Not all states impose all of the same claim-handling requirements, nor do they do so in the same way. We'll discuss the following requirements in this article:

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  • Acknowledge receipt of the claim and provide contact information to the claimant
  • Reply to communications
  • Provide the necessary claim forms
  • Advise as to the acceptance or denial of a claim
  • Provide an explanation as to why the investigation and resolution of the claim are not completed and when such will occur
  • Advise of the running of a statutory or contractual statute of limitations
  • Pay that portion of a claim that is not in dispute

Sixteen states require that the insurer send an acknowledgment of the receipt of the claim. The deadlines for compliance are 10 days in Alaska, New Hampshire, New Jersey, Pennsylvania, Rhode Island, Vermont, and Virginia; 15 days in California, Kentucky, Nebraska, New York, Ohio, and Utah; 20 days in Nevada; and 30 days in Oregon. Oklahoma's deadline is 30 days by statute, but its administrative rules mandate 20 days. Research did not reveal a reason for this distinction.

Six states require that the insurer provide claim forms and instructions. Alaska requires that this must be done "promptly," with no specific time given. New York and Ohio specifically require that this be done within 15 days. Rhode Island and Virginia require that this be done "promptly," or at least 10 days after receipt of the notice of claim. New Jersey also requires that it be done "promptly," but limits the third-party obligation to only those not represented by counsel.

Sixteen states set a time limit for responding to communications from the claimant or someone acting on their behalf. Generally, this requirement is limited to communications that indicate a response is expected or anticipated. The time limit for compliance is 10 days in New Hampshire, New Jersey, Rhode Island, Vermont, Virginia, and Washington; 15 days in Alaska, Kentucky, Nebraska, New York, Ohio, Pennsylvania, and Utah; 20 days in Nevada; and 30 days in Oregon. Similar to above, Oklahoma's deadline is 30 days by statute, but its administrative rules mandate 20 days. Again, research did not reveal a reason for this distinction.

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