When property damage happens and an insurance claim is filed, the policyholder must complete out a Proof of Loss. This form aids the insurance company in determining the worth of the insured’s loss. It’s usually one page long and serves as a summary of the key information required under the policy, such as supporting documentation and estimations of the insurer’s present value of loss. It is the policyholder’s responsibility to submit and justify their loss to the insurance company in an insurance claim situation; this form and its supporting documentation help the insured do just that.
The Proof of Loss form is a sworn declaration from the insured to the insurer about the extent of damage to their property that has been notarized. This information is used by the insurance company to determine their liability for the property damage. The insurance company must assess the claim after it has been submitted by the insured and react with their viewpoint on the claim.
Completing a fully documented Proof of Loss is critical to the claims procedure and the policyholder’s reimbursement; yet, if done incorrectly, your claim may be underpaid, delayed, or denied.
How to fill out a Proof of Loss form
A copy of your insurance policy is required to complete a Proof of Loss form. The policy will dictate what information must be included in a Proof of Loss, however it will require information such as:
- Estimates, inventories, invoices, and other documents that substantiate the property’s value and the amount of damage claimed;
- Parties with a stake in the property, such as the bank that holds the mortgage and the tenants.
Three items to remember when filling out a Proof of Loss form:
1.) Complete the form completely and truthfully.
Failure to correctly complete this form may result in underpayment, delay, or even denial of your claim. All of the material in this paper must be accurate and backed up by evidence. Any inaccuracies or misrepresentations could lead to a future refusal of coverage.
2.) Comply with timing constraints
The insurance policy will stipulate how long the policyholder has to fill out and submit a Proof of Loss form after damage has occurred under the part labeled “Section 1 Conditions (2) Duties After Loss.” If the insured does not comply with this deadline, their claim may be denied. It’s worth noting that the insurance company might not automatically give you a Proof of Loss form to fill out and return. In fact, it may be the policyholder’s responsibility to obtain, complete, and submit the forms ahead of time.
In some states, the time restriction for submitting a Proof of Loss begins when the insurance provider requests it in writing. Note that in most claims, the claim documentation, including estimates and inventories, is provided first, and then the actual Proof of Loss form is signed by the insured once a settlement agreement is reached.
3.) Obtain thorough estimates of the property’s damage.
It’s critical to have an exact, complete, and substantiated claim value on your Proof of Loss. This estimate must categorize and detail the property damage as well as the amount you owe as a result. Here, guesswork isn’t an option.
To prove, estimate, and acquire supporting evidence for their claim, insureds should have their own advocates and professionals who are not linked with the insurance business. While the insurance company may dispatch an adjuster to assess the damage, it is critical for the insured to have advocates prepare the claim on their behalf.
A public adjuster may not only assist you with preparing, estimating, negotiating, and settling your insurance claim, but also with minor matters such as appropriately filling out a Proof of Loss form, providing you peace of mind the first time. Public adjusters are independent contractors who work for the policyholder rather than the insurance company.
How do I fill out a proof of loss statement?
How to Fill Out a Proof of Loss Document in 6 Easy Steps
- Estimates, inventories, invoices, and other documents that support the value of your property and the amount of loss you claim.
What is proof of loss in insurance claim?
Proof of loss is documentation that establishes your ownership of specific objects in the event that they are stolen and you need to file a claim with your insurance company.
How many days does an insured have to provide proof of loss?
A Proof of Loss is a formal, legal document that specifies the amount of money the policyholder wants from the insurance company. It offers precise information to the insurance company about the formal damage claim. The policyholder signs this document (which may need to be notarized in some situations) and provides the relevant paperwork to substantiate the requested amount of money. Most insurance policies, including homeowners insurance, life insurance, and car insurance, require the filing of a Proof of Loss. Most insurance policies need a signed Proof of Loss to be submitted within 60 days of the insurance company’s request.
What happens if you don’t have receipts for insurance claim?
No, receipts are not required when submitting a renters insurance claim, and you need not be concerned if you don’t have any. Insurers are used to analyzing claims without receipts because most customers toss away the majority of their receipts.
If you have receipts, though, they will make it very easy to document the cost of your thing and prove that you were the owner. If you don’t, you’ll have to supply this information in a different way when filling out a proof of loss form.
What is proof of loss?
When you file a renters insurance claim for property loss or damage, you must complete out a proof of loss document. The proof-of-loss form certifies that the damaged property was yours and specifies its value.
Your insurer will ask you to attach any paperwork you have, such as receipts, to this document (which is occasionally an actual, physical paper, but is just as likely to be a digital form these days), which they’ll use to evaluate your claim.
Digital receipts are still receipts
When you buy something online, you’ll normally receive a digital receipt from the seller or the marketplace (such as Amazon). Don’t forget about them; they’re just as good as paper receipts in the eyes of your insurer.
- Obtain a copy of the expert’s curriculum vitae. You might also ask your own matching expert to offer any background information on the insurer’s expert or contractor. Background research on the internet might also be beneficial.
- Obtain a detailed description of what the expert will accomplish, including what will be inspected and what the inspection’s goal will be. To put it another way, come up with an inspection methodology that everyone can agree on.
- Determine whether the expert will perform destructive testing (or take samples), and if so, how and with what equipment. If destructive testing is agreed upon, the presence of the insured’s contractor or expert to document the testing is especially critical.
It may be prudent, as with the adjuster’s examination of the property, to follow up the inspection with a letter to the insurance, similar to the adjuster’s inspection follow-up letter.
All loss estimates, whether provided by an adjuster, contractor, or both, must be requested from the insurer. When the insurer indicates that no estimate was made, it is recommended that a letter be addressed to the insurer inquiring as to why none was prepared, given that the insurer is required to examine and analyze the loss amount.
A local contractor can assess insurers’ loss estimates to see if they appropriately reflect local prices and if they cover the entire scope of the loss. Insurers employ a variety of software packages to prepare their estimates, the most popular of which being Xactimate.
Xactimate estimates are purportedly updated on a regular basis to reflect local materials and labor costs. However, in a disaster, such expenditures may climb substantially in a short amount of time and not be represented in the Xactimate software right once.
Furthermore, because the Xactimate software is designed for repair rather than full replacement, it may not be particularly effective in evaluating full replacement of a home. It’s also possible that the Xactimate tool isn’t up to the task of evaluating damage to high-end properties. (According to United Policyholders’ 2008 publication, “Xactimate Demystified,” “If your property is unique to the extent that it is custom built, Victorian styled, era-built home, or located in a high value area, then Xactimate software will likely not be sufficient to reimburse you properly for your loss”). An expert in the use of Xactimate could be useful in assessing these and other potential Xactimate estimation limits.
Insurance companies are required to check the accuracy of their estimations. Title 10, section 2695.9(d) of the California Code of Regulations requires estimates to comply with applicable policy provisions and to provide an amount that will restore the damaged property to no less than its pre-loss condition while also allowing for repairs to be made in a manner that meets accepted trade standards for good and workmanlike construction. The insurer or its claims agents must take reasonable steps to ensure that the repair or rebuilding prices they use are accurate and typical of expenses in the local market region.
Insurers can adjust the unit pricing for labor and materials in the Xactimate application, so keep that in mind. It’s not uncommon to discover that the unit prices have been reduced as a result of this. In that case, finding a contractor who can do the work for the Xactimate cost may be very challenging for the insured.
Send us your signed, sworn proof of loss within 60 days of our request, which states forth, to the best of your knowledge and belief:
- All “insured’s” and others’ interests in the property concerned, as well as all liens on the property;
- Receipts for increased living expenditures spent, as well as records supporting the reduction in fair rental value;
- Evidence or affidavit supporting a claim under Section 1 Property Coverages, E.6. Credit Card, Electronic Fund Transfer Card Or Access Device, Forgery And Counterfeit Money, showing the amount and source of loss.
It’s crucial to follow through on any requests for proof of loss. As needed, more time to comply may be requested. Failure to comply could be considered a contract breach. (See Abdelhamid v. Fire Insurance Company of California, 2010 182 Cal.App.4th 990, 999-1001.) Without the insurer’s permission, the insured may submit its own proof of loss, together with supporting paperwork.
When an insured/client does not know the complete amount of their claim and an insurer presents them with a proof of loss that contains what the insurer believes is the full amount of the loss, the insured may sign the proof of loss and make changes to it by writing on it “Partial Loss Proof.”
Insurers frequently cite an insured’s failure to provide all of the requirements for a proof of loss as a justification for delaying claim processing and/or claiming that the insured has violated the policy. However, it is commonly acknowledged that “All that is necessary is “reasonable and significant compliance with the policy requirements” for evidence of loss filing (See 1231 Euclid Homeowners Assn. v. State Farm Fire & Cas. Co. (2006) 135 Cal.App.4th 1008, 1018).
When an insurer rejects a proof of loss, the insured/client should inquire as to why it was rejected (if one is not supplied) and, if necessary, request more time to comply with the evidence of loss requirement. Furthermore, an insurer cannot reject a proof of loss simply because the amount requested in the evidence of loss is not acceptable to it. The Policy has no clause that allows the insurer to do so.
In most Property Policies, the insured is required to “submit to examination under oath, while not in the presence of another “insured,” and sign the document. (ISO HO 3 Form, HO 00 03 10 00, p. 13 of 22; ISO HO 3 Form, HO 00 03 10 00, p. 13 of 22.)
An insurer’s most typical reason for requesting an oath examination is that the insurer suspects insurance fraud. Additional information about the insured’s real and personal property loss is another cause. However, an insurer’s request for an oath test to investigate fraud when the insurer has no evidence of fraud may be considered bad faith. (See, for example, Tomaselli v. Transamerica Insurance Company, 25 Cal.App.4th 1269, 1281.)
As part of the insurer’s investigation of the insured’s claim, an insurer may contractually require that an insured submit to an oath examination and answer all proper questions as a condition of coverage. (See Globe Indemnity Company v. Superior Court, 6 Cal.App.4th 725, 730-73, 1992.) Counsel should research and be conversant with Section 2071.1 of the Insurance Code before responding to any request for an oath examination.
An insurer’s request for an oath examination is frequently accompanied by a lengthy document request. The request could be for records that aren’t related to the insured’s claim, don’t exist, or are difficult to get. The scope of such demands may be limited as a result of a recent addition to the insurance code. According to Section 2071.1, “An insurer may only conduct an oath examination to acquire information that is relevant and reasonably required to process or investigate the claim.” This provision allows an insured to argue that the insurer’s document requirements are irrelevant or unreasonably burdensome. However, caution should be exercised in asserting this stance so that the insurer does not have a cause to deny coverage due to the insured’s refusal to comply with this policy condition.
Another option is to give the insurer a time-limited authorization to get particular types of documents so that the insured is not inconvenienced “They’ve been “burdened” with the task of providing them. This eliminates the possibility of a later claim that the insured failed to deliver the required paperwork.
Whenever you write the insurer a letter requesting a response, remind the insurer that the insurer is expected to react promptly by mentioning the Unfair Claims Settlement Practices Act clause addressing timely response to correspondence. Failure to react to the insured’s correspondence in a timely manner is, in fact, an unfair claims settlement practice. (See California Insurance Code 790.03(h)(2) and 10 CCR 2695.5(d) for more information.) You are making a record in the insured’s claim file that they are not behaving in good faith by bringing this out.
The California Unfair Claims Practices Act clearly defines the standards for timely payment of claims and should be used when the insurer fails to pay the claim on time (See Ins. Code, 790.03(h)(5) Unfair claim settlement practice to not pay a claim on time) “attempt in good faith to reach prompt, fair, and equitable settlements of claims where liability is reasonably clear.) It has been said elsewhere that “An insurer is required to pay its insured within a reasonable time after receiving a demand.” The insurer is required to pay the claim’s uncontested amount, which is the amount established by the insurer and owed under the policy. (See 10 C.C.R. 2695.7.) (h).
Do not threaten lawsuit or make charges of bad faith in your correspondence with the adjuster. Your letters will be used as evidence at trial, and you’ll want them to show that you worked with the insurer throughout the process and didn’t make any claims about the insurer’s actions.
A first-party insurance property claim, such as a fire loss, can be difficult to navigate and full of traps for the unwary. The preceding is merely a small example of the various challenges that may occur in such situations, but hopefully it is instructive. Wherever possible, such claims should be handled by or in conjunction with experienced claimants’ counsel.
How do I get a receipt for an insurance claim?
Top tip: Most merchants offer electronic receipts that are delivered to your email address, so you don’t have to bother about maintaining physical receipts. You can take images of paper receipts and keep them on your computer or flash drive if they don’t supply electronic receipts.
How long does an insurance company have to respond to a proof of loss?
- 15 days to recognize the claim and give instructions and documentation to the policyholder. Proof-of-loss documents, for example, are a sworn statement from the policyholder detailing the extent of the damage or injuries.
- After receiving completed proof-of-loss paperwork, you have 40 days to make a decision on the claim.
There are a number of factors that can influence how long an insurance company takes to settle a claim. Claims involving significant or multiple injuries, for example, take longer to settle. Furthermore, a lack of communication between the driver, the insurance company, and the insurance adjuster might stymie the process.
Nonetheless, you are entitled to a speedy resolution. If you believe your insurance company is breaking the law or acting unethically, you may be able to launch a “bad faith” case, which might result in you receiving the initial settlement amount plus interest and penalties.
How do you write a loss of coverage letter?
Supporting paperwork is required when enrolling in insurance coverage outside of Open Enrollment due to a loss of coverage. A Loss of Coverage Letter or, if you lost an employment-sponsored plan, a letter from your previous employer will be required.
Letter of Involuntary Loss of Coverage – A letter from your prior health insurance provider stating an involuntary loss of coverage.
Your name, the names of any dependents who were covered under the previous plan, and the date the previous health coverage ended must all be listed on the supporting paperwork. The date your previous health coverage expired must be within 60 days of the day you submitted your application.
Letter from your prior job – This letter must be typed and signed on company letterhead or stationery.
It must include your name, the names of any dependents who were previously covered under the previous plan, and the date the previous health coverage expired.
Example of an acceptable document from a previous health carrier
Because it features the official insurance carrier emblem at the top of the page and includes the name of the member to whom it applies, as well as the coverage effective date and termination date, the Certificate of Creditable Coverage (COCC) below is an excellent example of a loss of coverage document.
This certificate of prior credible coverage details periods of group health insurance provided by one or more of United HealthCare’s affiliated insurance providers.
We acknowledge that the following individual(s) participated in a group health benefit plan, as required by the Health Insurance Portability and Accountability Act of 1996:
What is the maximum amount of time in which an insured must supply written proof of loss to the insurance company?
Within 20 days of the loss, the insured must give the insurer written notice of the loss.