There is a growing antagonistic relationship between insurance companies and their policyholders in Nevada. Disputes are frequent when it comes to trying to get a maximum payout for loss and the claimant is often unsure of their options. There are also confusing terms in the insurance industry that can leave people wondering if the insurer is behaving in a legal manner.
One such issue is first-party claims. This is when a person files a claim against their own policy. State law has certain requirements for the insurer. If there are delays, unreasonable denials, or any other problem with a claim, it is imperative that the policyholder understands their rights.
What are insurers legally obligated to do with a first-party claim?
When the insurer has received proof of loss, the claimant will be informed of approval or denial of the claim within 30 days. If they issue a denial, it must be referenced in the policy provisions, conditions, or exclusions. In other words, the denial must be made based on the details of the policy and what the claimant had agreed to. It must be given in writing and kept in the claim file.
When the insurer approves the claim, the payment must be made within 30 days of it having been accepted. Payments not made in that time frame will accrue interest, calculated from the date the payment is due. If there is a denial for any other reason and it is not done in writing, there must be a notation placed in the claim file.
Some claims cannot be decided within 30 days. The claimant will then need to be informed of the delay within 30 working days. They must also say why there will be a delay. It could be due to an incomplete investigation. In that instance, they will have 30 days to inform the claimant and continue to do so every 30 days.
The insurer cannot simply delay without justification for doing so. Some reasons for a delay include particularly complex cases, an absence of information, a dispute over liability, or the insurer acting in bad faith.
First-party claims can be complicated and help might be necessary
People who have filed a first-party claim with their insurance company and believe the company is not acting as it is legally obligated to regarding the claim need to know their rights. The purpose of insurance is to be protected in case of loss, but the company also wants to mitigate costs. To make sure the case is decided fairly, it is important for claimants to have assistance from those who are widely experienced in insurance law.
