When an insured person asks a question to their insurer, an answer is expected. An insurance company must respond to all inquiries quickly and under no circumstances later than 15 days. If an insured person submits proof of loss that the insurer has agreed to and asks "when can I expect to be paid?" The insurer should respond with specificity immediately. Most policies and government regulations require payment within 30 calendar days of agreement to proof of loss. If the question is ignored and the payment is not made, after the insurer has approved the proof of loss, the insurer breaks the agreement and if it without good reason, the bond of good faith and fair trade. Often, bad faith is just the difference between politeness and lack of politeness.
See the full video at https://youtu.be/3sCRBHDDcfE  An insurance company may not deny coverage where all the relevant facts the insurer was known from the beginning, but it was unreasonably late to assert a basis for disclaimer. An unexplained delay of two months can be found to be unreasonable in the disclaimer. When the insurer waited even longer, with an inexplicable delay of about a year, before mentioning two new reasons for disclaimer, the court found the insurer's actions to be unreasonable by law. [ Allstate Ins. Co. v. Gross 27 NY2d 263, 269-270) and Mendoza v. American Country Ins. Co., 19 AD3d 300, 797 NYS2d 492, 2005 NY Slip Op 5432 (NY App. Div., 2005).]
The insurance adjuster knows better than an insured what is needed to prove damages. If, for example, the adjuster does not request proof of loss, documentation to support a claim or the insured's sworn testimony during an examination under oath, until months after the loss, the delay in the request may upset the insured and lead to accusations of breach of contract.
Failure to claim proof of loss within the prescribed time, together with other documents calculated to make the insured believe that the proof does not need to be provided within the prescribed time, is sufficient to show an implied waiver in Georgia. [ Condon mot Des Moines Mut. Hail Ass’n 120 Iowa, 80, 94 N. W. 477. The insurer's conduct throughout the negotiations shows conduct inconsistent with the assertion that the insured did not immediately submit evidence of loss. [ Knight from Ku Klux Klan Inc against Fid. &. Deposit Co. Of Md ., 169 S.E. 514, 47 Ga.App. 12 (Ga. App., 1933)]
Some insurance companies have careful control over their adjusters. Each management level has limited authority to regulate claims. If the person meeting the insured has no authority and has to work his way through several layers of bureaucracy, delays that upset the insured become inevitable. If the insurance adjuster has adequate authority to decide with the insured or the tortfeasor without delay, it will not develop into an infidelity. "
© 2020 – Barry Zalma
Barry Zalma, Esq., CFE, now limits his practice to working as an insurance consultant specializing in insurance coverage, insurance management, insurance operations and insurance fraud almost equal for insurance policyholders. He also serves as an arbitrator or mediator for insurance-related disputes, practicing law in California for more than 44 years as an insurance coverage and claims lawyer and for more than 52 years in the insurance industry.He is available at http://www.zalma.com and zalma @ zalma.com
Mr Zalma is the first recipient of the first annual Claims Magazine / ACE Legend Award.
For the past 52 years, Barry Zalma has devoted his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following libraries of books and other materials to enable insurers and their claims staff to become professionals in insurance claims.
https://zalma.com/zalmas-insurance-fraud-letter-2/ Last read two issues of ZIFL here.
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Listen to the podcast: Zalma om försäkring https://anchor.fm/dashboard/episodesZalma om försäkring
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Go to the Insurance Claims Library – https://zalma.com/blog/ Insurance -claims libraries /
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