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Everette Lee Herndon, Jr.

Claims Consultant and Expert Witness

CLAIM-HANDLING GUIDELINES


Claims Magazine provides free guidelines and regulations in order to help adjusting professionals stay abreast of each state's unique property and casualty claim-handling requirements. Each guideline features an explanation of the act to be performed, compliance time-frames for each act, and hyper-linked references to each state's insurance code. The links were compiled by compiled by Lynch & Associates, www.northlaw.com. We hope you find them useful and informative. Please note that these guidelines were updated in 2010, but occasional changes in each state's code are to be expected. These guidelines should be used as a reference only, and do not supercede each state's published regulations.

http://www.propertycasualty360.com/1969/12/31/claims-magazine-claim-handling-regulations


The National Association of Insurance Commissioners (NAIC) issued some Model Laws which have been adopted in whole or in part by many states in the form of Unfair Claims Handling Acts or Guidelines or Regulations.

Model # 900 - Unfair Claims Settlement Practices Act

Model # 902 - Unfair Property/Casualty Claims Settlement Practices Model  Regulation

They can normally be purchased individually.

More information or copies of the Model Laws can be ordered from:

http://www.naic.org

http://www.naic.org/store_pub_legal.htm


United Policyholders, a consumer advocate organization, has prepared and posted  Guidelines for Reviewing Adjusters’ and Contractors’ Estimates to Repair/Rebuild Your Home  as well as providing many other useful tips for dealing with insurance claims.

http://www.unitedpolicyholders.org/pdfs/Guidelines_Estimates.pdf


Mike Johnston, a trial lawyer from Oklahoma who practices in the area of insurer's bad faith, has prepared a list of what he considers the "Top 40" types of acts of bad faith by insurance companies:   The Bad Faith Top 40

http://www.quatloos.com/traps/badfaith.htm


Thomas F. Segalla published a quite lengthy and well researched article entitled Bad Faith as a Continuum: From Claim to Trial, available on The Federation of Defense and Corporate Counsel website.  The article appeared in the FICC QUARTERLY, Vol.  52, No. 1, Fall, 2001

http://www.thefederation.org/documents/segalla.htm


For a quick summary of where your state may stand on Bad Faith as a cause of action, either tort or contract, check out the Policyholders of America web-site at http://www.policyholdersofamerica.org/does_your_state_punish_bad_faith.pdf  for a chart covering the 50 states. For definite information on your state, consult a local attorney as laws change frequently.


ADJUSTER PROFESSIONAL CODE OF ETHICS


The Canons and Rules of the Code of Professional Ethics

By:   Chartered Property Casualty Underwriters Society

http://www.aicpcu.org/doc/canons.pdf


Ethics Guidelines   

By:    Society of Registered Professional Adjusters

http://www.rpa-adjuster.com/ethics.html


Code of Conduct:  Rules of Professional Conduct and Ethics   

By:    National Association of Public Insurance Adjusters

http://www.napia.com/learn/code-conduct.asp


IASIU Code of Ethics

By:     International Association of Special Investigation Units (IASIU)

https://www.iasiu.org/about_us/code_of_ethics


THE FUTURE


Factory and Firm:  The Future of Claims Handling  by McKinsey & Company

The evolving of claims handling - good or bad?

https://www.mitchell.com/mcms/content/pub/White_Papers/McKinsey_Factory-Firm_whtp-1962.pdf


PROBLEM AREAS TO BE AWARE OF


The Ten Worst Insurance Companies in America: How They Raise Premiums, Deny Claims, and Refuse Insurance to Those Who Need it Most   

By:   American Association for Justice  [Formerly the Association of Trial Lawyers of America (ATLA)]

The Ten Worst Insurance Companies

1. Allstate

2. Unum

3. AIG

4. State Farm

5. Conseco

6. WellPoint

7. Farmers

8. UnitedHealth

9. Torchmark

10. Liberty Mutual

http://www.justice.org/resources/AAJ_Report_TenWorstInsuranceCompanies_FINAL.pdf


The “Good Hands” Company or a Leader in Anti-consumer Practices?   Excessive Prices and Poor Claims Practices at the Allstate Corporation      July 18, 2007

By:  J. Robert Hunter,  Director of Insurance,  Consumer Federation of America (CFA)

A report by the  CFA  on their findings following their investigation of Allstate’s business practices

http://www.consumerfed.org/elements/www.consumerfed.org/file/finance/Allstate_Report _07_18_07.pdf


Property/Casualty Insurance in 2007: Overpriced Insurance, Underpaid Claims, Declining Losses and Unjustified Profits January 8, 2007      

By:   J. Robert Hunter,  Director of Insurance,  Consumer Federation of America

This report concludes that:  “The property/casualty industry has been remarkably successful in recent years in maximizing profit through rate increases, coverage reductions, inappropriate claims practices and the shifting of high risks onto taxpayers.”

http://www.consumerfed.org/pdfs/2007Insurance_White_Paper.pdf


Patterns of Greed 2007:  How Insurance Companies Put Profits over Policyholders

By:   American Association for Justice  [Formerly the Association of Trial Lawyers of America (ATLA)]

According to this report, “the insurance industry has made a practice of collecting billions of dollars from policyholders over the years and then stiffing them in their time of greatest need.”

Patterns of Greed 2007


An Insurer in the Grip of Greed

By:   David J. Bernardinelli.   Published in TRIAL, July 2007

A discussion of Allstate Corp and McKinsey & Co. And a re-design of Allstate’s claims handling

An Insurer in the Grip of Greed


CNN 360 Anderson Cooper - Auto Insurance

Video - Part 1  -

http://www.youtube.com/watch?v=IvPW087RiJ8&feature=related


Video - Part 2 -   

http://www.youtube.com/watch?v=pkq-CX17aO8&feature=related