Insured v Insurer: Motivating Insurers

Posted on behalf of Rizk Law on Nov 30, 2009 in Insurance Issues

You paid thousands in insurance premiums and have presented few, in any, claims until now. As a loyal customer you innocently believed that if someday you made a claim, it would be promptly and fairly resolved. Wrong!

Instead of quick claim resolution, you were delayed, denied and treated like a petty criminal. Instead of prompt claim payment, you now face a “no win” choice: accept a denied claim or file suit. What a way to treat a loyal customer?! Good news for Oregon policyholders: there are ways to set up and motivate your insurer in this situation.

First, send your insurer and agent a written “Proof of Loss”. Label the letter “PROOF OF LOSS” in big letters at the top. This “Proof of Loss” letter should describe the loss in sufficient detail so to “permit an insurer to estimate its obligations.” In other words, the letter should plainly and accurately describe the loss and the events and persons involved. Include copies of relevant, favorable photos and estimates. Don’t say what you don’t know.

Next, fax and mail (certified) the “Proof of Loss” to BOTH your agent and claims examiner. Print out the fax confirmation sheets and keep the return postcard. Keep a copy of everything you sent your insurer.

Now, should you eventually be awarded more than the amount offered by your insurer within 6 months of the insurer’s receipt of the proof of loss, your insurer will be exposed to attorney fees should a suit be needed. ORS 742.061. Since insurers don’t want to pay your fees in addition to the claim, many insurers will now be more reasonable about claim value. In the event you take the case to trial, a trial judge now has a basis to award fees.

ORS 742.061 applies to many, but not all, insured v. insurer suits (where you have to sue your own insurer or your own insurer sues you, over insurance coverage). ORS 742.061 may not apply, for example, to uninsured or underinsured auto claims where the only issues are liability and damages, and the insurer, in writing, consents to binding arbitration within 6 months of the loss. See, Scott v. State Farm Mutual Ins. Co.