CHAPTER Ins 1000 CLAIM SETTLEMENT
Statutory
Authority: RSA 400-A:15, I.
PART Ins 1001 CLAIM SETTLEMENT FOR
ALL INSURERS, EXCEPT PROPERTY AND CASUALTY
Ins 1001.01 Communications Time
Limit.
(a) Every insurer, upon notice of a claim, shall acknowledge
the receipt of such notice in writing within 10 working days. This requirement of written acknowledgment
shall not preclude a speedier method of acknowledgment where the circumstances
warrant. Notification given to an agent
of an insurer shall be notification to the
insurer. If the notification is given to
the agent of an insurer, such agent may acknowledge receipt of such
notice. Unless otherwise provided by law
or contract, notice to an agent of an insurer shall not be notice to the insurer
if such agent notifies the claimant within 5 working days that the agent is not
authorized to receive notices of claims.
(b) Every insurer shall reply within 10 working
days to all claims communications from insureds, claimants, or authorized
representatives of either.
(c) Every
insurer, upon receipt of an inquiry from the insurance department shall within
10 working days furnish the department with a complete and accurate written
response to the inquiry.
Source. #1900, eff 1-1-82; ss by #4287, eff 7-1-87;
ss by #5649, eff 7-1-93; ss by #6999, eff 5-24-99, EXPIRED: 5-24-07
New.
#8900, eff 7-1-07
Ins 1001.02 Claims Settlement
Time Limits.
(a) A complete decision regarding member payment or
coverage or denial shall be made by the insurer within 30 days of receipt of
any health insurance claim. In the event
of extenuating circumstances, if a complete coverage decision is not made
within 30 days, the insurer shall provide a written explanation to the member
claimant justifying such delay. This
provision shall not apply to provider submitted claims for reimbursement for
services which have been provided to members.
(b) Unless otherwise provided by law, every
insurer shall establish procedures to commence an investigation of any claim
filed by an insured, claimant or authorized representative of either within 5
working days upon receipt of notice of loss.
The procedures established shall anticipate the seasonal changes in the
volume of claims. Every insurer shall
mail to every insured, claimant, policyholder or their authorized
representative a notification of all items, statements or forms as well as
blank copies of all statements or forms which the insurer reasonably believes
will be required in the settlement of the claim.
(c) Unless otherwise provided by law, within 10
working days after acknowledgment of the receipt of a notice of a claim from the insured, claimant or
authorized representative of either, the insurer shall advise the insured,
claimant or authorized representative of either in writing of the acceptance or
rejection of the claim. If the insurer
needs more time to determine whether the claim should be accepted or rejected,
the insurer shall so notify the insured, claimant or authorized representative
of either within 10 working days after acknowledgement of the loss and provide
the reasons for the delay.
(d) The insurer shall within 30 days from the
date of the letter setting forth a need for further time and every 30 days
thereafter, send to the insured, claimant or authorized representative of
either a letter setting forth the reasons for the delay in the claim
settlement, unless the insured, claimant or authorized representative otherwise
agrees.
(e) An insurer shall not justify a delay in
processing or paying a claim on the grounds of suspected fraud unless the insurer has notified the
department and has provided the department with specific reasons to support
their suspicions.
(f) Whenever
the insurer denies a claim on the basis of no coverage or the amount of loss is
below the deductible, the insurer shall inform the insured in writing the
reason for the denial and include the department’s toll-free telephone number.
(g) Any letter setting forth the need for further
time after the first 30-day period shall contain the following statement:
"Should you wish to
take this matter up with the
(h) Unless otherwise provided by law, every
insurer shall pay any amount finally agreed upon in settlement of all or part
of a claim not later than 5 working days from the date of such agreement or
from the date of the performance by the insured, claimant or authorized
representative of either of all conditions
set forth by such agreement.
(i) An insurer shall not request of a claimant or
insured a waiver of insurer obligations under Ins 1000, except to request a
waiver of the 30 day delay letter provision of this rule. This waiver shall be in writing and signed by
the insured or claimant. The signed
waiver shall be retained in the claim file.
Source. #1900, eff 1-1-82; ss by #4287, eff 7-1-87;
ss by #5649, eff 7-1-93; ss by #6999, eff 5-24-99, EXPIRED: 5-24-07
New.
#8900, eff 7-1-07
Ins 1001.03 Additional Information
Required in Accepting or Rejecting Claims.
(a) If a claim is denied in whole or in part the
insured, claimant or authorized representative of either shall be given the
reason for the denial. In any case where
coverage is denied the insurer shall notify the insured, claimant or authorized
representative of either of the applicable policy provision upon which denial
is based.
(b) Statements setting forth benefits included
within claim payments shall be in writing and in sufficient detail so that the
insured, claimant or authorized representative of either can reasonably
understand the benefits included within the claim payment.
Source. #1900, eff 1-1-82; ss by #4287, eff 7-1-87;
ss by #5649, eff 7-1-93; ss by #6999, eff 5-24-99, EXPIRED: 5-24-07
New.
#8900, eff 7-1-07 (from Ins 1001.04)
Ins 1001.04 Undisputed
Amounts. In any case where
there is no dispute as to one or more elements of the claim, an offer of
settlement for such undisputed elements shall be made without prejudice to
either party notwithstanding the existence of disputes as to other elements of
the claim.
Source. #1900, eff 1-1-82; ss by #4287, eff 7-1-87;
ss by #5649, eff 7-1-93; ss and moved by #6999, eff 5-24-99 (from Ins 1001.05),
EXPIRED: 5-24-07
New. #8900, eff 7-1-07 (from Ins 1001.05)
Ins 1001.05 Notice
of Insurance Department. Any
notice rejecting a claim in whole or in part shall contain the following
statement:
"We will, of course,
be available to you to discuss the position we have taken. Should you, however, wish to take this matter
up with the
Source. #1900, eff 1-1-82; ss by #4287, eff 7-1-87;
ss by #5649, eff 7-1-93; ss and moved by #6999, eff 5-24-99 (from Ins 1001.06)
), EXPIRED: 5-24-07
New.
#8900, eff 7-1-07 (from Ins 1001.06)
Ins 1001.06 Advance Payments. No insurer shall refuse to grant advance
payments on a claim because the claimant, insured or authorized representative
of either has retained an attorney for the purpose of facilitating recovery on
his behalf.
Source. #1900, eff 1-1-82; ss by #4287, eff 7-1-87;
ss by #5649, eff 7-1-93; ss and moved by #6999, eff 5-24-99 (from Ins 1001.07)
), EXPIRED: 5-24-07
New.
#8900, eff 7-1-07 (from Ins 1001.07)
Ins 1001.07 Physician's
Examination. Unless otherwise provided by law, when a
disability benefits claim has been accepted by an insurer under either an
individual accident and health policy or group policy, the insurer shall not
require additional reports from the insured's or beneficiary's physician to
substantiate disability which has already been established by a prior report.
Source. #1900, eff 1-1-82; ss by #4287, eff 7-1-87;
ss by #5649, eff 7-1-93; ss and moved by #6999, eff 5-24-99 (from Ins 1001.08),
EXPIRED: 5-24-07
New.
#8900, eff 7-1-07 (from Ins 1001.08)
Ins 1001.08 Insurers
Use of Unlicensed Adjusters Prohibited. No insurer shall employ or otherwise utilize
the services of an adjuster unless that adjuster has complied with all the
appropriate licensing provisions of RSA 402-B or has been granted a temporary
license pursuant to RSA 402-B:11.
However, any claim adjusted to the satisfaction of an insurer and the
claimant by an unlicensed adjuster shall bind the insurer.
Source. #1900, eff 1-1-82; ss by #4287, eff 7-1-87; ss
by #5649, eff 7-1-93; ss and moved by #6999, eff 5-24-99 (from Ins 1001.09),
EXPIRED: 5-24-07
New. #8900,
eff 7-1-07 (formerly Ins 1001.13)
Ins 1001.09 Telephone Communications With Claims
Department. Every insurer shall provide telephone
facilities whereby the insured, claimant, or authorized representative of
either can, without expense, contact the company claims office handling the
particular claim. If the company has no
claims office located in
Source. #1900, eff 1-1-82; ss by #4287, eff 7-1-87;
ss by #5649, eff 7-1-93; ss and moved by #6999, eff 5-24-99 (from Ins 1001.10),
EXPIRED: 5-24-07
New.
#8900, eff 7-1-07 (formerly Ins 1001.14)
Ins 1001.10 Other Insurer
Responsibilities.
(a) If, under the
provisions of RSA 417:4, XV(a)(12), the insured fails or refuses to submit a
report of the loss to the insurer, this shall be considered to be a request by the
insured not to pay the claim.
(b) The insurer shall
adjust all claims in accordance with the provisions of the
Source. #1900, eff 1-1-82; ss by #4287, eff 7-1-87;
ss by #5649, eff 7-1-93; ss and moved by #6999, eff 5-24-99 (from Ins 1001.11),
EXPIRED: 5-24-07
New.
#8900, eff 7-1-07
Ins 1001.11 Penalty. Any insurer or representative thereof who
shall knowingly violate any provision of this part shall be subject to the provisions
of RSA 400-A;15, III.
Source. #1900, eff 1-1-82; ss by #4287, eff 7-1-87;
ss by #5649, eff 7-1-93; ss and moved by #6999, eff 5-24-99 (from Ins 1001.12),
EXPIRED: 5-24-07
New. #8900,
eff 7-1-07 (formerly Ins 1001.16)
PART Ins 1002 CLAIM SETTLEMENT FOR PROPERTY & CASUALTY
INSURANCE
Statutory Authority: RSA 400-A:15,
Ins 1002.01 Purpose
and Scope.
(a) The purpose of this part is to
establish claim settlement standards for all property and casualty insurance,
except workers' compensation and policies for large commercial policyholders as
defined in RSA 412:3, XI., unless otherwise provided by law.
(b) This part is applicable to all
licensed property and casualty insurers.
Source. #8900, eff 7-1-07
Ins 1002.02 Definitions.
(a) "Claim file" means
the complete and specific claim file record of events and dates maintained to
show clearly the inception, handling, and disposition of each claim.
(b) "Claimant" means any person who sustains bodily
injury or property damage and who asserts a right to recover for damages
against an insured. The term
"claimant" includes the claimant's authorized representative acting
on behalf of the claimant.
(c) "Communications"
means all correspondence and contact(s), regardless of source or type, that is
materially related to the handling of the claim.
(d) "Documentation"
means, but is not limited to, all communications, transactions, notes, work
papers, claim forms, bills and statement of loss relative to the claim.
(e) "Fair market value"
means the price at which an asset would change hands between a willing buyer and
a willing seller when neither is under compulsion to act and both have
knowledge of all facts relevant to the sale.
(f) "Independent repair shop
or facility" means any entity that:
(1) Provides automobile repair
services; and
(2) Has no arrangement with
respect to repair prices or services with the insurer making a payment for
settlement of the damaged motor vehicle; but might have arrangements with
respect to repair prices or services with other insurers.
(g) "Insured" means, for
the purposes of this rule only, a person or persons who are included in the
definition of an insured as set forth in the insurance policy. The term "insured" includes the insured's authorized
representative acting on behalf of the insured.
(h) "Investigation" means
the initial contact or documented attempted contact with the insured or
claimant and all activities of an insurer directly or indirectly related to the
determination of liabilities under coverages afforded by an insurance policy.
(i) "Local market area"
means a maximum distance of 75 miles surrounding the area where the motor
vehicle is principally garaged and not limited to the geographic boundaries of
the state of
(j) "Motor vehicle"
means motor vehicle as defined in RSA 259:60 I.
(k) "Notice of a claim"
means any notification, whether in writing or other means acceptable under the
terms of an insurance policy, to an insurer or its appointed producer, by an
insured or claimant, that apprises the insurer of the facts pertinent to a
claim.
(l) "Uninsured motor
vehicle" means a motor vehicle that is:
(1) Not insured under any
insurance policy;
(2) An insured motor vehicle for
which the insurer is unable to make payment within the insured liability limits
due to insolvency; or
(3) An insured motor vehicle that
at the time of the accident had limits of liability insurance that were lower
than the minimum limits required for a motor vehicle liability policy pursuant
to applicable law.
Source. #8900, eff 7-1-07
Ins 1002.03 Computation of Time.
(a) Unless otherwise specified, all time periods referenced in this part
shall be calendar days.
(b) Computation of any period of time referred to
in this part shall begin with the day after the action which sets the time period in motion, and shall include
the last day of the period so computed.
(c) If the last day of the period so computed
falls on a Saturday, Sunday or legal holiday, then the time period shall be extended to include the first
business day following the Saturday, Sunday, or legal holiday.
Source. #8900, eff 7-1-07
Ins 1002.04 Communications Time Limit.
(a) Notice of a claim given by an
insured or claimant to an insurer’s appointed producer shall be considered
notification to the insurer, unless:
(1) Otherwise provided by law or
the policy; or
(2) The appointed producer
notifies the insured or claimant within 5 working days of receipt of notice of a
claim that the appointed producer is not authorized to receive notices of
claims.
(b) Every insurer shall reply in no later than 10
working days to all claims communications from insureds or claimants. Receipt of documentation or information by an
insurer that was requested of the insured or claimant is a communication subject to response under this section.
(c) Every insurer, upon receipt of
an inquiry from the insurance department shall within 10 working days furnish
the department with a complete and accurate written
response to the inquiry.
Source. #8900, eff 7-1-07
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
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 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.
(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, 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.
Source. #8900, eff 7-1-07
Ins 1002.06 Additional
Information Required in Accepting or Denying Claims.
(a) In addition to the provisions
of Ins 1002.05 if a claim is denied in whole or in part the insured or claimant
shall be given a written notice of the reason for the denial and any applicable
policy provision upon which denial is based, provided however that if the
reason for the denial is fraud the notification shall be deemed sufficient if
it provides a general statement explaining that the damage did not occur in the
manner reported by the insured and/or claimant.
(b) Every insurer shall provide
with each claim payment, either on the check, draft or in a letter, the reason
for the payment and the date of loss, for example, collision payment for your
accident on (date), homeowner contents payment for your fire loss on (date) or
property damage loss to your motor vehicle as the result of an accident on
(date).
Source. #8900, eff 7-1-07
Ins 1002.07 Undisputed Amounts. In
any case where there is no dispute as to one or more elements of the claim, an
offer of settlement for such undisputed elements shall be made without
prejudice to either party notwithstanding the existence of disputes as to other
elements of the claim.
Source. #8900, eff 7-1-07
Ins 1002.08 Advance
Payments. No insurer shall refuse to grant advance payments on a claim because the
insured or claimant has retained an attorney for the purpose of facilitating
recovery on his behalf.
Source. #8900, eff 7-1-07
Ins 1002.09 Value of Total Losses – (Other than Motor
Vehicle). When the insured's or claimant's property has
been determined to be a total loss, and there is no dispute concerning liability
or coverage, and the provisions of RSA 407:11 do not apply, insurers attempting
to establish the value of the property shall:
(a) Value the property in the community where the total loss
property is located;
(b) Be prohibited from using arbitrary
methods to establish the value of the property that do not take into
consideration the specific characteristics of the property;
however, this shall not preclude the
insurer from making an offer of settlement on property based upon the fair
market value of like, kind and quality property wherever situated.
(c) Consider as an element of
damages additional costs incurred in purchasing and shipping the property.
(d) In addition to
the above requirements, every total loss settlement made or offered by the
insurer to replace lost or damaged jewelry, watches, precious, or semi-precious
stones, under applicable property insurance, shall comply with the provisions
of Ins 1002.18
Source. #8900, eff 7-1-07; amd by #9495, eff 6-29-09
Ins 1002.10 Insurers Use of Unlicensed Adjusters
Prohibited. No insurer shall employ or otherwise utilize
the services of an adjuster unless that adjuster has complied with all the
appropriate licensing provisions of RSA 402-B or has been granted a temporary
license pursuant to RSA 402-B:11, however, any claim adjusted to the
satisfaction of an insurer and the insured or claimant by an unlicensed
adjuster shall bind the insurer.
Source. #8900, eff 7-1-07
Ins 1002.11 Communications With Claims Department. To facilitate communication, every insurer
shall provide a toll-free telephone number on all forms or correspondence and if it chooses to do so, a
facsimile number and/or e-mail address whereby the insured or claimant can
contact the company claims office, independent adjuster or appraiser handling
the particular claim.
Source. #8900, eff 7-1-07
Ins 1002.12 Other Insurer Responsibilities.
(a) Prior to concluding that there
is no coverage for the loss as a result of the insured's failure to comply with
any obligation imposed on the insured under the policy, the
insurer shall:
(1) Establish that the breach was a material breach
that excuses the insurer from performance under the insurance policy;
(2) Document the basis for concluding that the
breach is material in the claim file.
(b) An insurer shall not refuse to
make an evaluation of the insured's liability in any claim because the insured
requests that the insurer not make a claim payment for a reported loss.
Source. #8900, eff 7-1-07
Ins 1002.13 Loss of Use. In all motor vehicle property
damage liability claims when liability has become clear the insurer shall:
(a) Immediately inform the claimant that coverage exists for the rental of a motor
vehicle that is of like kind and quality for the time period necessary for
repair provided however that the insurer shall:
(b) Not be required to provide coverage for that portion of the
motor vehicle rental that the insurer establishes is required due to an
unreasonable delay in the repair caused by the direct action or inaction of the
claimant;
(c) Document the basis for the
finding of unreasonable delay pursuant to (b) above in the claim file.
(d) Be able to deduct the costs
that would have been incurred in the operation of the claimant's own motor
vehicle from the total costs of renting and operating the
rented motor vehicle, provided, however that if the claimant does not have
comprehensive and collision insurance coverage as required by the rental
company, the insurer shall pay the reasonable cost of the comprehensive and
collision coverage.
(e) Specifically document the
claim file with evidence to show that a rental was offered to the claimant.
Source. #8900, eff 7-1-07
Ins 1002.14 Estimates. The insured or claimant shall only
be responsible for the cost of one damage estimate for motor vehicle property
damage liability and collision and comprehensive claims. The insurer shall be responsible for any
charge incurred by the insured or claimant for a second or any subsequent damage
estimates required by the insurer.
Source. #8900, eff 7-1-07
Ins 1002.15 Determining Amount of
Motor Vehicle Total Loss Claims.
(a) In adjusting motor vehicle total
loss property damage liability and collision and comprehensive damage claims, insurers shall determine total loss
settlement based upon the motor vehicle’s fair market value using one of the
following methods:
(1) The average retail value derived from the
application of a process or methodology that the department accepts as a
statistically valid method of establishing fair market value in the local
market area, developed and submitted according to the following guidelines:
a. In order for a methodology to be acceptable,
the insurer, or vendor on behalf of the insurer, shall submit to the department
a description of their methodology or model accompanied by supporting
details. Supporting details shall include
a discussion of how the valuation process or model is designed and an
analytical and/or statistical validation of the assumptions, parameters, data
elements and results of the process or model.
b. The department will publish a list annually, at
the beginning of the calendar year, of accepted valuation guides and
methodologies;
c. If there are any changes made to the process
or methodology provided to the department pursuant to (1)(a) above, the insurer
or vendor shall provided the department with details as to the changes being
made so that the department can determine whether the process or method will
remain on the accepted list.
d. Information submitted to the department
pursuant to this section shall be:
1.
Considered confidential and commercial information under RSA 91-A:5, not
subject to disclosure; and
2.
Treated as confidential by the commissioner pursuant to RSA 400-A:25.
(2) Documented sales cost of no fewer than 2
motor vehicles of the same make, model and year as the total loss motor vehicle
that have occurred within the previous 90 days within the local market area;
(3) If documented sales cost
of
a motor vehicle of the same make, model and year as the total loss motor
vehicle, as described in (a)(2) is unavailable then:
a. Documented sales cost of no fewer than 2
motor vehicles of like kind and quality that have occurred within the previous
90 days within the local market area; or
b An average sales price derived from written quotations
for a motor vehicle that is the same make, model and year as the total loss
motor vehicle, obtained by the insurer from at least 3 different licensed
dealerships located within the local market area, that engage in the buying and
selling of motor vehicles of like kind and quality in the ordinary course of
their business;
(b) In conjunction with a total loss settlement offer, the
insurer shall provide to the insured or claimant a report which explains the
basis for the valuation underlying the offer.
(c) The following deviations from the valuation methods in (a)(1) through (a)(3)
shall be permitted:
(1) For construction equipment as defined in RSA
259:42 and commercial motor vehicles as defined in RSA 259:12-e,
data may be collected from outside the local market area but only to the extent
necessary to obtain sufficient data as required in (a)(1) through (a)(3) above;
(2) If the insurer can demonstrate that the motor
vehicle is a make or model vehicle not customarily found in the local market
area, data may be collected from outside the local market area but only to the
extent necessary to obtain sufficient data as required in (a)(1) through (a)(3)
above.
(d) If the insured or claimant disagrees
with the value derived from any methodology allowed under (a)(1) above, and can
demonstrate by presenting to the insurer within 15 days of receipt of the
settlement payment, evidence from 2 reliable sources that the motor vehicle
would have a higher cash value in the local market area than as represented by
the total loss settlement, then the insurer shall recalculate a new total loss
settlement considering this reliable evidence in determining a revised total
loss settlement.
(e) Reliable sources shall be
limited to the following:
(1) Any objective documented process or
methodology that the department accepts pursuant to section (a)(1);
(2) Actual sales of one or more motor vehicles of
the same make, model and year as the total loss motor vehicle, that have
occurred within the previous 90 days within the local market area;
(3) Actual sales of one or more motor vehicles of
like kind and quality that have occurred
within the previous 90 days within the local market area; or
(4) At least 2 written quotations for a motor
vehicle of the same make, model and year, obtained from licensed dealerships
located within the local market area, that engage in the buying and selling of
motor vehicles of like kind and quality in the ordinary course of their
business.
(f) Fair market value as
determined in (a) (1) through (3) and (e) (1) through (4) above shall be
adjusted to reflect motor vehicle condition, high and low mileage and accessory
options if not otherwise provided for in the methodology or data source;
(g) Betterment or depreciation
adjustments to total loss value shall be calculated as follows:
(1) Betterment
deductions shall be allowable only if the deductions:
a. Reflect a measurable decrease
in fair market value attributable to prior damage to the motor vehicle,
considering its age, for any of the following:
1. Normal wear and tear or rust,
limited to no more than a deduction of $1,000;
2. Missing parts, limited to the
reduction in the fair market value of the vehicle as a result of the missing
parts;
3. Damage to the motor vehicle
limited to the reduction in the fair market value as a result of the damage.
b. Are measurable, itemized, specified
as to dollar amount and documented in the claim file.
(2) No insurer
shall require the insured or claimant to supply parts for replacement.
(3) No insurer
shall decrease market value for motor vehicle reconditioning or dealer
preparation costs.
(4) No insurer
shall reduce or attempt to reduce for depreciation any settlement or any offer
of settlement for motor vehicle accessory options not adversely affected by
age, use, or obsolescence.
(h) The provisions of (d) above shall
not apply if the insurer included in its documentation at the time of
settlement, a written notification of the availability and location in the
local market area of a specified and comparable vehicle of the same manufacturer, same year, similar body style and
similar options, in as good or better condition as the total loss vehicle,
which could have been purchased for an amount equal or less than the fair
market value of the total loss vehicle as determined by the insurer. The documentation shall include the vehicle
identification number.
(i) If the insured or claimant
chooses to keep the motor vehicle, the settlement payment shall be the
difference between the total loss value as determined in (a) through (g) above
and the salvage value for a motor vehicle of like kind and quality. Salvage value shall be calculated based on
the salvage value available within a 150 mile radius of the insured's or
claimant's residence or upon the salvage value available to the insurer from
any salvage facility that is utilized by the insurer in the normal course of
the insurer's business. Any costs that
the insurer would have incurred for storage or transportation to any salvage
facility shall be deducted from the salvage value.
Source. #8900, eff 7-1-07
Ins 1002.16 Willing and Able Contractors and Repairers; Other Than Motor
Vehicle.
(a) Every settlement made or
offered upon the basis of an appraisal conducted on behalf of the insurer
relative to property and liability insurance
shall:
(1) Include a written statement that if the
claimant or insured cannot find a contractor or repairer to do the repair or
replace the damage property for the price quoted, then the insured or claimant
may request that the insurer supply the insured or claimant with the name and
address of any known recognized, competent and conveniently located contractor
or repairer who is ready, willing and able to repair or replace the damaged
property with other of like, kind and quality for the price quoted in the
appraisal or as otherwise provided for in the insurance policy.
(2) If the insurer provides the insured or
claimant with the name of a contractor or repairer as set forth in (a)(1) above, the
insurer shall also provide a written disclosure that any contractor or
repairer may be used at the discretion of the insured or claimant.
(3) If the insurer is unable to provide the name
of a contractor or repairer upon request, then any fair and reasonable cost
incurred to repair or replace the damage as set forth in the appraisal, in
excess of the insurer's appraisal price, shall be at the expense of the
insurer. If the insurer has provided the
insured or claimant with the name of a contractor or repairer who is ready,
willing and able to repair or replace the damaged property with other of like,
kind and quality for the price quoted in the appraisal and the insured or
claimant uses another contactor or repairer, then any cost in excess of the
insurer's appraisal prices shall not be at the expense of the insurer.
(b) The
insured or claimant shall be entitled to the usual and customary guarantees as
to materials and workmanship relative to the property that is being repaired or
replaced.
(c) In processing
any claim for damage to a home, dwelling or other property, the insurer shall
not require as a condition to the payment of such claims that repairs be made
by a particular contractor or repairer.
(d) Any settlement made based upon
an agreement negotiated by an adjuster on behalf of the insurer with a
contractor or repairer shall include a provision for coverage of hidden damage
that is determined to be connected with the claim in question.
(e) For all claims, insurers and
their adjusters, whether hired under contract or employed, shall not make any
coercive, threatening, or intimidating
statements at any time, orally or in writing, to an insured or claimant for the purpose of
influencing the insured’s or claimant's choice of a particular contractor or
repairer.
(f) In addition to
the above requirements, every settlement made or offered by the insurer to
repair or replace damaged jewelry, watches, precious, or semi-precious stones,
under applicable property insurance, shall comply with the provisions of Ins
1002.18.
Source. #8900, eff 7-1-07; amd by #9495, eff 6-29-09
Ins 1002.17 Willing and Able Repair Facilities; Motor
Vehicle Insurance.
(a) Every settlement made or
offered upon the basis of an appraisal conducted on behalf of the insurer
relative to motor vehicle insurance shall:
(1) Represent the fair and reasonable price in
the area charged by repair shops or facilities providing similar services with the
usual and customary guarantees as to materials and workmanship.
(2) Include a written statement that the insurer
shall supply to the insured or claimant the name and address of a recognized,
competent and conveniently located repair shop or facility who is willing and
able to repair or replace the damaged motor vehicle with other of like, kind
and quality within a reasonable time for the price quoted in the
appraisal.
(3) Include in the written statement a disclosure
that any repair shop or facility may be used at the discretion of the insured
or claimant.
(b) The insured
or claimant shall be entitled
to the usual and customary guarantees as to materials and workmanship relative
to the motor vehicle that is being repaired or replaced.
(c) If the insurer is unable to
provide the name of a repair shop or facility upon request, any additional
repair or replacement costs incurred in excess
of the insurer’s appraisal price shall be at the expense of the insurer.
(d) In processing any claim for any
damage to a motor vehicle, the insurer shall not require as a condition to the
payment of such claims, that repairs be made in a particular repair shop or
facility.
(e) Insurers specifying the use of
after market parts shall:
(1) Pursuant to RSA 407-D:4 not require the use
of after market parts unless the parts are at least equal in like kind and
quality to the original part in terms of fit, quality and performance. Accordingly, no insurer shall require the use
of such part unless the insurer states or certifies in writing that the part is
of like kind and quality; and
(2) Consider the cost of any modifications,
re-repairs or delays that might become necessary when making the repair.
(f) Any settlement made based upon
an agreement negotiated by an appraiser or an adjuster on behalf of the insurer
with a repair shop or facility shall include a provision providing for coverage
of hidden damage that is determined to be connected with the claim in question.
(g) If an independent repair shop
or facility and an insurer are unable to agree on a price, and the insurer has
complied with (a) through (f) above, then:
(1) The price shall be the price available from
any other recognized, competent and conveniently located independent repair
shop or facility that is willing and able to repair the damaged motor vehicle
within a reasonable time; and
(2) The insurer shall furnish to the insured or
claimant a written statement
containing the following disclosure:
“Under
(h) For all claims, insurers and
their appraisers and adjusters, whether hired under contract or employed, shall
not make any coercive, threatening, or intimidating statements at any time,
orally or in writing, to insureds or claimants for the purpose of influencing
the insureds’ or claimants’ choice of repair shop or facility.
Source. #8900,
eff 7-1-07
Ins 1002.18 Additional Requirements, Settlement of
Jewelry Claims.
(a) In addition to
any other requirements set forth in this part, every settlement made or offered
by the insurer to replace or repair lost or damaged jewelry, watches, precious,
or semi-precious stones, under applicable property insurance, shall also:
(1) Be based upon an appraisal which reflects
values of such property of like kind and quality found in the local market
area; and
(2) Include a notice to the insured or claimant
that they may request an appraisal from an appraiser having no arrangement with
the insurer, and of their choosing, in order to receive validation that the
insurer's settlement offer reflects a fair market value and that the resulting
repaired or replaced property will be of like kind and quality.
(b) If the insurer
provides the insured or claimant with the name of the seller or repairer as set
forth pursuant to Ins 1002.16 (a)(1), the insurer shall also provide a written
disclosure as to the nature of any business arrangement between the insurer and
the seller or repairer.
Source. #9495, eff 6-29-09
Ins 1002.19 Miscellaneous Provisions.
(a) Pursuant to RSA 417-A:11 an
insurer shall not apply an insured's collision deductible when the damage is:
(1) Caused by an uninsured motor vehicle, and
(2) The operator of the uninsured motor vehicle
has been positively identified; and
(3) The operator of the uninsured motor vehicle
is solely at fault.
(b) Every insurer shall exercise
due diligence in the pursuit of subrogation
on behalf of the insured. Upon receipt
of the final subrogation recovery, the insurer shall return the insured’s
portion as soon as practical but not later than 30 days from receipt of the
final recovery.
Source. #8900, eff 7-1-07; renumbered by #9495 (from
Ins 1002.18)
Ins 1002.20
Insurer Documentation. Every insurer shall maintain in its files, in either
written or electronic form, physical evidence of compliance with all of the
provisions of this part and RSA 400-B.
Source. #8900, eff 7-1-07; renumbered by #9495 (from Ins 1002.19)
Ins 1002.21 Penalty. Any insurer or representative
thereof who shall knowingly violate any provision of this part shall be subject
to the provisions of RSA 400-A:15, III.
Source. #8900, eff 7-1-07; renumbered by #9495 (from
Ins 1002.20)
APPENDIX
|
RULE |
|
|
|
|
|
Ins 1001.01 |
RSA 400-A:15 I; 417:4
XV |
|
Ins 1001.02 |
RSA 400-A:15 I; 407:12; 417:4 XV |
|
Ins 1001.03 |
RSA 400-A:15 I; 417:4 XV; 417:4 XVII |
|
Ins 1001.04 |
RSA 400-A:15 I; 407:12-a; 417:4 XV |
|
Ins 1001.05 |
RSA 400-A:15 I; 417:4 XVII |
|
Ins 1001.06 |
RSA 400-A:15 I; 417:4 XV |
|
Ins 1001.07 |
RSA 400-A:15 I; 412:12 |
|
Ins 1001.08 |
RSA 400-A:15 I; 402-B |
|
Ins 1001.09 |
RSA 400-A:15 I; 417:4
XVII |
|
Ins 1001.10 |
RSA 400-A:15 I; 417:4
XV |
|
Ins 1001.11 |
RSA 400-A:15 I; 417:6;
417:10 |
|
|
|
|
Ins 1002.01 |
RSA 400-A:15 I; 417:4
XV |
|
Ins 1002.02 |
RSA 400-A:15 I |
|
Ins 1002.03 |
RSA 400-A:15 I; 417:4
XV; 417:4 XVII. |
|
Ins 1002.04 |
RSA 400-A:15 I; 417:4 XV;
417:4 XVII |
|
Ins 1002.05 |
RSA 400-A:15 I;
407:12; 417:4 XV; 417:4 XVII |
|
Ins 1002.06 |
RSA 400-A:15 I;
407:15; 417:4 XV |
|
Ins 1002.07 |
RSA 400-A:15 I;
407:12-a; 417:4 XV |
|
Ins 1002.08 |
RSA 400-A:15 I; 417:4
XV |
|
Ins 1002.09 |
RSA 400-A:15 I; 407:11;
417:4 XV |
|
Ins
1002.09 (d) |
RSA
400-A:15, |
|
Ins 1002.10 |
RSA 400-A:15 I; 402-B |
|
Ins 1002.11 |
RSA 400-A:15 I; 417:4
XVII |
|
Ins 1002.12 |
RSA 400-A:15 I; 417:4
XV; 417:4 XVII |
|
Ins 1002.13 |
RSA 400-A:15 I; 417:4
XV |
|
Ins 1002.14 |
RSA 400-A:15 I; 417:4
XV |
|
Ins 1002.15 |
RSA 400-A:15 I; 417:4
XV, XX |
|
Ins 1002.16 |
RSA 400-A:15 I; 407:12 |
|
Ins
1002.16 (f) |
RSA
400-A:15, |
|
Ins 1002.17 |
RSA 400-A:15 I;
407-D:3; 407-D:4; 417:4 XV; 417:4 XVII; 417:4 XX |
|
Ins
1002.18 |
RSA
400-A:15, |
|
Ins 1002.19 |
RSA 400-A:15 I; 417:4
XV |
|
Ins 1002.20 |
RSA 400-A:15 I;
417-A:11 |
|
Ins 1002.21 |
RSA 400-A:15 I; 400-B |