Adjusters are forever between the proverbial rock and a hard place. Gallons of ink have been spilled in articles discussing insurance coverage for claims as a result of COVID-19. The departments of insurance's regulations for good faith claims handling dictate how adjusters must investigate a loss. While courts are months away from interpreting coverage, adjusters cannot delay their investigations into COVID-19 losses.

Do

• 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.