Claim Handling Requirements by State: Ohio

In states like Ohio where catastrophic disasters are not as common as in other states, policyholders should still understand how important it is to have a claim handled properly. Ohio’s most common disasters are tornadoes, snow, and floods. Although not common, Ohio has been affected by hurricane winds and rain that have reached some areas. Other risks are forest fires and earthquakes.¹

Insurance companies in Ohio are regulated and claim settlement practices are defined. Denial of a claim shall not be based on a first party claimant’s failure to make available for inspection the property which is the subject of the claim.² No claimant should have a claim denied for not providing a written notice of loss within a specific time unless required by a policy condition or it is unreasonable as to constitute a breach of contract.³ No insurer shall issue checks or drafts in partial settlement of a loss or claim under a specific coverage that contains language purporting to release the insurer or its insured from total liability.⁴

A notification given to an agent will be considered a notification to the insurer.⁵ An insurer shall acknowledge the receipt of a claim within 15 days of receiving notification and must satisfy requirement of payment within the same 15 days period,⁶ this rule would not apply if a complaint had been file in court. The insurer shall within 21 days of the receipt of properly executed proof(s) of loss decide whether to accept or deny such claim(s),⁷ if more time is needed for investigation than insurer has the continuing obligation to notify the claimant in writing at least every 45 days of the status of the investigation.

If insurer suspects of any fraudulent act or misrepresentation from the insured claims, within 60 days of receipt of that information, it shall be presented to the Fraud division. Any denial of claim shall be made on the grounds of a specific reference to the provision in the policy. No insurer shall require an insured to submit to a polygraph examination unless authorized under the applicable policy.⁸ An insurer shall not use settlement practices to offer substantially less than the amounts claimed in actions brought by such claimants.⁹ All replacements shall include the cost of physical damages incurred by removing and when a replacement item does not match the damaged item then the result should be one with a reasonably comparable appearance.¹⁰

Policyholders should read their policies carefully before signing any contract and be aware of risks of being underinsured or not having the correct protections. If Ohio policyholders feel they have been treated unlawfully they should also consider contacting and filing a complaint with the Ohio Department of Insurance.
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¹ Brock Restoration, Natural Disaster Risks in Ohio, https://www.brockrestoration.com/natural-disaster-risks-in-ohio/
² OAC 3901-1-54 (E)(3)
³ OAC 3901-1-54 (E)(4)
⁴ OAC 3901-1-54 (E)(6)
⁵ OAC 3901-1-54 (F)(1)
⁶ OAC 3901-1-54 (F)(2)
⁷ OAC 3901-1-54 (G)(1)
⁸ OAC 3901-1-54 (G)(4)
⁹ OAC 3901-1-54 (G)(10)
¹⁰ OAC 3901-1-54 (I)(1)(a)(b)