The next stop in our 50-state tour of claims handling requirments is the Keystone State. While New Jersey and Pennsylvania may have a bit of rivalry (Giants v. Eagles or Pennsylvania drivers in the left lane, for example). Their claims handling requirements are somewhat similar.
Pennsylvania code provides that a carrier must acknowledge the claim, provide all claims forms, instruction and reasonable assistance to the claimaint within 10 working days of reciept of the claim.1 They must reply to all “pertinent” communications within 10 working days.2 The insurance carrier must complete its investigation within 30 days of their receipt of the notification of the claim.3 If they cannot meet that deadline, they must send written notice to the insured as to why additional time is needed within those 30 days and every 45 days thereafter.4 They must advise of a first party claimaint of acceptance or denial of the claim within 15 working days of the reciept of a proof of loss.5 Finally, the carrier must advise all first party claimants with whom they are negotating if a statute of limitation may affect their rights at least 30 days before the deadline would expire.6
Unlike New Jersey, Pennsylvania has more robust insruance bad faith laws of which insurance carriers must take notice. Accordingly, claimants and their representatives must be aware of the requirments and push for their insurer to follow them. Knowing these requirments and making sure the carrier follows them will help to get the claim paid properly and promptly.
As we approach the ski season here in the Northeast, I can’t help but remember this commerical which was ubiquitous on the television in my youth. I cannot ski the Pocono Mountains without singing this song at least once to myself.
1 31 Pa. Code § 146.5(a) & (d).
2 31 Pa. Code § 146.5(c).
3 31 Pa. Code § 146.6.
4 31 Pa. Code § 146.6.
5 31 Pa. Code § 146.7(a)(1).
6 31 Pa. Code § 146.7(e).
