An insured reports a comprehensive auto claim after their parked vehicle is heavily vandalized. The insurer acknowledges the claim promptly, and the insured submits a fully completed, signed proof of loss form along with repair estimates on April 10th. As of June 25th, the insurer has not contacted the insured, has not requested any additional information, and has not indicated whether the claim will be approved or denied.
Under standard state insurance regulations, which specific Unfair Claims Settlement Practice has the insurer committed?
- AFailing to acknowledge and act reasonably promptly upon communications with respect to claims.
- BRefusing to pay claims without conducting a reasonable investigation based upon all available information.
- Failing to affirm or deny coverage of claims within a reasonable time after proof of loss statements have been completed.Cevap
- DFailing to promptly provide a reasonable explanation of the basis in the insurance policy for denial of a claim.
Cevap
Failing to affirm or deny coverage of claims within a reasonable time after proof of loss statements have been completed.
The correct answer accurately identifies that the insurer violated the requirement to affirm or deny coverage within a reasonable time after receiving a completed proof of loss. While state timeframes vary, a delay of over two months with no communication or request for additional time is universally considered an unreasonable delay under Unfair Claims Settlement Practices regulations.
Adım Adım Çözüm
Anahtar Kavram
Unfair Claims Settlement Practices - Affirming or Denying Coverage