Washington has laws in place to protect insurance policy holders from unfair insurance claim settlement practices. The law defines what counts as unfair treatment and sets guidelines for communications and processing claims. You may want to document all interactions to ensure that your insurer is fulfilling all their obligations, and you will want to familiarize yourself with the guidelines insurers must follow.
Prompt responses
Washington’s insurance law gives providers up to 10 working days to respond to your initial claim upon receiving it, and this communication guideline also applies to all communications thereafter. Providers must also send you the necessary forms and information that you need to continue with your claim.
Fast claim investigations
In most situations, providers only have a maximum of 30 days to finish the investigation process. The time starts upon receipt of your claim. Providers might have more time to investigate if they can’t reasonably finish within 30 days. If the provider needs more time to investigate, then they need to notify you within 15 working days. They must provide the reason for needing more time.
Notification of approval or denial
You must have notification of approval or denial within 15 working days after the provider receives your proof of loss unless the provider uses the full 30 days to perform an investigation. When an insurer denies a claim, insurance law requires that they point out which provision in their policy is the basis for denial. Claim denials must be in writing as well.
Other unfair claim practices
The law protects you from insurers who misrepresent facts or provisions. It’s illegal for insurers to deny claims without conducting a fair investigation. Failure to pay claims that insurance policy holders should receive is also against the law.
Knowing your rights as an insurance policy holder in Washington helps protect you from unfair claim practices. Working with a lawyer will also ensure a favorable outcome.