Claims Commandments

Published: Nov. 1, 2022, 4:41 p.m.

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Claims Commandment III - Thou Shall Communicate Often With The Third  Party Insured and the Claimant 

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 Insurance claims is a service business. The claims person \\u2013 whether  acting for the insurer or the insured \\u2013 provides a service to the  insured and the insurer. Communication is essential to providing the  service promised by the insurance policy.  In some states, like California, communications are required by  regulation:  Every insurer shall disclose to a first party claimant or beneficiary,  all benefits, coverage, time limits or other provisions of any insurance  policy issued by that insurer that may apply to the claim presented by  the claimant. When additional benefits might reasonably be payable under  an insured\\u2019s policy upon receipt of additional proofs of claim, the  insurer shall immediately communicate this fact to the insured and  cooperate with and assist the insured in determining the extent of the  insurer\\u2019s additional liability. [10 CCR 2695.4 (a)]

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