Inform insureds of available coverages
Begin reasonable investigation immediately
Ask insureds if closed due to COVID-19 on staff, or due to civil authority
Have several managers review claims
Timely send reservation of rights letters
Properly document file with coverage determination reasons
Timely send declination of coverage letters

Don't

Allow insureds to believe they have coverage for loss
Wait for courts to interpret coverage
Remain silent regarding coverage
Assume all claims will be denied
Hide coverage questions from insureds
Be cryptic about coverage determination in claim notes
Conceal investigative findings from insured

Adjusting COVID-19 claims appears routine: adjusters review the policy, determine coverage, and resolve the claim. The Model National Association of Insurance Commissioners (NAIC) Unfair Claims Settlement Practices Act has regulations, which most states have adopted, concerning the refusal of paying claims without conducting a reasonable investigation and failing to provide a reasonable and accurate explanation for denying claims.

Special Reports /

Adjusting COVID-19 claims

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