Florida Regulations 69O-166.024: Failure to Acknowledge Communications and Act Promptly as to Communications with Respect to Claims and to Implement Standards for the Prompt Investigation of Claims
Current as of: 2024 | Check for updates
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Every insurer shall adopt and implement standards for the acknowledgement of communications and investigation of claims with respect to claims so that:
(1) Upon the insurer’s receiving a communication with respect to a claim, it shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgement. If the acknowledgement is not in writing, a notification indicating acknowledgement shall be made in the insurer’s claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer. As used in this subsection, “”agent”” means any person to whom an insurer has granted authority or responsibility to receive or make such communications with respect to claims on behalf of the insurer. This subsection shall not apply to claimants represented by counsel beyond those communications necessary to provide forms and instructions.
(2) Such acknowledgement shall be responsive to the communication. If the communication constitutes a notification of a claim, unless the acknowledgement reasonably advises the claimant that the claim appears not to be covered by the insurer, it shall provide necessary claim forms, and instructions, including an appropriate telephone number.
(3) Unless otherwise provided by the policy of insurance or by statutes, such insurer shall within 10 working days of its receipt of proof of loss statements begin such investigation as is reasonably necessary, unless the failure to begin such investigation is caused by factors beyond the control of the insurer which reasonably prevent the commencement of such investigation.
Rulemaking Authority 624.308 FS. Law Implemented 624.307(1), 624.3161, 626.9541(1)(i)3.a., 627.4131 FS. History-New 11-2-92, Formerly 4-166.024.
(1) Upon the insurer’s receiving a communication with respect to a claim, it shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgement. If the acknowledgement is not in writing, a notification indicating acknowledgement shall be made in the insurer’s claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer. As used in this subsection, “”agent”” means any person to whom an insurer has granted authority or responsibility to receive or make such communications with respect to claims on behalf of the insurer. This subsection shall not apply to claimants represented by counsel beyond those communications necessary to provide forms and instructions.
(2) Such acknowledgement shall be responsive to the communication. If the communication constitutes a notification of a claim, unless the acknowledgement reasonably advises the claimant that the claim appears not to be covered by the insurer, it shall provide necessary claim forms, and instructions, including an appropriate telephone number.
(3) Unless otherwise provided by the policy of insurance or by statutes, such insurer shall within 10 working days of its receipt of proof of loss statements begin such investigation as is reasonably necessary, unless the failure to begin such investigation is caused by factors beyond the control of the insurer which reasonably prevent the commencement of such investigation.
Rulemaking Authority 624.308 FS. Law Implemented 624.307(1), 624.3161, 626.9541(1)(i)3.a., 627.4131 FS. History-New 11-2-92, Formerly 4-166.024.