Insurance · General

When must an insurer acknowledge receipt of a claim and begin investigation under most state unfair claims practices acts?

Correct answer

Within 24 hours of receiving the claim, acknowledgment; investigation must begin promptly; most states require acknowledgment within 10-15 working days and denial or offer within 30-45 days of receiving proof of loss

  1. A Within 90 days
  2. B Within 24 hours of receiving the claim, acknowledgment; investigation must begin promptly; most states require acknowledgment within 10-15 working days and denial or offer within 30-45 days of receiving proof of loss
  3. C Whenever the adjuster gets around to it
  4. D Only after the insured provides all documentation

Why this is the answer

UNFAIR CLAIMS SETTLEMENT PRACTICES: Every state has laws (based on the NAIC model) regulating insurer claims handling. COMMON REQUIREMENTS: Acknowledgment of claim receipt: typically within 10 business days; Prompt investigation: begin within a reasonable time (some states specify days); Communication: respond to claimant inquiries within 10 business days; Coverage decision: accept or deny within 30-45 days of receiving proof of loss (varies by state); Payment: within a specified period after agreement (often 5-30 business days); PROHIBITED PRACTICES: Failing to acknowledge claims; unreasonably delaying investigation; offering unreasonably low settlements; requiring unnecessary documentation; failing to provide prompt denial explanation; CONSEQUENCES: Bad faith claims exposure; regulatory penalties; adjuster licence discipline; ADJUSTER RESPONSIBILITY: Know your state's specific timeframes and calendar all deadlines proactively.
Source: Insurance Adjuster — Claims Process, State Regulation Timeframes

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