30 DAYS: Prove Your Loss
After you submit a "Proof of Loss," the insurance company must make payment to you within 30 days.
The Louisiana Guide to Property Insurance Claims: Deadlines, Laws, and FAQs
Fact checked by Brelly Legal TeamLast updated on September 25, 2023
Homeowners who have experienced a property or contents loss can file an insurance claim to recover their losses and be made whole. But, filing a homeowners insurance claim in Louisiana can be overwhelming and complicated. The great news is that homeowners insurance policies and state laws provide tons of protection to homeowners to make sure claims are paid fully, fairly, and fast.
This page breaks down the rules, processes, requirements, forms, and laws you need to know to get your claim filed right, processed fast, and paid fairly.
30 DAYS: Get Your Check
Insurance companies must pay all claims within 30 days of receiving receipt of satisfactory proof of loss.
Making a Claim - Frequently Asked Questions
Making a homeowners insurance claim is incredibly simple. Sometimes referred to as a “First Notice of Loss” or “FNOL,” making a claim is exactly that: simply giving notice to the insurance company that a loss exists. It’s important to do this quickly after learning about a loss, and to keep close track of this notice so you can prove you did it. Here are some frequently asked questions to help you make your homeowners claim right.
How do I make an insurance claim?
Making an insurance claim is very simple!
There are two key elements:
- Give notice to the insurance company that you sustained a loss;
- Keep detailed records of that notice so you can prove it later.
That’s it! In the insurance industry, the “claim” is referred to as the “First Notice of Loss” or “FNOL.” There are many ways that you can deliver this FNOL, and the most popular ways are to fill out a form provided by the insurance company itself (oftentimes, online!), or to contact your insurance broker. Further, the insurance policy typically has a provision that dictates ways to notify them in the event of a loss.
Keeping records of your claim is really important. You want to keep a copy of the notice itself, and any records to prove exactly how you sent it, that it was sent, and when it was sent. This is critical to keeping the insurance company on the clock, and avoiding any notion that you didn’t properly notify the insurance company about the loss.
Do I need to use specific forms to make an insurance claim?
After making your insurance claim, the insurance company is required to provide you with any forms that you should use, including proof of loss forms. La R.S. 22:1312, for example, related to fire insurance policies, requires insurance companies to provide “a form suitable for filing a proof of loss and shall advise the insured that he is required under the terms of the policy to submit a proof of loss” within 30 days of receiving notice of the claim.
How long do I have to make an insurance claim?
Most insurance policies have a provision requiring you to make a claim within a reasonable time after you learn of the property loss.
Note that special timelines exist in Louisiana when there is a state of disaster or emergency declared. In those cases – if you are in the declaration’s area – then La R.S. 22:1264 extends how long you have to provide a sufficient proof of loss. The statute says that insurance companies cannot deny a claim because of “the inability…to provide sufficient proof of loss within the time limits…of the policy.” The insurance policy terms, therefore, are overridden by law, and are at least 180 days from after the declaration of emergency is terminated and civil authorities are not blocking access to the property.
How long do I have to wait after filing a claim for the insurance company to act?
After making your claim, insurance companies should get moving fairly fast. In fact, Louisiana law puts insurance companies on the clock.
In normal circumstances, insurance companies must “initiate loss adjustment” of your claim within 14 days after receiving notice of the claim.
In the event of catastrophic loss, this deadline is extended to 30 days.
It is possible that a presidentially declared emergency or disaster, or gubernatorial declared emergency or disaster, can create an additional 30-days allowed, if the Louisiana insurance commissioner issues a special ruling to create the additional 30-days.
What happens if the insurance company takes too long or blows through these deadlines?
They are subject to penalties! These penalties are outlined by La. R.S. 22:1973.
This is why it’s so important to be organized when making your claim. Keep track of your first making of the claim and track all of their responses, so you can put the insurance company on the clock. If they miss this window by even a day, the penalties are granted to you by law and are required.
Can I get some money up front while I wait for the insurance proceeds?
In many cases, the answer is yes!
In many situations, your insurance policy or the laws will give you access to cash quickly, so you can get underway on certain repairs like emergency repairs, and/or to cover your living expenses.
For example, Louisiana law gives you access to living expenses immediately in some circumstances. La. R.S. 22:1338 (Effective January 1, 2023) requires insurance companies to cut you a check for 3 months of your additional living expenses if: (i) you have the additional living expense coverage in your policy; and (ii) you had a total loss to your home.
Proving Your Loss - Frequently Asked Questions
Making a claim is just your first step. The burden is on YOU to prove the extent of your losses. This is a critical part of the claims process. Proving your losses fast will make your claim close faster. Proving your loss completely will make your claim paid more fairly and fully. Here are some frequently asked questions to help.
What is a “Proof of Loss?”
You will hear the term “Proof of Loss” a lot, and see it in your insurance policy. Do not be intimidated! This simply means that you must satisfactorily demonstrate to the insurance company that (1) you sustained covered losses to your property and (2) the value of those losses.
There are some best practices for this — which includes filling out a “proof of loss form” and getting it notarized. This form and the act of notarizing it enables you to explain your losses “under oath,” which elevates your proof to the insurance company.
A proof of loss is a powerful tool for moving claims forward, but it’s not always necessary in Louisiana. Even when your insurance policy requires a “sworn proof of loss,” some Louisiana case law exists to suggest that you satisfy this requirement by simply allowing a claims adjuster onto the property.
In other words, while you should prepare a robust Proof of Loss document, the requirement can be quite thin in the long run.
How do I get a Proof of Loss Form?
As mentioned in the above FAQ, the “Proof of Loss” form does not need to be in any specific, hyper-strict format in Louisiana. However, it must actually contain some key information, and therefore, it is a good idea to have high confidence in the form you are using.
One good thing is that you can get the form from the insurance company. And if they don’t provide it to you, it could help your claim and put the insurer on the hot seat.
La R.S. 22:1312, for example, related to fire insurance policies, requires insurance companies to provide “a form suitable for filing a proof of loss and shall advise the insured that he is required under the terms of the policy to submit a proof of loss” within 30 days of receiving notice of the claim.
If you’ve asked your insurer for a Proof of Loss form and they haven’t provided you one, you can download one for free.
Will the insurance company adjust my claim? Can I get a copy of it?
The insurance company will adjust your claim (and must do so within just a short time after receiving your notice of loss). And, you can get a copy of the adjuster’s report. You can make a formal request for the report, and La. R.S. 22:1892 requires the insurance company to provide it to you within just 14 days.
Important note: While the insurance company will send out a “Claims Adjuster” to adjust your loss, this is not someone working for you.. This person is working for the insurance company. You have the burden to prove your losses. The claims adjuster report may help, it may be great and well done…but, at the end of the day, the extent of your claim and your rights to payment under the policy will be dictated by how much you demonstrate and prove your loss.
What happens after submitting a proof of loss?
In Louisiana, the insurance company must make a “written offer to settle” your claim “within 30 days after receipt” of a satisfactory proof of loss. See La. R.S. 22:1892(A)(4).
Getting Your Cash - Frequently Asked Questions
It’s time to get paid. Once losses are proved, the money is yours and insurance companies are obligated to get it to you quickly. It’s common for insurance payments to come in increments, to have depreciation amounts removed, to have many check endorsements, and more. In other words, the payment process can be complicated. Here are frequently asked questions to help you get through it in Louisiana.
How long does an insurance company have to pay my homeowners claims?
The good news is that insurance companies must pay you FAST. In Louisiana, the law imposes stiff penalties on an insurance company if they don’t pay you within just 30 days after “receipt of satisfactory proof of loss.”
The bad news is that payment can still be complicated and delayed.
First, this clock runs from receipt of “satisfactory proof of loss.” This makes it critical that you “prove your loss” enough. You can learn more about this in our explainer on a Proof of Loss.
Second, payments can be held up for a variety of reasons after you get the check. The most common problem is with check endorsements. Homeowners policy claim checks frequently come written to you and your bank. This creates delay because you must usually go through the check endorsement process of your bank, which can take quite a long time.
Third, and finally, claim payments can be delayed because they are incremental. You may prove one piece of you claim at a time. You may have to wait for work to be done to get the full payment (i.e. depreciation may be withheld from the check, etc.).
So, in short, insurance claim payments should come quick, and insurance companies are obligated by law to get money out to you fast. However, there are many details to consider and other delays that could arise.
How does my deductible work in a homeowners insurance claim?
In Louisiana, it is common that homeowners policies have named-storm or hurricane loss” deductibles. It’s important to note that this deductible can only be applied 1x each calendar year. So, if 2 named-storms both cause damage in a single calendar year, the deductible can only be applied one time.
How long do I have to complete my repairs and recover depreciation?
In Louisiana, there are special rules for losses related to declared disasters or emergencies. La. R.S. 22:1264(B) first provides you with additional time to make repairs, requiring policyholders be given at least 1 year from the date insurance proceeds are received to complete the repairs. And if the policy has “replacement cost provisions” in the policy, they shall “receive full value of the covered damage that has been repaired, without reduction due to depreciation.”
What if the insurance company violates a timeline or doesn’t pay me?
Insurance companies must follow strict legal timelines when handling your claim and must treat you fairly. If they don’t…they will be penalized.
If I need help getting my claim paid, am I allowed to hire a public adjuster in Louisiana?
Yes.
A public adjuster is a licensed insurance adjuster who works for policyholders instead of insurance companies. Not every claim needs a public adjuster. You also have to pay for the public adjuster’s services, although payment usually isn’t owed unless the adjuster succeeds in increasing the payout on your claim. But in some claims, especially complex claims where the insurer isn’t paying what it should, a public adjuster may be helpful in recovering what’s owed. Before engage a public adjuster, be sure to confirm they’re licensed by the state, and check references with former clients of the adjuster.
If you’re worried whether state law or your insurance policy prohibits you from hiring a public adjuster, don’t. Louisiana law specifically licenses the practice of public adjusting. And under Revised Statutes 22:1274, your insurance policy cannot prohibit you from working with a public adjuster (unless the policy is a commercial surplus lines policy).
Louisiana Laws & Statutes That Impact Your Insurance Claim
Louisiana has a lot of laws applicable to the insurance claims process for homeowners. Here is a selection of some of the statutes (all housed within Title 22 of the Louisiana Revised Statutes) that will help you with the process.
La. R.S. 22:1264: Presumption of Coverage
A. For losses that arose due to a catastrophic event for which a state of disaster or emergency was declared pursuant to law by civil officials, for those areas within the declaration, no damages to covered property shall be automatically denied by the inability of the policyholder to provide sufficient proof of loss within the time limits and requirements of the policy. The time limit for the submission of proof of loss shall be not less than one hundred eighty days. The time limit shall not commence as long as a declaration of emergency is in existence and civil authorities are denying the insured access to the property.
B. For losses that arose due to a catastrophic event for which a state of disaster or emergency was declared pursuant to law by civil officials, for those areas within the declaration, any policyholder with replacement cost provisions shall be entitled to complete repairs to the property within one year from the date of the loss or the issuance of applicable insurance proceeds, whichever is later. Adherence to this provision shall entitle the policyholder with a replacement cost provision to receive full value of the covered damage that has been repaired, without reduction due to depreciation.
C. The provisions of this Section shall be applicable to all new policies and renewal policies delivered in the state of Louisiana after April 18, 2006.
La. R.S. 22:1270: Personal property; specific coverage; valuation; exemptions
A. In any case in which a policy includes coverage for loss of or damage to personal property of the insured, from whatever cause, if the insurer places a valuation upon the specific item of covered property and uses such valuation for purposes of determining the premium charge to be made under the policy, the insurer shall compute any covered loss of or damage to such property which occurs during the term of the policy at such valuation without deduction or offset, unless a different method is to be used in the computation of loss, in which latter case, the policy, and any application for the policy, shall set forth in type of prominent size, the actual method of such loss computation by the insurer.
B. (1) The provisions of this Section shall not apply to any of the following:…(c) (c) Insurance on a group of items insured as contents insurance on household items, unless specifically insured under Subsection A of this Section.
La. R.S. 22:1273: Presumption of coverage; civil authority prohibited use
A. For losses that arise due to a catastrophic event in which a state of disaster or emergency is declared by civil officials, for those areas within the declaration, if a civil authority prohibits the insured from using their residential premises as a result of damage to a neighboring premises due to a peril covered by the policy, the civil authority prohibited use coverage shall be afforded as provided in the policy.
B. For purposes of this Section, insurers shall interpret all actions of a civil authority without regard to whether formal orders of evacuation were issued.
La. R.S. 22:1274: Prohibited policy provision
Effective August 1, 2023
A. An insurer shall not include a provision in any policy of property insurance that prohibits an insured from hiring a public adjuster for services provided pursuant to the provisions of this Title.
B. Subsection A of this Section does not apply to commercial insurance policies written by any surplus lines insurer as defined in R.S. 22:46.
[STANDARD FIRE POLICIES] La. R.S. 22:1312: Forms to be provided
Upon receiving notice of loss from the insured, the insurer shall provide within thirty days to the insured a form suitable for filing a proof of loss and shall advise the insured that he is required under the terms of the policy to submit a proof of loss.
[STANDARD FIRE POLICIES] La. R.S. 22:1316: Suits on fire insurance policies
Whenever suit is filed to recover loss on a fire insurance policy which has been issued either in the name of a married man or a married woman on property belonging to the community of acquets and gains or on property which is the separate and paraphernal property of either husband or wife, it shall not be a good defense on the part of the insurer, except in case of fraud to allege that the policy was issued in the name of the husband, whereas the title to the property was in the name of the wife or vice versa; or that the policy was issued in the name of the husband, whereas the property was the separate and paraphernal property of the wife or vice versa, any contract to the contrary notwithstanding.
The insurer shall have the burden and duty of issuing the policy in the name of the real owner of the property covered by such policy.
[STANDARD FIRE POLICIES] La. R.S. 22:1318: Valued policy clause; exceptions
A. Under any fire insurance policy insuring inanimate, immovable property in this state, if the insurer places a valuation upon the covered property and uses such valuation for purposes of determining the premium charge to be made under the policy, in the case of total loss the insurer shall compute and indemnify or compensate any covered loss of, or damage to, such property which occurs during the term of the policy at such valuation without deduction or offset, unless a different method is to be used in the computation of loss, in which latter case, the policy, and any application therefor, shall set forth in type of equal size, the actual method of such loss computation by the insurer. Coverage may be voided under said contract in the event of criminal fault on the part of the insured or the assigns of the insured.
B. Any clause, condition, or provision of a policy of fire insurance contrary to the provisions of this Section shall be null and void, and have no legal effect. Nothing contained herein shall be construed to prevent any insurer from cancelling or reducing, as provided by law, the insurance on any property prior to damage or destruction.
C. The liability of the insurer of a policy of fire insurance, in the event of total or partial loss, shall not exceed the insurable interest of the insured in the property unless otherwise provided for by law. Nothing in this Section shall be construed as to preclude the insurer from questioning or contesting the insurable interest of the insured.
D. This Section shall apply only to policies issued or renewed after January 1, 1992, and shall not apply to a loss covered by a blanket-form policy of insurance. As used in this Section, the term “fire insurance policy” shall mean any property insurance policy, with the exception of builders risk policies of insurance, that provides coverage for the peril of fire, regardless of any other coverage provided by the policy.
[HOMEOWNERS] La. R.S. 22:1337: Homeowners’ insurance deductibles applied to named-storms, hurricanes, and wind and hail deductibles
A. For purposes of this Section, the following definitions shall apply:
(1) “Hurricane” means a storm system that has been declared a hurricane by the National Hurricane Center of the National Weather Service.
(2) “Named storm” means a storm system that has been declared a named storm by the National Hurricane Center of the National Weather Service.
(3) “Separate deductible” means a deductible that applies to damage incurred during a specified weather event and may be expressed as a percentage of the insured value of the property or as a specific dollar amount and includes hurricane, named-storm, and wind and hail deductibles.
B. For all homeowners’ insurance policies or other policies insuring a one- or two-family owner occupied premises for fire and allied lines, issued or renewed by authorized insurers on or after January 1, 2010, any separate deductible that applies in place of any other deductible to loss or damage resulting from a named storm or hurricane shall be applied on an annual basis to all named-storm or hurricane losses that are subject to the separate deductible during the calendar year.
C. If an insured incurs named-storm or hurricane losses from more than one named storm or hurricane during a calendar year that are subject to the separate deductible referred to in Subsection B of this Section, the insurer may apply a deductible to the succeeding named storms or hurricanes that is equal to the remaining amount of the separate deductible, or the amount of the deductible that applies to all perils other than a named storm or hurricane, whichever is greater. Insurers may require policyholders to maintain receipts or other records of such losses in order to apply such losses to subsequent named-storm or hurricane claims.
D.
(1) The commissioner shall prescribe a separate form regarding named storm, hurricane, and wind and hail deductibles proposed in a policy of homeowners’ insurance. The form shall list the specific amount for each deductible expressed as a percentage of the insured value of the property, or as a specific dollar amount, or as both. For new policies with an effective date after January 1, 2023, an insurer shall provide the form and request that it be signed by the named insured or his legal representative. The completion of a new form shall not be required if a renewal, reinstatement, substitute, or amended policy is issued to the same named insured by the same insurer or any of its affiliates.
(2) An insurer shall provide a new form and request that it be signed by the named insured or his legal representative, if the insurer changes the percentage or specific dollar amount of any named storm, hurricane, or wind and hail deductible listed in the policy. If the policy uses a percentage deductible, a new form shall not be required if the dollar amount of the deductible changes because of an increase in policy limits; however, a new form shall be required if the percentage changes.
(3) A new form provided to an insured shall be for the insured’s informational purposes only, and it shall not affect the terms and conditions of the policy.
(4) If a policy is purchased using electronic means or the insured elects to receive policy documents electronically, the insurer shall transmit the form provided for in this Subsection to the insured electronically and provide a method whereby the insured may sign the form electronically.
(5) Nothing in this Subsection shall be interpreted to create a cause of action not otherwise provided by law.
[HOMEOWNERS] La. R.S. 22:1338: Additional living expense coverage; total loss
A. In the event of a total loss to an insured dwelling caused by a covered peril, if the insured has additional living expense coverage, the insurer shall, upon request by the insured, render an advance payment equal to the estimated value of three months of increased cost of living expenses, as defined in the policy, required for the members of the household to maintain their normal standard of living. Further payments of additional living expense coverage, after the advance period, shall be payable upon submission of satisfactory proof of loss, if it is determined that the actual cost of incurred additional living expenses exceeds the amount previously advanced.
B. Nothing in this Section shall be interpreted to prohibit an insurer from restricting payment in cases of suspected fraud.
[RE: CLAIMS ADJUSTERS] La. R.S. 22:1674.1: Standards of conduct; acknowledgment required
A. The following standards of conduct shall be binding on all claims adjusters:
(1) An adjuster shall not have a direct or indirect financial interest in any aspect of the claim, other than the salary, fee, or other consideration established with the insurer.
(2) An adjuster shall not acquire any interest in salvage of property subject to the contract with the insurer.
(3) An adjuster shall not solicit employment for, recommend, or otherwise solicit engagement, directly or indirectly, for any attorney at law, contractor, or subcontractor, in connection with any loss or damage for which the adjuster is employed or concerned.
(4) An adjuster shall not solicit or accept any compensation, directly or indirectly, from, by, or on behalf of any contractor or subcontractor engaged by or on behalf of any insured by which such adjuster has been, is, or will be employed or compensated, directly or indirectly.
(5) An adjuster shall treat all claimants fairly.
(6) An adjuster shall not provide favored treatment to any claimant.
(7) An adjuster shall adjust all claims strictly in accordance with the insurance contract.
(8) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured.
(9) An adjuster shall make truthful and unbiased reports of the facts after completing a thorough investigation.
(10) An adjuster shall handle every adjustment and settlement with honesty and integrity, without any remuneration to himself except that to which he is legally entitled.
(11) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim.
(12) An adjuster shall promptly report to the department any conduct by any licensed insurance representative of this state which violates any provision of this Title or department rule.
(13) An adjuster shall exercise appropriate care when dealing with elderly claimants.
(14) An adjuster shall not negotiate or effect settlement directly or indirectly with any third-party claimant represented by an attorney, if the adjuster has knowledge of such representation, except with the consent of the attorney. For purposes of this Paragraph, the term “third-party claimant” does not include the insured or the insured’s resident relatives.
(15) An adjuster may interview any witness, or prospective witness, without the consent of opposing counsel or party. In doing so, however, the adjuster shall scrupulously avoid any suggestion calculated to induce a witness to suppress or deviate from the truth, or in any degree affect the witness’s appearance or testimony during deposition or at the trial. If any witness making or giving a signed or recorded statement so requests, the witness shall be given a copy of the statement.
(16) An adjuster shall not advise a claimant to refrain from seeking legal advice, nor advise against the retention of counsel to protect the claimant’s interest.
(17) An adjuster shall not knowingly make any oral or written misrepresentation or statement in regards to applicable policy provisions, contract conditions, or pertinent state laws.
(18) An adjuster shall not undertake the adjustment of any claim for which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise.
(19) An adjuster shall not permit an unlicensed employee or representative of the adjuster to conduct business for which a license is required pursuant to the provisions of this Part.
(20) No adjuster, while so licensed by the department, may represent or act as a public adjuster.
(21) No adjuster shall materially misrepresent to an insured or other interested party the terms and coverage of an insurance contract with intent and for the purpose of effecting settlement of a claim for loss or damage or benefit under such contract on less favorable terms than those provided in and contemplated by the insurance contract.
B. Upon license issuance and license renewal, claims adjusters shall read and acknowledge the claims adjuster standards of conduct provided in this Section, in a manner prescribed by the commissioner.
C. Violation of any provision of Subsection A of this Section shall be grounds for administrative action against the licensee. In addition to administrative action, a claims adjuster who violates the provisions in Subsection A of this Section shall be deemed to have committed an unfair trade practice pursuant to R.S. 22:1964, and the penalties contained in R.S. 22:1969 may be enforced by the commissioner.
D. This Section does not create any civil action or create any cause of action not otherwise provided by law.
[RE: CLAIMS ADJUSTERS] La. R.S. 22:1677: Reporting of Actions
A. The adjuster shall report to the commissioner of insurance any administrative action taken against the adjuster in any jurisdiction or by another governmental agency within thirty days of the final disposition of the matter. This report shall include a copy of the order, consent order, or other relevant legal documents.
B. Within thirty days of a conviction, the adjuster shall report to the commissioner of insurance any criminal prosecution of the adjuster taken in any jurisdiction for violation of insurance laws or regulations, any felony, or any misdemeanor involving misappropriation of funds. The report shall include a copy of the initial complaint filed, the order resulting from the hearing, and any other relevant legal documents.
[RE: PUBLIC ADJUSTERS] La. R.S. 22:1703: Public adjuster fees
A. A public adjuster may charge the insured a reasonable fee. A public adjuster shall not solicit for or enter into any contract or arrangement between an insured and a public adjuster which provides for payment of a fee to the public adjuster which is contingent upon, or calculated as a percentage of, the amount of any claim or claims paid to or on behalf of an insured by the insurer and any such contract shall be against public policy and is null and void.
B. A public adjuster shall not pay a commission, service fee, or other valuable consideration to another for public adjusting in this state if that person is required to be licensed under this Part and is not so licensed.
C. A person shall not accept a commission, service fee, or other valuable consideration for public adjusting in this state if that person is required to be licensed under this Part and is not so licensed.
[RE: PUBLIC ADJUSTERS] La. R.S. 22:1704: Contract between public adjuster and insured
A. Public adjusters shall ensure that all contracts for their services are in writing and contain the following terms:
(1) Legible full name of the adjuster signing the contract, as specified in Department of Insurance records.
(2) Permanent home state business address and phone number.
(3) Department of Insurance license number.
(4) Title of “Public Adjuster Contract”.
(5) The insured’s full name, street address, insurance company name, and policy number, if known or upon notification.
(6) A description of the loss and its location, if applicable.
(7) Description of services to be provided to the insured.
(8) Signatures of the public adjuster and the insured.
(9) Date contract was signed by the public adjuster and date that the contract was signed by the insured.
(10) Attestation language stating that the public adjuster has satisfied the financial responsibility requirements of state law.
(11) Full salary, fee, compensation, or other considerations the public adjuster is to receive for services.
(12) If applicable, an acknowledgment that a mortgage holder exists on any property adjusted by the public adjuster and that such mortgage holder is or may be an additional insured on the claim.
B. Compensation provisions in a public adjusting contract shall not be redacted in any copy of the contract provided to the commissioner of insurance. Such a redaction shall constitute an omission of material fact.
C. If the insurer, not later than seventy-two hours after the date on which the loss is reported to the insurer, either pays or commits in writing to pay to the insured the policy limit of the insurance policy, the public adjuster shall:
(1) Inform the insured that the loss recovery amount cannot be increased by the insurer.
(2) Be entitled only to reasonable compensation from the insured for services provided by the public adjuster on behalf of the insured, based on the time spent on a claim and expenses incurred by the public adjuster, until the claim is paid or the insured receives a written commitment to pay from the insurer.
D. A public adjuster contract may not contain any contract term that:
(1) Allows the public adjuster’s fee to be collected when money is due from an insurance company, but not paid, or that allows a public adjuster to collect the entire fee from the first check issued by an insurance company, rather than as a percentage of each check issued by an insurance company.
(2)
(a) When any payment on a claim is made and the insured is represented by a public adjuster, the insurer’s check or checks may be made payable to the insured and the public adjuster when all of the following occurs:
(i) The amount of the check does not exceed the public adjuster’s fee,
(ii) The amount of the fee is indicated in a written compensation agreement signed by the insured.
(iii) The balance of the proceeds, not included in the check made payable to the insured and the public adjuster, is made payable to the insured or to the insured and other lienholder or holders as is required by law.
(b) Should a dispute arise between a public adjuster and the insured with which he contracts, the public adjuster is prohibited from acting in any manner which would interfere with or cause the insured not to receive the undisputed portion of the insurance proceeds. Should the insured’s check, which contains that amount not associated with the public adjuster’s fee, be mailed to or received by the public adjuster, the public adjuster shall promptly present the check to the insured.
(3) Imposes collection costs or late fees.
(4) Precludes the insured from pursuing civil or judicial remedies.
E. Prior to the signing of the contract, the public adjuster shall provide the insured with a separate disclosure document regarding the claim process that states:
(1) Property insurance policies obligate the insured to present a claim to his insurance company for consideration. There are three types of adjusters that could be involved in that process. The definitions of the three types are as follows:
(a) “Company adjusters” means the insurance adjusters who are employees of an insurance company. They represent the interest of the insurance company and are paid by the insurance company. Company adjusters shall not charge insureds a fee.
(b) “Independent adjusters” means the insurance adjusters who are hired on a contract basis by an insurance company to represent the insurance company’s interest. They are paid by your insurance company. Independent adjusters shall not charge insureds a fee.
(c) “Public adjusters” means the insurance adjusters who do not work for any insurance company. They work for the insured to assist in the investigation, appraisal, evaluation, and reporting of the claim. The insured hires them by signing a contract agreeing to pay them a fee.
(2) The insured is not required to hire a public adjuster to help the insured meet his obligations under the policy but has the right to do so.
(3) The insured always has the right to initiate direct communications with the insured’s attorney, the insurer, the insurer’s adjuster, and the insurer’s attorney, or any other person regarding the settlement of the insured’s claim. Once a public adjuster has been retained, the public adjuster shall not restrict communications between the insurer and its insured.
(4) The public adjuster is not a representative or employee of the insurer.
(5) The salary, fee, or other consideration to be paid to the public adjuster is the obligation of the insured, not the insurer.
F. The contracts shall be executed in duplicate to provide an original contract to the public adjuster and an original contract to the insured. The public adjuster’s original contract shall be available at all times for inspection without notice by the commissioner of insurance.
G. The public adjuster shall provide the insurer a notification letter, which has been signed by the insured, indicating that the insured and the public adjuster have a contract pursuant to this Part. Delivery of this letter shall not prohibit or impede the right of the insured to communicate directly with the insurer.
H. The insured has the right to rescind the contract within three business days after the date the contract was signed. The rescission shall be in writing and mailed or delivered to the public adjuster at the address in the contract within the three business day period.
I. If the insured exercises the right to rescind the contract, any thing of value given by the insured under the contract will be returned to the insured within fifteen business days following the receipt by the public adjuster of the cancellation notice.
J. The contract shall not be construed to prevent an insured from pursuing any civil or judicial remedy.
[RE: PUBLIC ADJUSTERS] La. R.S. 22:1706: Standards of conduct of public adjuster
A. A public adjuster is obligated, under his license, to serve with objectivity and complete loyalty to the interest of his insured alone and to render to the insured such information and service, as within the knowledge, understanding, and good faith of the licensee, as will best serve the insured’s insurance claim needs and interest.A. A public adjuster is obligated, under his license, to serve with objectivity and complete loyalty to the interest of his insured alone and to render to the insured such information and service, as within the knowledge, understanding, and good faith of the licensee, as will best serve the insured’s insurance claim needs and interest.
B. A public adjuster shall not solicit, or attempt to solicit, an insured during the progress of a loss-producing occurrence, as defined in the insured’s insurance contract.
C. A public adjuster shall not permit an unlicensed employee or representative of the public adjuster to conduct business for which a license is required under this Part.
D. A public adjuster shall not have a direct or indirect financial interest in any aspect of the claim, other than the compensation established in the written contract with the insured.
E. A public adjuster shall not acquire any interest in salvage of property subject to the contract with the insured.
F. A public adjuster shall not solicit employment for or otherwise solicit engagement, directly or indirectly, for or on behalf of any attorney at law, contractor, or subcontractor, in connection with any loss or damage with respect to which such adjuster is concerned or employed. Nothing in this Part shall be interpreted to prevent a public adjuster from recommending a particular attorney, contractor or subcontractor; however, the public adjuster is prohibited from collecting any fee, compensation, or thing of value for such referral.
G. A public adjuster shall not solicit or accept any compensation, direct or indirect, from, by, or on behalf of any contractor or subcontractor engaged by or on behalf of any insured by which such adjuster has been, is, or will be employed or compensated, directly or indirectly.
H. Public adjusters shall also adhere to the following general requirements:
(1) No public adjuster, while so licensed by the department, may represent or act as a company adjuster or independent adjuster in Louisiana.
(2) A public adjuster shall not enter into a contract or accept a power of attorney that vests in the public adjuster the authority to choose the persons who shall perform repair work.
(3) A public adjuster shall ensure that all contracts for the public adjuster’s services are in writing and set forth all terms and conditions of the engagement.
(4) A public adjuster shall not file or record on behalf of an insured client any complaint to or with any court of record or agency of the state.
(5) A public adjuster shall not provide services with any claim except a first- party claim on behalf of an insured against such insured’s insurer.
(6) A public adjuster shall not provide services to the insured in connection with any claim for personal injury.
(7) A public adjuster shall not render legal advice to the insured, including but not limited to legal advice regarding the policy provisions or coverage issues.
(8) A public adjuster shall not engage in the unauthorized practice of law as defined in R.S. 37:212 and 213.
(9) A public adjuster may not agree to any loss settlement without the insured’s knowledge and written consent.
(10) A public adjuster shall not act as an appraiser or umpire pursuant to the appraisal provisions of R.S. 22:1311 or any similar provision of a policy of insurance if that public adjuster is adjusting or has adjusted all or any part of the claim, or both, or property subject to that appraisal provision.
B. A public adjuster shall not solicit, or attempt to solicit, an insured during the progress of a loss-producing occurrence, as defined in the insured’s insurance contract.
C. A public adjuster shall not permit an unlicensed employee or representative of the public adjuster to conduct business for which a license is required under this Part.
D. A public adjuster shall not have a direct or indirect financial interest in any aspect of the claim, other than the compensation established in the written contract with the insured.
E. A public adjuster shall not acquire any interest in salvage of property subject to the contract with the insured.
F. A public adjuster shall not solicit employment for or otherwise solicit engagement, directly or indirectly, for or on behalf of any attorney at law, contractor, or subcontractor, in connection with any loss or damage with respect to which such adjuster is concerned or employed. Nothing in this Part shall be interpreted to prevent a public adjuster from recommending a particular attorney, contractor or subcontractor; however, the public adjuster is prohibited from collecting any fee, compensation, or thing of value for such referral.
G. A public adjuster shall not solicit or accept any compensation, direct or indirect, from, by, or on behalf of any contractor or subcontractor engaged by or on behalf of any insured by which such adjuster has been, is, or will be employed or compensated, directly or indirectly.
H. Public adjusters shall also adhere to the following general requirements:
(1) No public adjuster, while so licensed by the department, may represent or act as a company adjuster or independent adjuster in Louisiana.
(2) A public adjuster shall not enter into a contract or accept a power of attorney that vests in the public adjuster the authority to choose the persons who shall perform repair work.
(3) A public adjuster shall ensure that all contracts for the public adjuster’s services are in writing and set forth all terms and conditions of the engagement.
(4) A public adjuster shall not file or record on behalf of an insured client any complaint to or with any court of record or agency of the state.
(5) A public adjuster shall not provide services with any claim except a first- party claim on behalf of an insured against such insured’s insurer.
(6) A public adjuster shall not provide services to the insured in connection with any claim for personal injury.
(7) A public adjuster shall not render legal advice to the insured, including but not limited to legal advice regarding the policy provisions or coverage issues.
(8) A public adjuster shall not engage in the unauthorized practice of law as defined in R.S. 37:212 and 213.
(9) A public adjuster may not agree to any loss settlement without the insured’s knowledge and written consent.
(10) A public adjuster shall not act as an appraiser or umpire pursuant to the appraisal provisions of R.S. 22:1311 or any similar provision of a policy of insurance if that public adjuster is adjusting or has adjusted all or any part of the claim, or both, or property subject to that appraisal provision.
[RE: PUBLIC ADJUSTERS] La. R.S. 22:1707: Reporting of actions
A. The public adjuster shall report to the commissioner of insurance any administrative action taken against the public adjuster in any jurisdiction or by another governmental agency within thirty days of the final disposition of the matter. This report shall include a copy of the order, consent order, or other relevant legal documents.
B. Within thirty days of a conviction, the public adjuster shall report to the commissioner of insurance any criminal prosecution of the public adjuster taken in any jurisdiction. The report shall include a copy of the initial complaint filed, the order resulting from the hearing, and any other relevant legal documents.
[CLAIMS] La. R.S. 22:1892: Payment and adjustment of claims
A.
(1) All insurers issuing any type of contract, other than those specified in R.S. 22:1811, 1821, and Chapter 10 of Title 23 of the Louisiana Revised Statutes of 1950, shall pay the amount of any claim due any insured within thirty days after receipt of satisfactory proofs of loss from the insured or any party in interest. The insurer shall notify the insurance producer of record of all such payments for property damage claims made in accordance with this Paragraph.
(2) All insurers issuing any type of contract, other than those specified in R.S. 22:1811, R.S. 22:1821, and Chapter 10 of Title 23 of the Louisiana Revised Statutes of 1950, shall pay the amount of any third party property damage claim and of any reasonable medical expenses claim due any bona fide third party claimant within thirty days after written agreement of settlement of the claim from any third party claimant.
(3) Except in the case of catastrophic loss, the insurer shall initiate loss adjustment of a property damage claim and of a claim for reasonable medical expenses within fourteen days after notification of loss by the claimant. In the case of catastrophic loss, the insurer shall initiate loss adjustment of a property damage claim within thirty days after notification of loss by the claimant except that the commissioner may promulgate a rule for extending the time period for initiating a loss adjustment for damages arising from a presidentially declared emergency or disaster or a gubernatorially declared emergency or disaster up to an additional thirty days. Thereafter, only one additional extension of the period of time for initiating a loss adjustment may be allowed and must be approved by the Senate Committee on Insurance and the House Committee on Insurance, voting separately. Failure to comply with the provisions of this Paragraph shall subject the insurer to the penalties provided in R.S. 22:1973.
(4) All insurers shall make a written offer to settle any property damage claim, including a third-party claim, within thirty days after receipt of satisfactory proofs of loss of that claim.
(5) An insurer shall issue a copy of the insurer’s field adjuster report, relative to the insured’s property damage claim, to the insured within fifteen days of receiving a request for such from the insured.
(6) If an insurer issues a check, draft, or other negotiable instrument that is jointly payable to an insured and a mortgagee or mortgage servicer as payment of insurance settlement proceeds for multiple types of coverage, the insurer shall provide with the check, draft, or other negotiable instrument, a statement indicating the dollar amount of insurance settlement proceeds paid under each type of coverage including but not limited to dwelling, personal property, and additional living expenses. In lieu of issuing a statement pursuant to this Paragraph, an insurer may issue separate checks, drafts, or other negotiable instruments for payment of each type of coverage.
B.
(1)
(a) Except as provided in Subparagraph (b) of this Paragraph, failure to make such payment within thirty days after receipt of such satisfactory written proofs and demand therefor or failure to make a written offer to settle any property damage claim, including a third-party claim, within thirty days after receipt of satisfactory proofs of loss of that claim, as provided in Paragraphs (A)(1) and (4) of this Section, respectively, or failure to make such payment within thirty days after written agreement or settlement as provided in Paragraph (A)(2) of this Section when such failure is found to be arbitrary, capricious, or without probable cause, shall subject the insurer to a penalty, in addition to the amount of the loss, of fifty percent damages on the amount found to be due from the insurer to the insured, or one thousand dollars, whichever is greater, payable to the insured, or in the event a partial payment or tender has been made, fifty percent of the difference between the amount paid or tendered and the amount found to be due as well as reasonable attorney fees and costs. Such penalties, if awarded, shall not be used by the insurer in computing either past or prospective loss experience for the purpose of setting rates or making rate filings.
(b) In the case of a presidentially or gubernatorially declared disaster, failure to make such payment within thirty days after receipt of such satisfactory written proofs and demand therefor or failure to make a written offer to settle any property damage claim, including a third-party claim, within thirty days after receipt of satisfactory proofs of loss of that claim, as provided in Paragraphs (A)(1) and (4) of this Section, respectively, or failure to make such payment within thirty days after written agreement or settlement as provided in Paragraph (A)(2) of this Section when such failure is found to be arbitrary, capricious, or without probable cause, shall subject the insurer to a penalty, in addition to the amount of the loss, of fifty percent damages on the amount found to be due from the insurer to the insured, or two thousand five hundred dollars, whichever is greater, payable to the insured, or in the event a partial payment or tender has been made, fifty percent of the difference between the amount paid or tendered and the amount found to be due as well as reasonable attorney fees and costs or two thousand five hundred dollars, whichever is greater. The penalties, if awarded, shall not be used by the insurer in computing either past or prospective loss experience for the purpose of setting rates or making rate filings.
(2) The period set herein for payment of losses resulting from fire and the penalty provisions for nonpayment within the period shall not apply where the loss from fire was arson related and the state fire marshal or other state or local investigative bodies have the loss under active arson investigation. The provisions relative to time of payment and penalties shall commence to run upon certification of the investigating authority that there is no evidence of arson or that there is insufficient evidence to warrant further proceedings.
(3) The provisions relative to suspension of payment due to arson shall not apply to a bona fide lender which holds a valid recorded mortgage on the property in question.
(4) Whenever a property damage claim is on a personal vehicle owned by the third party claimant and as a direct consequence of the inactions of the insurer and the third party claimant’s loss the third party claimant is deprived of use of the personal vehicle for more than five working days, excluding Saturdays, Sundays, and holidays, the insurer responsible for payment of the claim shall pay, to the extent legally responsible, for reasonable expenses incurred by the third party claimant in obtaining alternative transportation for the entire period of time during which the third party claimant is without the use of his personal vehicle. Failure to make such payment within thirty days after receipt of adequate written proof and demand therefor, when such failure is found to be arbitrary, capricious, or without probable cause shall subject the insurer to, in addition to the amount of such reasonable expenses incurred, a reasonable penalty not to exceed ten percent of such reasonable expenses or one thousand dollars whichever is greater together with reasonable attorneys fees for the collection of such expenses.
(5) When an insurance policy provides for the adjustment and settlement of first-party motor vehicle total losses on the basis of actual cash value or replacement with another of like kind and quality, and the insurer elects a cash settlement based on the actual cost to purchase a comparable motor vehicle, such costs shall be derived by using one of the following:
(a) A fair market value survey conducted using qualified retail automobile dealers in the local market area as resources. If there are no dealers in the local market area, the nearest reasonable market can be used.
(b) The retail cost as determined from a generally recognized used motor vehicle industry source; such as, an electronic database, if the valuation documents generated by the database are provided to the first-party claimant, or a guidebook that is available to the general public. If the insured demonstrates, by presenting two independent appraisals, based on measurable and discernable factors, including the vehicle’s preloss condition, that the vehicle would have a higher cash value in the local market area than the value reflected in the source’s database or the guidebook, the local market value shall be used in determining the actual cash value.
(c) A qualified expert appraiser selected and agreed upon by the insured and insurer. The appraiser shall produce a written nonbinding appraisal establishing the actual cash value of the vehicle’s preloss condition.
(d) For the purposes of this Paragraph, local market area shall mean a reasonable distance surrounding the area where a motor vehicle is principally garaged, or the usual location of the vehicle covered by the policy.
(6)
(a) For the purposes of this Paragraph the following terms have the meanings ascribed to them:
(i) “Damaged property” means a dwelling, structure, personal property, or any other property, except a vehicle, that requires repairs, replacement, restoration, or remediation to reestablish its former condition.
(ii) “Depreciation” means depreciation including but not limited to the cost of goods, materials, labor, and services necessary to replace, repair, or rebuild damaged property.
(b) An insurance policy covering damaged property may allow for depreciation.
(c) An insurance policy covering damaged property shall provide notice that depreciation may be deducted or withheld, in a form approved by the commissioner.
(d) If depreciation is applied to a loss for damaged property, the insurer shall provide a written explanation as to how the depreciation was calculated.
(e) Depreciation shall be reasonable and based on a combination of objective criteria and subjective assessment, including the actual condition of the property prior to loss.
C.
(1) All claims brought by insureds, workers’ compensation claimants, or third parties against an insurer shall be paid by check or draft of the insurer or, if offered by the insurer and the claimant requests, electronic transfer of fundsto the order of the claimant to whom payment of the claim is due pursuant to the policy provisions, or his attorney, or upon direction of theclaimant to one specified; however, the check or draft shall be made jointly to the claimant and the employer when the employer has advanced the claims payment to the claimant. The check or draft shall be paid jointly until the amount of the advanced claims payment has been recovered by the employer.
(2) No insurer shall intentionally or unreasonably delay, for more than three calendar days, exclusive of Saturdays, Sundays, and legal holidays, after presentation for collection, the processing of any properly executed and endorsed check or draft issued in settlement of an insurance claim.
(3) Any insurer violating this Subsection shall pay the insured or claimant a penalty of two hundred dollars or fifteen percent of the face amount of the check or draft, whichever is greater.
D.
(1) When making a payment incident to a claim, no insurer shall require repairs be made to a motor vehicle, including window glass repairs or replacement, in a particular place or shop or by a particular entity.
(2) An insurer shall not recommend the use of a particular motor vehicle service or network of repair services without informing the insured or claimant that the insured or claimant is under no obligation to use the recommended repair service or network of repair services.
(3) An insurer shall not engage in any act or practice of intimidation, coercion, or threat to use a specified place of business for repair and replacement services.
(4) The commissioner may levy the following fines against any insurer that violates this Subsection:
(a) For a first offense, one thousand dollars.
(b) For a second offense within a twelve-month period, two thousand five hundred dollars.
(c) For a third or subsequent offense within a twelve-month period, five thousand dollars.
(5) A violation of this Subsection shall constitute an additional ground, under R.S. 22:1554, for the commissioner to refuse to issue a license or to suspend or revoke a license issued to any producer to sell insurance in this state.
E.
(1) An insurer shall not require that repairs, replacement, restoration, or remediation be made to an insured’s property by a particular preferred vendor or recommended contractor when making a payment on a residential or commercial property damage claim.
(2) An insurer shall not recommend the use of a particular preferred vendor or recommended contractor without informing the insured or claimant that the insured or claimant is under no obligation to use the preferred vendor or recommended contractor to complete repairs, replacement, restoration, or remediation of the insured’s property.
F.
(1) In the adjustment or settlement of first-party losses under fire and extended coverage policies, an insurer is required to include general contractor’s overhead and profit in payments for losses when the services of a general contractor are reasonably foreseeable. This requirement applies to policies that provide for the adjustment and settlement of losses on a replacement cost basis and to policies that provide for the adjustment and settlement of losses on an actual cash value basis.
(2) The deduction of prospective contractor overhead, prospective contractor profit, and sales tax in determining the actual cash value of an adjustment or settlement is not allowed on replacement cost policies or on actual cash value policies.
G. Residential property insurance policies shall contain the following provision, with permission to substitute the words “this company” with a more accurate descriptive term for the insurer:
“Appraisal. If you and this Company fail to agree as to the amount of loss, either party may demand that the amount of the loss be set by appraisal. If either party makes a written demand for appraisal, each party shall select a competent appraiser and notify the other party of their appraiser’s identity within twenty days of receipt of the written demand for appraisal. The appraisers shall select a competent and impartial umpire. If after fifteen days the appraisers have not agreed upon who will serve as umpire, the umpire shall be appointed by a judge of the court of record in which the property is located. The appraisers shall appraise the loss. If the appraisers submit written notice of an agreement as to the amount of the loss to this Company, the amount agreed upon shall set the amount of the loss. If the appraisers fail to agree within thirty days, the appraisers shall submit their differences along with any supporting documentation to the umpire, who shall appraise the loss. The appraisers may extend the time to sixty days for which they shall agree upon the amount of loss or submit their differences and supporting documents to the umpire, if the extension is agreed to by the appraisers from both parties. A written agreement signed by the umpire and either party’s appraiser shall set the amount of the loss, pursuant to the appraisal process, but shall not preclude either party from exercising its rights under the policy or the law. Each appraiser shall be paid by the party selecting that appraiser. Other expenses of the appraisal and the expenses of the umpire shall be divided and paid in equal shares by you and this Company. If there is an appraisal award, all applicable policy terms, limits, deductibles, and conditions shall apply. If you file a lawsuit relative to this policy against this Company prior to a demand for appraisal, the lawsuit will be held in abatement during the period between a timely demand for appraisal and the deadline for execution of an appraisal award, pursuant to this clause. The court of record in which the property is located may enforce the deadlines of this clause, set a reasonable deadline for timely demanding appraisal after all parties have filed pleadings in a lawsuit, and require compliance with discovery and disclosure obligations relative to aspects of the lawsuit unrelated to the appraisal.”
[CLAIMS] La. R.S. 22:1893: Claims involving immovable property
A.
(1) No insurer shall use the floodwater mark on a covered structure without considering other evidence, when determining whether a loss is covered or not covered under a homeowner’s insurance policy.
(2) No insurer shall use the fact that a home is removed or displaced from its foundation without considering other evidence, when determining whether a loss is covered or not covered under a homeowner’s insurance policy.
B. If damage to immovable property is covered, in whole or in part, under the terms of the policy of insurance, the burden is on the insurer to establish an exclusion under the terms of the policy.
C. Any clause, condition, term, or other provision contained in any policy of insurance which alters or attempts to alter the burden on an insurer as provided in Subsection B of this Section shall be null and void and of no effect.
D. Any insurer determined to be in violation of the provisions of this Section shall be liable pursuant to R.S. 22:1973.
[CLAIMS] La. R.S. 22:1894: Filing claims; extension for claims arising from hurricane activity
A. Notwithstanding any other provision of this Title to the contrary, any person or entity having a claim for damages pursuant to a homeowners’ insurance policy, personal property insurance policy, tenant homeowners’ insurance policy, condominium owners’ insurance policy, or commercial property insurance policy, and resulting from Hurricane Katrina shall have through September 1, 2007, within which to file a claim with their insurer for damages, unless a greater time period to file such claim is otherwise provided by law or by contract.
B. Notwithstanding any other provision of this Title to the contrary, any person or entity having a claim for damages pursuant to a homeowners’ insurance policy, personal property insurance policy, tenant homeowners’ insurance policy, condominium owners’ insurance policy, or commercial property insurance policy, and resulting from Hurricane Rita shall have through October 1, 2007, within which to file a claim with their insurer for damages, unless a greater time period to file such claim is otherwise provided by law or by contract.
[CLAIMS] La. R.S. 22:1895: Homeowner’s insurance; claims payments and settlements
No payment of a claim on a homeowner’s insurance policy shall be considered a final settlement if the insurer fails to provide the insured with a statement that accurately reflects the amount paid under each category of coverage under the policy. The statement shall list each provision of coverage in the policy under which the insured may be entitled to payment, the maximum amount that may be paid under each category of coverage, and the amount actually included for payment under each category of coverage. The statement shall be given to the insured prior to the execution of a release by the insured.
[CLAIMS] La. R.S. 22:1896: Right to transparency and integrity in adjustment of property claims
A. An insurer of a residential or commercial property shall respond to all inquiries or requests from the insured within fourteen days of the inquiry or request, unless such time period to respond has been extended by the commissioner of insurance because of a disaster or emergency declared in accordance with R.S. 29:721 et seq.
B. An insurer of a residential or commercial property shall provide prompt adjustment by a qualified adjuster pursuant to the provisions of R.S. 22:1661 et seq., the Louisiana Claims Adjuster Act.
C. Any violations of this Section that are committed or performed with such frequency as to indicate a general business practice such as those enumerated in R.S. 22:1964(14) shall be subject to the provisions of R.S. 22:1964 et seq., the Unfair Trade Practices Act.
[CLAIMS] La. R.S. 22:1897: Adjuster communications
A. For a personal residential insurance claim that arises due to a named storm or hurricane for which a state of emergency or disaster is declared pursuant to R.S. 29:724, and the insurer within a six-month period assigns a third or subsequent claims adjuster to be primarily responsible for the insurance claim, the insurer shall provide the insured in a timely manner all of the following:
(1) A written status report that shall include at least the following:
(a) The manner in which the insured’s deductible has been applied and a statement as to whether the applicable deductible has been exhausted.
(b) The dollar amounts available under each coverage.
(c) The dollar amounts paid under each coverage.
(d) The dates on which payments were issued, to whom checks were payable, and addresses to which checks were sent or the means by which funds were otherwise delivered.
(e) A summary of items known to the insurer, as of the date of the status report, that remain to be adjusted and for which the insured must provide further information or documentation to the insurer in order to complete the adjustment process.
(2) A primary contact.
(3) Two or more direct means of communication with the primary contact.
B.”Primary contact” in Paragraph (A)(2) of this Section means an adjuster or team employed or retained as a member or members of the insurer’s staff who are knowledgeable about the claim. The insurer shall maintain a primary contact until the insurer closes the claim or a party files suit on the claim. The designation of a primary contact shall not preclude other claims personnel, vendors, or professionals, including clerical staff members, and call center staff members from working on portions of the insured’s claim.
C. The primary contact shall refer the insured to his supervisor at the request of an insured.
[CLAIMS] La. R.S. 22:1898: Catastrophe claim process disclosure form; rules and regulations
A. The commissioner shall promulgate all rules and regulations for a catastrophe claims process disclosure form that shall include but not be limited to the following:
(1) An explanation of the claims process, and the manner through which the insurer should communicate with the insured, subject to the terms and conditions of the insurance policy.
(2) An explanation of the supplemental claims process and the manner through which insurer should communicate with the insured, subject to the terms and conditions of the insurance policy.
(3) An explanation of the methodology used to calculate the percentage of the insured value of the property applicable to the insured’s hurricane, named storm, wind, and hail deductibles.
(4) An explanation of the difference between the actual cash valuation and the replacement cost valuation.
(5) The rights and protections a policyholder has under state law.
(6) An explanation of the duties a policyholder has in order to settle an insurance claim.
(7) An explanation of the items necessary to properly document an insurance claim.
(8) An explanation of the procedure for filing a complaint with the department if the policyholder is not satisfied with either the claim process or the claim settlement.
(9) A statement that informs the policyholder that if he files a claim for damage to a property subject to a mortgage, he may be required to notify the lender or mortgage servicer of the claim.
(10) A statement that informs the policyholder that if he receives proceeds from an insurance settlement for damage to a property subject to a mortgage, the policyholder may be required to contact the lender or mortgage servicer, as the lender or mortgage servicer may be a named payee whose endorsement may be required prior to depositing the insurance proceeds.
(11) An explanation of the procedure for filing a complaint with the Office of Financial Institutions if there is any dissatisfaction with how the lender or mortgage servicer handled the disbursement of the insurance proceeds.
(12) The process for utilizing the Hurricane Mediation Program if there is a disputed residential property insurance claim for property damage.
B.
(1)If the governor declares a state of emergency pursuant to R.S. 29:724, an insurer settling a property insurance claim that arises out of the state of emergency shall send to a policyholder filing a property insurance claim, the catastrophe claim process disclosure form promulgated by the commissioner pursuant to Subsection A of this Section.
(2) The insurer shall send the catastrophe claim process disclosure form to the policyholder no later than the date of the initial investigation of the claim by an adjuster. The disclosure form may be sent by United States mail, electronic delivery, or hand delivery.
C. Nothing in this Section shall be construed to provide a policyholder with a civil cause of action.
[UNFAIR PRACTICES] La. R.S. 22:1973: Good faith duty; claims settlement practices; cause of action; penalties
A. An insurer, including but not limited to a foreign line and surplus line insurer, owes to his insured a duty of good faith and fair dealing. The insurer has an affirmative duty to adjust claims fairly and promptly and to make a reasonable effort to settle claims with the insured or the claimant, or both. Any insurer who breaches these duties shall be liable for any damages sustained as a result of the breach.
B. Any one of the following acts, if knowingly committed or performed by an insurer, constitutes a breach of the insurer’s duties imposed in Subsection A of this Section:
(1) Misrepresenting pertinent facts or insurance policy provisions relating to any coverages at issue.
(2) Failing to pay a settlement within thirty days after an agreement is reduced to writing.
(3) Denying coverage or attempting to settle a claim on the basis of an application which the insurer knows was altered without notice to, or knowledge or consent of, the insured.
(4) Misleading a claimant as to the applicable prescriptive period.
(5) Failing to pay the amount of any claim due any person insured by the contract within sixty days after receipt of satisfactory proof of loss from the claimant when such failure is arbitrary, capricious, or without probable cause.
(6) Failing to pay claims pursuant to R.S. 22:1893 when such failure is arbitrary, capricious, or without probable cause.
C. In addition to any general or special damages to which a claimant is entitled for breach of the imposed duty, the claimant may be awarded penalties assessed against the insurer in an amount not to exceed two times the damages sustained or five thousand dollars, whichever is greater. Such penalties, if awarded, shall not be used by the insurer in computing either past or prospective loss experience for the purpose of setting rates or making rate filings.
D. The provisions of this Section shall not be applicable to claims made under health and accident insurance policies.
E. Repealed by Acts 1997, No. 949, §2.
F. The Insurance Guaranty Association Fund, as provided in R.S. 22:2051 et seq., shall not be liable for any special damages awarded under the provisions of this Section.
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