What Is Unfair Claims Practice?
Unfair claims practice is theimproper avoidance of a claim by an insurer or an attempt to reduce the size of the claim. By engaging in unfair claims practices, an insurer tries to reduce its costs. However, this is illegal in many jurisdictions.
Key Takeaways
- An unfair claims practice is what happens when an insurer tries to delay, avoid, or reduce the size of a claim that is due to be paid out to an insured party.
- Insurers that do this are trying to reduce costs or delay payments to insured parties, and are often engaging in practices that are illegal.
- Many states have passed unfair claims practices laws to protect insured parties from bad behavior on the part of insurers in the claims settlement process.
- Unfair Claims Settlement Practices Acts (UCSPA) are enforced by individual states, rather than the federal government, and vary state-by-state.
Understanding Unfair Claims Practice
The National Association of Insurance Commissioners (NAIC) has created a model of unfair claims practicelegislation that mandatesclaims be handled fairly and that there beclear communication between the insurer and the insured. States, not the federal government, regulate insurance; many jurisdictions have implemented unfair claims practices laws modeled after the NAIC's model act.
Also, most states have enacted a version of thismodel law. Called the Unfair Claims Settlement Practices Act, it protects insurance buyers from unjust behavior by insurers in the claims settlement process. Specifics of thelaw vary from state to state. Unfair Claims Settlement Practices Acts (UCSPA) are not federal law; instead, theyare enforced by individual state insurance departments.
Example of Unfair Claims Practice
Consider a small business owner that insures hiscompany's building and business personal property under acommercial property policy. Unfortunately, a fire broke out in thebuilding, causing $100,000 in property damage. The insurance company delays payment, rendering the business ownerunable to repair any of the damage.The insurance company continuesusing delay tactics to avoid making a payment. For example, theclaims representative keeps"forgetting" to send the claim forms. Also,the adjustersays he needs another proof of loss, but the small business owner has alreadysubmittedproof of loss twice. These are the types of situations that unfair claims practice laws are designed to prevent.
Other Examples ofUnfair Claims Practice
- Misrepresenting relevant facts or policy provisions. For instance, your commercial property policy states thatBuilding Ordinancecoverage is included, but yourinsurerinsists the coverage is excluded.
- Making a significant alteration in an application without your consent and then settling a claim based on the alteration. For instance, in your application, you requested a $50,000 limit forUtility Interruptioncoverage, but your insurer reduced the limit to $10,000 without telling you. The insurer then refuses to pay more than $10,000 for a loss.
- Settling claims for less than what you would reasonably expect based on a written advertisem*nt you received. For instance, an ad announcesa $50,000 limit for damage caused by flooding. However, the ad doesn't mention anywhere that this coverage is provided only if the insuredpays an additional premium beyond the premium stated in the ad.
