It has been four long months since Hurricanes Irma and Maria devastated America’s Paradise; yet, many insureds have still not received a single payment (or even a meaningful response) from their insurance company. Regrettably, these are not isolated or one-off situations.
The Virgin Islands Division of Banking, Insurance and Financial Regulation, the agency tasked with the dual function of both insurance regulation and consumer protection, received scores of complaints from policyholders about significant delays in the claim handling process. In some cases, claims were inspected and investigated by an adjuster from the insurance company, but the policyholder have not received a response or any communication from the insurance company explaining the status of the claim or providing any reason for the delay. So much so, the Division determined there was an emergency need to set forth procedures for the expeditious and efficient settlement of hurricane-related first-party residential property damage claims.
Invoking its authority to safeguard and protect insureds in the territory, the Division issued Amended Emergency Order No. 2017-04,1 setting forth the following emergency rules for residential claims:
- Within fifteen (15) business days of receiving a notice of a first-party claim, the insurance company shall acknowledge, either verbally or in writing, receipt of the claim.
- Within thirty (30) calendar days of an on-site inspection of first-party claim and the claimant submittal of required documentation in support of the claim being made, the insurance company shall accept or deny claim.
- If a determination cannot be reached in that thirty (30) days period, an additional fifteen (15) days (which extends the period to forty-five days) may be permitted for the insurance company to accept or deny the claim, if the insurance company provides a reasonable basis supported by specific information to the policyholder and the Division for the extension.
- Where an insurance company has received and accepted the adjuster’s final report or a sworn proof of loss or estimate, thirty (30) days ago or more, the claim must be settled with fifteen (15) days or the insurance company must submit written notice to the policyholder with a copy to Division, as to why a settlement cannot be made in fifteen (15) calendar days.
- If settlement cannot be reached in that fifteen (15) days period, the insurance company, by notifying the policyholder with a copy to the Division, may request additional time to accept or deny the claim. The notification must set out the specific reasons the insurer requires additional time to investigate the claim.
For those affected by the hurricanes, hopefully, these new rules motivate carriers to promptly pay all sums due to the policyholders. However, if a policyholder continues to have concerns about how their claim is being processed, the policyholder should immediately contact the Division or a knowledgeable insurance law attorney.
1 Amended Emergency Order No. 2017-04 is available at http://ltg.gov.vi/downloads/forms/b&i/Amended_Emergency_Order_No2017_04_LtSeal.pdf (last assessed January 17, 2018).