Insurance · Claim Investigation

What is a 'reservation of rights' letter?

Correct answer

A letter from the insurer to the insured acknowledging the claim is being investigated and the insurer will pay valid claims, but reserving the right to deny coverage if investigation reveals the claim is not covered — protects the insurer's position while investigation continues

  1. A Reservation in a registry
  2. B Reserves the right to deny the claim
  3. C Hotel reservation
  4. D A letter from the insurer to the insured acknowledging the claim is being investigated and the insurer will pay valid claims, but reserving the right to deny coverage if investigation reveals the claim is not covered — protects the insurer's position while investigation continues

Why this is the answer

A Reservation of Rights (ROR) letter is sent by the insurer when coverage is uncertain — when the insurer must investigate and possibly defend a claim but has not yet determined whether the loss is actually covered. The letter formally notifies the insured: (1) The insurer is investigating and may provide a defense (for liability claims) or repair/payment (for first-party claims) under the policy; (2) The insurer is doing so without waiving any coverage defenses; (3) If investigation determines the claim is not covered, the insurer reserves the right to withdraw and deny coverage. Why used: in liability claims, the insurer often must provide defense even if coverage is uncertain (the duty to defend is broader than the duty to indemnify); without an ROR, the insurer might be deemed to have waived coverage defenses by providing defense. The ROR keeps the coverage question open while investigation proceeds. After investigation: insurer may pay/defend fully, deny coverage entirely (then file declaratory judgment action if needed), or settle with reservation. Improper or untimely RORs can themselves be bad faith. The insured may want their own attorney (sometimes paid by the insurer) given the conflict of interest the ROR creates.
Source: NAIC Adjuster Reservation of Rights

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About this topic: Claim Investigation

Claim investigation questions cover gathering evidence, taking statements, inspecting damage, establishing coverage and cause of loss, and spotting fraud indicators — while meeting the time limits set by unfair-claims-practice rules. This is one of 10 Insurance Adjuster questions on claim investigation, each with a full explanation on a single study page.

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