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The Denial Must Be in Writing Setting Out All Reasons for the Denial   

https://zalma.com/blog

Once a claim is denied, the insured no longer need comply with the  conditions of the policy.  He or she need not submit a sworn proof of  loss nor respond to requests for records or an examination under oath.   Therefore, an insurer should not make the decision to deny a claim until  it is convinced that it has completed a thorough investigation.  If the investigation reasonably justifies a denial of the claim, the  insured should always be notified in writing.  After the investigator is convinced that the investigation is complete  and the file is properly documented, all the information must be  gathered and evaluated in an objective and impartial manner. A fair and  thorough analysis will negate charges of bad faith or malice to the  insured. All information that can be corroborated must be corroborated  by the fraud investigator.  Advice of counsel is not an absolute defense to a bad faith action. It  is often no defense at all. Sometimes, if the insurer refuses to give  the lawyer all of the information, it is evidence of bad faith.  Most  courts agree that the advice of counsel is only evidence to be  considered in determining whether the insurer denied a claim in bad  faith.  On the other hand, denial can be enforced if the insured \\u2013 even on the  advice of counsel \\u2013 refuses to fulfill a required condition of the  policy. Therefore, the insured\\u2019s purported reliance on the alleged  advice of counsel in refusing to answer an insurer\\u2019s questions and  failing to supply requested documentation did not excuse her failure to  comply with the policy conditions requiring her to supply the requested  documents and answer material questions at her EUO. The insurer properly  denied coverage on the basis that the insured\\u2019s failure to comply  constituted material breaches of her contractual duties.  \\xa9 2021 \\u2013 Barry Zalma  Barry Zalma, Esq., CFE, now limits his practice to service as an  insurance consultant specializing in insurance coverage, insurance  claims handling, insurance bad faith and insurance fraud almost  equally for insurers and policyholders. He also serves as an arbitrator  or mediator for insurance related disputes. He practiced law in  California for more than 44 years as an insurance coverage and claims  handling lawyer and more than 52 years in the insurance business. He is  available at http://www.zalma.com and zalma@zalma.com.  Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE  Legend Award.  Over the last 53 years Barry Zalma has dedicated his life to insurance,  insurance claims and the need to defeat insurance fraud. He has created  the following library of books and other materials to make it possible  for insurers and their claims staff to become insurance claims  professionals.  Go to the podcast Zalma On Insurance at https://anchor.fm/barry-zalma;   Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry  Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry  Zalma on YouTube-  https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to the  Insurance Claims Library \\u2013  https://zalma.com/blog/insurance-claims-library/ Read posts from Barry  Zalma at https://parler.com/profile/Zalma/posts; and the last two issues  of ZIFL at https://zalma.com/zalmas-insurance-fraud-letter-2/