Section Ins 1002.05 - Claims Settlement Time Limits(a) Unless otherwise provided by law, every insurer shall establish procedures to: (1) Commence an investigation of any notice of a claim filed by an insured or claimant not later than 5 working days from receipt of the notice of a claim; and(2) Anticipate the seasonal changes in the volume of claims in order to comply with this section.(b) Every insurer, upon receipt of notice of a claim, shall acknowledge the receipt of such notice to the insured or claimant, within 10 working days, as follows: (1) By written correspondence, including facsimile or e-mail if acceptable to both parties; or(2) By telephone or face-to-face communication if the insurer provides the insured or claimant with the toll free telephone number of the insurer's claims office handling the claim. Thereafter, should the insured or claimant request a written acknowledgment, the insurer shall provide written acknowledgment within 5 working days from the request of the insured or claimant.(c) Unless otherwise provided by law, within 30 days from the receipt of the notice of claim, the insurer shall make a complete decision regarding coverage, acceptance, denial, or payment of a claim and communicate this to the insured or claimant with the following exceptions: (1) If a decision cannot be made because the insurer needs more time to make a decision, the insurer shall provide the insured or claimant, in writing, a delay letter setting forth the specific factual or legal reasons that the insurer needs more time to determine whether the claim will be covered, accepted, paid, or denied;(2) The insurer shall, within 30 days from the date of the delay letter in (c)(1) above, and every 30 days thereafter, send a letter setting forth the specific factual or legal reasons for the continued delay in the claim settlement process;(3) If the reason the claim remains open is that the insurer is waiting for documentation or information requested of the insured or claimant, then the insurer shall send a letter to the insured or claimant requesting the particular documentation or information necessary to accept, pay, or deny the claim, but shall not be required to send the delay letter(s) to the insured or claimant as required in (c)(1) or (c) (2) above; and(4) If either party has filed suit, and the settlement of the claim is being litigated in a court of law, the delay letter in (c)(1) or (c)(2) above shall not be required.(d) Unless otherwise provided by law or court order, every insurer shall pay all or part of the claim: (1) Within 5 working days from date of agreement with an insured or claimant; or(2) Within 5 working days after receipt from the insured or claimant, of documentation needed to process the claim for payment as requested by the insurer.(e) In any claim in which the insurer cannot make a decision within 5 working days from the date of agreement or of receipt of the requested documentation, the insurer shall send a delay letter to the insured or claimant explaining the reasons for the delay in the claim settlement process.(f) The insurer shall, within 30 days from the date of the delay letter in (e) above, and every 30 days thereafter, send a letter setting forth the specific reasons for the continued delay in the claim settlement process.(g) When the reason for delay is suspected fraud a delay letter issued pursuant to (c) or (d) above shall be deemed sufficient if it indicates that the reason for the delay is that further investigation is needed to determine the validity of the claim.(h) Whenever the insurer denies a claim, in whole or in part, including on the basis of no coverage or that the amount of the loss is below the deductible, or issues a reservation of rights letter, or when sending a second or subsequent delay letter(s) as provided in (c)(2) and (f) above, the insurer shall include the following statement in at least 12-point font bold type: "We will, of course, be available to you to discuss the position we have taken. You may reach us at (insurance company toll free telephone number). If you are a New Hampshire resident; if your policy insures property located in New Hampshire; or if you have been injured/your property has been damaged by a New Hampshire resident and you wish to take this matter up with the New Hampshire Insurance Department, it maintains a consumer services division to assist consumers with complaints at 21 South Fruit Street, Suite 14, Concord, NH, 03301. The New Hampshire Insurance Department can be reached, toll free, by dialing 1-800-852-3416.
(i) An insurer shall not request of an insured or claimant a waiver of the insurer's obligations under this part, except to request a waiver of the 30 day delay letter provision of (c)(2) and (f) above. The waiver shall be in writing and signed by the insured or claimant. The signed waiver shall be retained in the claim file.N.H. Admin. Code § Ins 1002.05
Amended by Volume XXXV Number 45, Filed November 12, 2015, Proposed by #10962, Effective 10/26/2015, Expires 10/26/2025.