Insurance policies are contracts and legal rules come into play when you file an insurance claim. If you arm yourself with basic knowledge about your rights and the claim process, you can speed up your settlement and improve your odds of getting paid what you’re owed.
Your insurance company, and its employees, are required to follow Oregon law when handling your property damage claim. Adjusters, especially those who come from out of state after a disaster, don’t always know or follow insurance laws and regulations, so it’s often up to you to understand and enforce them for yourself or your client. You can use our guidance and sample letters to help you navigate this process.
Communicating with Your Insurer
In order to advocate for yourself and increase the likelihood of your claim being promptly and equitably handled, communication is key. It is a good idea to communicate with your insurance company and your agent in writing so that you have a clear record and paper trail. This does not mean you should stop speaking to your adjuster during the claim process. Instead, you should communicate in writing when possible or send follow-up emails summarizing what was said or agreed to during a spoken conversation. For suggestions on communicating effectively with an insurance company, read: “Speak UP”.
Claim Handling and Time Frames
The information included here will give you a basic understanding of some of your rights and the claim process in general. These claim handling rules are found in the Oregon Administrative Rules (“OAR”). To trigger many of your legal rights, you must give your insurer written notice of your claim. Below are just a few timeframes and claim handling practices to be aware of.
Processing your claim
30 Days – Your insurer must acknowledge the notification of your claim within 30 days after receipt. This information should be included in the insurers claim file. OAR 836-080-0225(1).
30 Days – After receiving notice of your claim, your insurer has 30 days to provide necessary claim forms, instructions, and assistance to help you comply with the policy conditions and the insurers reasonable requirements. OAR 836-080-0225(4).
Communicating information to you
30 Days – Your insurer must reply to all pertinent communications from you that reasonably indicate a response is expected within 30 days after receipt. OAR 836-080-0225(3).
Investigating your claim
45 Days – Your insurer must complete its claim investigation within 45 days of receipt of the claim, unless the investigation cannot reasonably be completed in that time. OAR 836-080-0230.
Paying or denying your claim
30 Days – An insurer must let you know if your claim is being accepted or denied within 30 days after receipt of a properly executed proof of loss. Your insurer may not deny a claim on the basis of a policy provision, condition, or exclusion unless the denial includes reference to the provision. A claim denial must be in writing. OAR 836-080-0235(1).
Preserving your rights
30 Days – If your insurer continues negotiations with you and you are not represented by an attorney, or an attorney yourself, your insurer must provide you written notice that your rights may be affected by a statute of limitations. This notice must be given to you not less than 30 days before the statute of limitations has run. OAR 836-080-0235(6).
A statute of limitations sets out the maximum amount of time that you have to initiate a legal proceeding from the date of the alleged offense or date of claim. Check your policy for a “suit against us” provision, or similarly worded provision, to find out how your insurance policy bounds your right to bring a legal claim.
Unfair Claim Settlement Practices
Your insurer is prohibited from using unfair claim settlement practices. These practices are set out generally in the Oregon Revised Statutes (“ORS”). The following are a few examples listed in ORS 746.230 Unfair claim settlement practices:
(1) An insurer or other person may not commit or perform any of the following unfair claim settlement practices:
(a) Misrepresenting facts or policy provisions in settling claims;
(b) Failing to acknowledge and act promptly upon communications relating to claims;
(d) Refusing to pay claims without conducting a reasonable investigation based on all available information;
(e) Failing to affirm or deny coverage of claims within a reasonable time after completed proof of loss statements have been submitted;
(f) Not attempting, in good faith, to promptly and equitably settle claims in which liability has become reasonably clear;
(g) Compelling claimants to initiate litigation to recover amounts due by offering substantially less than amounts ultimately recovered in actions brought by such claimants;
(L) Failing to promptly settle claims under one coverage of a policy where liability has become reasonably clear in order to influence settlements under other coverages of the policy.
Complaints Against Your Insurance Company
The Oregon Division of Financial Regulation regulates insurance in the state. They can impose penalties on your insurance company if it finds that they did not comply with the laws in your state that require insurers to handle claims fairly and in good faith. Visit Insurance Resources for Oregon for resources and tips on the process and strategy of filing a formal complaint.
You can call the Oregon Division of Financial Regulation’s consumer hotline with any questions or complaints toll-free at 888-877-4894, email insurance questions to DFR.InsuranceHelp@oregon.gov, or file a complaint online, by going to https://dfr.oregon.gov/help/complaints-licenses/Pages/file-complaint.aspx and select “insurance industry” for an online form. Their mailing address is:
Oregon Division of Financial Regulation
P.O. Box 14480
Salem, OR 97309-0405
The agency states that most complaints are resolved within 60 days, depending on the type of complaint.
Oregon Expediting Claims Handling and Other Expectations Related to 2020 Wildfires
On September 25, 2020, Insurance Commissioner and Director Andrew Stolfi issued a bulletin seeking to clarify the division’s expectations for property insurers and provide guidance on expediting claims handling for Oregon insureds affected by wildfires. The Division made the below recommendations and encouraged insurers to take the active measures to help people and businesses affected by the wildfires. Oregon Department of Consumer and Business Services Division of Financial Regulation, Bulletin No. DFR 2020-18 can be found at https://dfr.oregon.gov/laws-rules/Documents/Bulletins/bulletin2020-18.pdf.
Advance of Additional Living Expenses
Insurers should adopt a standard ALE advance payment of at least four months for insureds experiencing a total loss or whose property is uninhabitable. Insurers should take into account any adverse circumstances that may require maintaining ALE benefits for policyholders whose property remains inaccessible due to damage caused by the wildfires once evacuation orders have been lifted.
Where access to property is restricted, insurance companies should not terminate ALE benefits until the property is accessible and deemed habitable.
Inventory Forms and Itemization of Certain Types of Property
Insurers should allow and accept any inventory form that contains similar information to what would be reported using a company-specific form. Insurers are allowed to request more information from the policyholder upon receipt of the inventory form.
Insurers should agree to accept an inventory form that includes groupings of categories of personal and commercial property, including, but not limited to, clothing, shoes, books, food items, business supplies, livestock supplies, or other categories of items that would be impractical to list each individual item separately.
* The above is a set of rules that outlines how insurance companies SHOULD act following the recent wildfires. While your insurance carrier may not be strictly bound by these rules, asserting them may give you leverage to help you better resolve your claim.
Hiring Professional Help
You have the right to hire a qualified attorney or public adjuster to help navigate your claim.
A qualified attorney can represent you in all aspects of resolving an insurance claim including giving legal advice, helping to document your loss, negotiating a settlement, representing you in an appraisal or mediation, and/or filing suit on your behalf.
Generally speaking, if you hire an attorney to help you resolve an insurance claim dispute, you should hire him or her on a contingency (not hourly) fee basis. Claim disputes are time-consuming, so it gets expensive fast when you pay by the hour. In some states, attorney contingency fees are restricted by law. Consult a qualified attorney if you have questions about how the law would apply to your specific situation. A “qualified attorney” is one that has experience successfully representing insurance consumers in claim disputes and is a member in good standing of the Oregon Bar. To find one, visit our Oregon Professional Help Directory.
A qualified public adjuster cannot practice law or give legal advice, but will be familiar with the insurer’s duties under the law in your state as well as insurance lingo and the claim process. A good public adjuster can document and prove your losses as well as negotiate a full and fair settlement. Generally speaking, if you hire a public adjuster, you agree to pay them a percentage of whatever benefits they recover on your behalf – not an hourly fee. Oregon public adjusters can also be found by visiting our Oregon Professional Help Directory.
For more information on hiring an attorney or public adjuster, check out:
FINAL TIPS AND SUGGESTIONS
Check out UP’s Oregon Wildfires Insurance Claim and Recovery Help Library for more information and resources throughout the recovery process: www.uphelp.org/ORwildfires
And follow these simple steps:
- Keep in contact with your insurance company. If you are not able to stay in your home, make sure the company has an address and phone number where it can reach you.
- Inventory and document your losses. Take pictures of identifiable items before they’re taken away for repairs and off your lot before it gets cleared (if applicable). Create detailed lists of damaged property. If your home was seriously damaged or completely destroyed, get at least one, ideally two, independent repair/replacement cost estimates.
- Make only temporary repairs. Your insurance company may deny your claim if you make permanent repairs before it inspects. If you’re not sure if your company considers a repair to be permanent, ask your company (in writing) before starting any repair work. The cost of these repairs and for storing personal belongings is likely covered by your policy.
- Be present for the inspection. It’s a good idea to be home when the adjuster performs his or her inspection. Feel free to ask your contractor to be there with you to discuss estimates with the adjuster or the company.
- Keep receipts. You must provide evidence that you bought replacement items and incurred expenses due to losing the use of all or part of your property. Receipts will help you get reimbursed more quickly for out of pocket expenses.