With the Imminent Arrival of Hurricane
Maria in Puerto Rico, we are re-posting our claims checklist for Puerto Rico
Insurers Should Keep in Mind the
Following Claim Handling Requirements from the Puerto Rico Insurance Code
- Response to Notice of
Loss – 15 Days.
Acknowledge the claim in writing and commence investigation within 15
days. 26 L.P.R.A. §2714
- Provide the Insured
with a Copy of the Policy – 10 Days. Insurer must provide a copy of the policy
within 10 days of being requested to do so. 26 L.P.R.A. §2703a
- Investigation and
Resolution of Claim – Less than 90 Days after Notice. The investigation,
adjustment and resolution of any claim must be done in the “shortest
reasonable period of time”, but no more than 90 days. 26 L.P.R.A.
§2716b(1)
- Document Extension
Needs.
If a claim cannot be completed within 90 days the claim file should
contain documents detailing the existence of just cause to exceed the 90
days. 26 L.P.R.A. §2716b(2)
- Resolution of a claim
means the full payment of the claim, the written and duly justified denial
of claim or closure of the claim for non-cooperation. 26 L.P.R.A.
§2716c.
- If an insurer has
“well grounded knowledge” of any fraudulent acts as part of a claim
submission, the insurer is required to report that information to the
Insurance Commissioner. 26 L.P.R.A. §2726
Additional Considerations:
- A reservation of
rights
should be issued as appropriate.
- Civil Authority –
Mandatory evacuations may be issued in advance of Irma.
- Service Interruption
– Power and telephone/cell service may be disrupted.
- Sue and Labor –
Businesses may shut down operations in advance.
- Adjuster licensing – Puerto Rico
requires all adjusters and public adjusters to be licensed in Puerto Rico.
However, the Insurance Codes provide that no license from Puerto Rico
shall be required of a nonresident independent adjuster for the adjustment
in Puerto Rico of a single loss or of losses arising from a catastrophe
common to all such losses. 26 L.P.R.A. §952(3). The Commissioner may also
grant a special emergency permit as adjuster to any person qualified for
adjusting losses arising from a general catastrophe after the presentation
of the application for the special permit. 26 L.P.R.A. §952(4).
- Flood hazard zone
areas—Areas identified on the Flood Insurance Rate Map can change so be
aware of applicable policy limits by hazard zone.
- Flood and Wind
sublimits.
Posted by Jonathan MacBride