Relating to insurer’s requests for information and claim timelines, and property and casualty insurer’s loss calculations, adjustments, payments of claims, and policy terms

The insurer is not required to provide privileged information, but must provide to the insured a written explanation for the basis of the privilege. If the information is later determined not to be privileged, the insurer’s prior refusal constitutes an unfair method of competition and unfair or deceptive act or practice.4(3). An insurer shall not include in a policy a deadline for an insured to provide notice of a loss if the insured could not have reasonably known about the loss and the insurer will not be prejudiced by a delay. If a policy provides for replacement cost, an insurer shall not include a deadline for the insured to recover the depreciation amount that is less than one year from the insurer’s most recent actual cash value payment to the insured, and shall notify the insured of such deadline no later than days prior to the deadline. An insurer shall not include in a policy language that imposes a statute of limitations for an insured to sue the insurer for wrongfully denying a claim to less than five years from the date of the loss, or two years from the denial of the claim, whichever is later, and shall notify the insured of such deadline no later than days prior to the deadline. For a policy providing for replacement cost for property, and the loss requires repair or replacement of a product or part, consequential physical damage shall be included in the calculation of loss, the insured shall not be required to pay for betterment or costs other than an applicable deductible, and the insurer shall repair or replace as much of the property necessary to achieve a reasonably similar appearance as detailed by the bill. “Reasonably similar appearance” is defined by the bill. If the loss requires repair or replacement of a building, the insurer shall repair or replace as much of the building necessary to bring the building into compliance with the local or state building code, and the insured shall not be required to pay for betterment or costs other than an applicable deductible. The requirement that an insurer bring a building into compliance with a local or state building code may be waived pursuant to an endorsement in a policy as detailed by the bill. A policy shall not include a roof payment schedule or a similar provision, or a provision that requires covered property damage to satisfy certain criteria in order to exclude or limit the insurer’s liability for cosmetic or nonfunctional damages, unless an endorsement providing otherwise is included in a policy as detailed by the bill. The replacement cost of damaged property shall be calculated based on the date the damaged property is repaired or replaced. For a policy providing for actual cash value for a claim, and the actual cash value is not calculated as the replacement cost less depreciation, the insurer shall provide the insured a copy of the claim file worksheet and an explanation of the calculation of depreciation and determination of the actual cash value. “Actual cash value” is defined by the bill. For property covered by a policy that is wholly destroyed or damaged and cannot be repaired, or is too expensive to repair, the insurer shall pay the limit of the policy and shall not withhold the cost of depreciation or the deductible. The bill requires an insurer to, within days of receiving notice of a claim, acknowledge receipt of the claim to the insured, commence review or investigation of the claim, and request from the insured any item, statement, or form related to the claim. An insurer shall reply within days to a communication from an insured to which an insured would reasonably expect a response, and shall address all material parts of the insured’s communication. An insurer shall notify an insured of the acceptance or denial of a claim no later than days from the date of receipt of a properly completed proof of loss form. If an insurer believes an insured fraudulently caused or contributed to a claim, the insurer shall notify the insured within days of receiving a proof of loss form of the reason additional time is required to investigate the claim, notify the insured every calendar days thereafter of the continuing reason additional time is required, and, within a reasonable amount of time after completing an investigation and a determination whether the insured fraudulently caused or contributed to the claim, notify the insured of the acceptance or denial of the claim. If part of a claim is denied by an insurer, the notice must include an explanation of the reason for the denial and a citation to applicable policy language or law that is the basis for the denial. If a denial is based on a written report or other documentation, the report or documentation shall be provided to the insured. If, prior to accepting or denying a claim, inspection of damaged property under a claim is required, the insurer shall schedule and complete the inspection within days of receipt of a proof of loss form. The inspection may only be delayed if an act of nature reasonably prevents the inspection, in which case the insurer shall notify the insured of the reason for delay. If an insurer accepts liability for all or part of a claim, the insurer shall pay the accepted portion of the claim within days. If payment is conditioned on the performance of an act by the insured, the insurer shall pay the portion for which liability has been accepted within days of the act being performed. Payment of a claim shall not be required if it is discovered that the damaged property does not belong to the insured, the policy does not provide coverage for the damaged property, or the claim is otherwise invalid. An insurer that violates the bill and has accepted all or part of a claim is liable for, in an action brought by an insured in which the insured prevails, the portion of the claim for which the insurer accepted liability plus simple interest at an annual rate of percent, the insured’s reasonable attorney fees, costs of litigation, and any other damages provided by law. The bill shall not be construed to prevent or replace an award of prejudgment interest or any other damages as provided by law. An insurer shall not include a provision in a policy that prohibits an insured from contracting with a public adjuster.