State Specific Compliance

State-Specific Compliance: Ensuring Fair Claim Handling

Each state has unique compliance requirements to ensure claims are handled in good faith. Below are compliance zaps for Florida, Georgia, Kentucky, Texas, and South Carolina, addressing liability, medical specials, future medicals, and transparency.

Florida

Adjuster Assertion: The claim is being handled in compliance with Florida law.

Zap Response:

Under Florida Statutes § 624.155, insurers are required to act in good faith and avoid unfair claim settlement practices. This includes:

Providing a detailed explanation for any reductions or denials.
Avoiding arbitrary reductions in documented medical specials or future medicals.
Ensuring transparency in liability evaluations and settlement offers.

Failure to comply with these provisions exposes the insurer to regulatory complaints and potential bad faith litigation.

Georgia

Adjuster Assertion: The claim has been evaluated in accordance with Georgia law.

Zap Response:

Under Georgia Code § 33-6-34, insurers must conduct claim evaluations transparently and avoid unfair trade practices. This includes:

Providing justifications for reductions in medical specials or other claim components.
Ensuring liability determinations are based on evidence, not speculation.
Avoiding delays or incomplete responses during negotiations.

Non-compliance may result in regulatory review or exposure to bad faith claims.

Kentucky

Adjuster Assertion: This offer reflects fair handling under Kentucky law.

Zap Response:

Kentucky Revised Statutes § 304.12-230 require insurers to act in good faith, including:

Timely and fair evaluation of all documented damages, including future medical costs.
Avoiding reductions unsupported by medical or legal evidence.
Providing detailed reasoning for liability determinations and any claim denials.

Violations may result in regulatory penalties or litigation risks for bad faith handling.

Texas

Adjuster Assertion: The evaluation adheres to Texas law.

Zap Response:

Under Texas Insurance Code § 541.060, insurers are prohibited from engaging in unfair settlement practices. Requirements include:

Clear and timely communication about claim evaluations and decisions.
Transparency in the basis for all reductions or denials.
Fair valuation of all components, including non-economic damages like pain and suffering.

Non-compliance risks regulatory actions and potential bad faith lawsuits.

South Carolina

Adjuster Assertion: The claim has been evaluated in compliance with South Carolina regulations.

Zap Response:

South Carolina Code § 38-59-20 mandates insurers to handle claims in good faith by:

Providing a clear rationale for any reductions or denials, supported by evidence.
Ensuring fair evaluation of liability and all claim components.
Avoiding delays or arbitrary reductions that undermine fair settlement practices.

Violations of these provisions expose insurers to regulatory scrutiny and litigation.