Comp. Stat. 5/154.6(i).
  • Promptly, on the case of the denial of a claim or the offer of a compromise settlement, provide a reasonable and accurate explanation of the basis in the insurance policy or applicable law for such denial or compromise settlement. 215 Ill. Comp. Stat. 5/154.6(n).
  • Within 30 days after affirmation of liability, offer payment on claims if the amount of the claim is determined and not in dispute. Admin. Code tit. 50, § 919.50(a).
  • Within 30 days after affirmation of liability, tender payment for portions of the claim which are not in dispute and for which the payee is known. Admin. Code tit. 50, § 919.50(a).
  • Within 30 days after investigation and determination of liability is completed, on first party claims if a settlement of a claim is less than the amount claimed, or if the claim is denied, provide a reasonable written explanation of the basis of the lower offer or denial. Include the police definition, limitation, exclusion or condition upon which denial was based, and a Notice of Availability of the Department of Insurance. Admin. Code tit. 50, § 919.50(a)(1).
  • Within 30 days, if the claim is denied, provide the third party a reasonable written explanation of the basis of the denial. Admin. Code tit. 40, §919.50(a)(1).
  • Within 30 days, report vexatious or unreasonable delay findings by a court of law to the director of the Illinois Department of Insurance and enclose copy of findings and penalties, if any. Admin. Code tit. 50, § 919.80(a); see also 215 Ill. Comp. Stat. 5/155.
  • Within 40 days, for automobile collision claims, make final payment or render the repaired automobile to the insured or third party claimant. Admin. Code tit. 50, § 919.80(b)(1), (2).
  • If a first party physical damage automobile claim remains unresolved for more than 40 calendar days from the date the claim is reported, provide a reasonable written explanation for the delay to the insured and include Notice of Availability of the Department of Insurance. Admin. Code tit. 50, §919.80(b)(2).
  • Within 60 days, for automobile property damage liability claims, make final payment or render the repaired automobile to the insured or third party claimant. Admin. Code tit. 50, § 919.80(b)(1), (3).
  • If an automobile property damage liability claim remains unresolved for more than 60 calendar days from the date the claim is reported, provide a reasonable written explanation for the delay to the third-party claimant and include Notice of Availability of the Department of Insurance. Admin. Code tit. 50, § 919.80(b)(1); see also Ill. Admin. Code tit. 50, § 919.80(d)(7)(A); see also 215 Ill. Comp. Stat 5/143.13.
  • Within 40 days, make final payment on claims on policies of fire and extended coverage insurance. Ill Admin. Code tit. 50, § 919.80(b)(1); see also Ill. Admin. Code tit. 50, § 919.80(d)(7)(A); see also 215 Ill. Comp. Stat 5/143.13.
  • If claim on a policy of fire and extended coverage insurance remains unresolved for more than 75 calendar days from the date it is reported, or 25 calendar days after receipt of proof of loss, whichever is less, provide reasonable written explanation for the delay to the insured and include Notice of Availability of the Department of Insurance. Admin. Code tit. 50, § 919.80(d)(7)(B); see also 215 Ill. Comp. Stat 5/143.13.
  • Upon request, for fire and extended coverage claims, supply copy of written estimate upon which settlement of partial losses is based to insured. Ill Admin. Code tit. 50, § 919.80(d)(7)(C).
  • Promptly, for fire and extended coverage claims, review and respond in writing to insured in regard to a written estimate obtained by insured and provide insured with the name of a repair shop or contractor that will make the repairs. Ill Admin. Code tit. 50, § 919.80(d)(7)(c).

 

Under Missouri law, there are fewer statutory duties for insurance companies. However, those duties that do exist are more strict and usually have shorter time frames. In Missouri, insurance providers have the following statutory duties:

  • Within 10 working days of receiving notification, acknowledge receipt of notification of claim from claimant. Code Regs. Ann. Tit. 20 § 100-1.030(1).
  • Within 15 calendar days of a request, provide forms necessary to present claims with reasonable explanations regarding their use. Code Regs. Ann. Tit. 20, § 100-1.030(3), see also Mo. Rev Stat. § 375.1007(13).
  • Within 10 working days, reply to communication from any claimant which reasonably suggests that a response is expected. Code Regs. Ann. Tit. 20, § 100-1.030(2).
  • Within 15 working days, advise the first-party claimant of the acceptance or denial of the claim. Code Regs. Ann. tit. 20, § 100-1.959(1)(C).
  • Within 45 days from the date of the initial notification and every 45 days after, notify claimant that investigation remains incomplete and state what information remains outstanding. Code Regs. Ann. tit. 20, § 100-1.050(1)(c).
  • Within 30 days before the date on which the time limit may expire, give first party claimant written notice that the statute of limitations may be expiring and may affect claimants rights. Code Regs. Ann. tit. 20, § 100-1.050(1)(c).
  • 60 days before the date on which the time limit may expire, give third party claimant notice that the statute of limitations may expire and may affect claimants rights. Code Regs. Ann. tit. 20, § 100-1.050(1)(E).
  • At the time settlement is entered into, give insured copy of the present value calculation of future benefits when offering cash settlements of first-party long-term disability income claims and have insured sign it. Code Regs. Ann. tit. 20, § 100-1.050(1)(G).

Knowing how these regulations work is a huge asset when negotiating your insurance settlement. Because these rules govern the behavior of the insurance adjuster, they are a good check on the most obvious examples of insurance company misconduct.  Missouri defines improper claims practices at Mo. Rev. Stat. section 375.1007 and Illinois’s statutes are referenced above.

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