February, 2001 dialogue between The Massachusetts Department of Insurance and Antone P. Braga concerning property insurance "Standard Policy" that covers damage done by disasters:
(DOI wrote:) 1. The policy changes are not an "erosion of the insureds authority or position". In all cases, it is a broadening:
(Braga wrote:) ^It is precisely that broadening that has weakened the consumer's position. When once it was clear and defined, it is now up for interpretation. When once it was clearly a responsibility and authority of the policyholder to file the claim, it is now broadened into a statement of loss at the request of the insurance company. When once there was leverage for a timely response there is a weakening.
(DOI wrote:) 2. "Proof of loss: is a sworn statement by the insured about the loss which the Standard Fire Policy mandated for every claim: this was in addition to the requirement that the insured file a claim "as soon as practical". The current policy does not require a proof of loss except when requested by the insurer.
(Braga wrote:) ^A Proof of Loss is a "claim" and also a formal demand for payment, and carries with it time limits for a response by the insurance company. The current policy not only does not require a proof of loss, it puts that right over to the insurance company's request. I'm flabbergasted that you see this as helping the consumer. I'm sorry, but is not at all helpful to lose leverage (authority) in adjusting.
(The DOI wrote) 3. The Standard Fire Policy set a rigid timetable for appraisal. The new ISO commercial lines policy adopted a "prudent man" standard, backed up the Unfair Claim Practices Act and the various unfair business acts. Under these acts, an insurer can be held liable for treble damages if it unfairly drags its feet on appointing an appraiser or paying the award.
(Braga wrote:) ^I'm familiar with the N.A.I.C. Unfair Claims Settlement Practices Model Regulation and the current N.A.I.C. Unfair Property/Casualty Claims Settlement Practices Model Regulation and can only say after careful comparison of the old and the new that consumers get the short end of the stick in many areas, while greater latitude is given over to insurance companies. I have that detailed if you want me to provide my lengthy comparison of actual wording changes. I would take the reasonable (specific) time limits that we had for many decades, any day, over interpretation of the terms "reasonable" or "prudent".
(The DOI wrote:) The Standard Fire Policy set a rigid timetable which an insurer could use to its advantage: on the 15th day after the appointment of the appraiser, it could declare an impasse, and file with a court of its own choosing (which, under a commercial policy, might be any where in the country) to appoint an umpire - three guesses who the umpire would be likely to favor? Under the current policy, if the two appraisers are able to settle the disagreement without an umpire, there is no need to spend the money appointing one.
(Braga wrote:) ^It has been my experience that umpires only charge for actual services rendered in resolving issues in which the appraisers cannot agree. By selecting an umpire before an impasse there is an established set of parties to the transaction. Can you imagine playing a ball game and waiting until you have a disagreement before you decide who should umpire? The only impasse I can imagine is if the appraisers could not agree on an umpire, and I think there is every bit as good a chance of an unbiased umpire being selected by the court, as there is in selection by the appraisers, after all, they try to get the umpire that is most likely favorable to each of them. It is only human nature.
To Insurance Consumers:
Unbeknown to the American Indian, sophisticated treaty wording led in large part to demise of authority and rights. Now comes an even larger group having their intrinsic authority and rights evaporate into the thin air of sophisticated wording: the insurance consumer. This is a major set-back for us all: property insurance policyholders (auto, home, business, boat, etc.).
In keeping with how insurance was set up in the first place, authority rests with the policyholder for presenting the claim, subject to review, audit, negotiation and adjustment. The companies need no more than the authority they have had for centuries under property insurance, i.e., receive and consider the claim filed by the policyholder.
A Statement of Loss is not a Proof of Loss. A Proof of Loss is a "claim." A Statement of Loss carries less weight and less leverage for the policyholder. This new wording may be enforced so that unless the insurance company requests you file a "claim" you may no longer have that authority. You may simply be able to submit a statement of loss if it is requested and wait for the insurance company to adjust your loss the way they see fit. It is no favor to have your responsibility taken away when it means losing YOUR RIGHT OF AUTHORITY. Now that the policyholder's right to make a "claim" is being eliminated in favor of statement of loss language at the request of the insurance company...try to imagine where the policyholder now stands with regard to rules governing insurance company behavior, when those rules are predicated on company behavior following the policyholder filing a "claim."
The insurance company control over what they want from you and when they want it, is the new standard. This final affront leaves no doubt and is far too costly, the guest has taken charge of the host, and with the apparent blessing of insurance authorities. There is no question who paid the insurance premium, but the new question is:
We must now set-out to win back our right to make a "claim"...a long road indeed, and one that can only be travelled through awareness from the bottom to the top. It affects us all.
In the meantime, best of luck with your insurance claims.
Antone P. Braga