Travel Insurance Claims

Filing a claim on your policy can be a stressful time. Sometimes you might feel it’s you against the big, bad insurance company. You wonder if there is anyone on your side. The answer is yes, not only do you have as your advocate but you’re also protected by your state’s laws that prohibit discriminatory, unfair, or deceptive insurance practices. These laws are based on models that are designed by the National Association of Insurance Commissioners (NAIC) and even though some states will tweak them they are very similar in content.

Here is what Connecticut says:

(6) Unfair claim settlement practices. Committing or performing with such frequency as to indicate a general business practice any of the following:
(a) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue;
(b) failing to acknowledge and act with reasonable promptness upon communications with respect to claims arising under insurance policies;
(c) failing to adopt and implement reasonable standards for the prompt investigation of claims arising under insurance policies;
(d) refusing to pay claims without conducting a reasonable investigation based upon all available information;
(e) failing to affirm or deny coverage of claims within a reasonable time after proof of loss statements have been completed;
(f) not attempting in good faith to effectuate prompt, fair and equitable settlements of claims in which liability has become reasonably clear;
(g) compelling insureds to institute litigation to recover amounts due under an insurance policy by offering substantially less than the amounts ultimately recovered in actions brought by such insureds;
(h) attempting to settle a claim for less than the amount to which a reasonable man would have believed he was entitled by reference to written or printed advertising material accompanying or made part of an application;
(i) attempting to settle claims on the basis of an application which was altered without notice to, or knowledge or consent of the insured;
(j) making claims payments to insureds or beneficiaries not accompanied by statements setting forth the coverage under which the payments are being made;
(k) making known to insureds or claimants a policy of appealing from arbitration awards in favor of insureds or claimants for the purpose of compelling them to accept settlements or compromises less than the amount awarded in arbitration;
(l) delaying the investigation or payment of claims by requiring an insured, claimant, or the physician of either to submit a preliminary claim report and then requiring the subsequent submission of formal proof of loss forms, both of which submissions contain substantially the same information;
(m) failing to promptly settle claims, where liability has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage;
(n) failing to promptly provide a reasonable explanation of the basis in the insurance policy in relation to the facts or applicable law for denial of a claim or for the offer of a compromise settlement;
(o) using as a basis for cash settlement with a first party automobile insurance claimant an amount which is less than the amount which the insurer would pay if repairs were made unless such amount is agreed to by the insured or provided for by the insurance policy.

Your policy also outlines obligations that you and the insurance company must follow. These provisions are in the “general conditions” section of you policy and usually outline:

  • Notice of Claim: specifies the amount of time that you have to notify the insurance company of your claim. Usually this requires that you notify the insurance company within a reasonable time from when the loss is incurred.
  • Proof of Loss: this section deals with the amount of time that you have to file the claim forms and other proofs of loss once you have notified the insurance company of your claim. Usually the time period is 90 days however, if it not reasonably possible for you to file the forms and other proofs within that time period than it does not invalidate your claim.
  • When Paid: this provision requires the insurance company to pay the claim when you’ve provided all of the required information. The key here is to follow their instruction completely and provide them with all of the information that they’ve asked for. I my experience the one greatest item that delays insurance companies from paying claims is incomplete information.

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