No. HB 459
Filed under Insurance.
Property Insurance Claims; Establishes mandatory procedure for resolution of disputed property insurance claims; requires insurers to notify policyholders of mandatory procedure; requires DFS to prepare consumer information pamphlet to be provided to policyholders; authorizes policyholder or insurer to file petition with Division of Administrative Hearings to resolve certain claims; specifies that parties to claim must bear cost of certain conferences; requires administrative law judge to dismiss petitions that do not contain specified information; requires that petition include certain certification; specifies that dismissal of petition or portion of petition is without prejudice & does not require hearing; requires insurer to pay requested claim or file response to petition within specified timeframe; requires administrative law judge to make final determination of total coverage amount within specified timeframe; requires such amount to be paid in specified manner.
Plain English Summary
AI-GENERATEDProperty claim disputes move from mediation to a formal process before the Division of Administrative Hearings. Either side may file a petition, and an administrative law judge issues a binding ruling on the total coverage owed.
The insurer must pay the claim or respond within 14 days, and the judge must rule on coverage within 60 days and set the final payment amount within 180 days of filing.
Both sides, not just the insurer, must now cover the cost of these proceedings, a shift from the old rule that put the entire expense on the insurer alone.
Four statutes that structured the old mediation and appraisal system are repealed outright, and a petition missing required details, including the policyholder's Social Security number, must be dismissed.
AIA policyholder or an insurer may file a petition with the Division of Administrative Hearings to resolve a claim that is ripe, due, and owing, in place of the old mediation conference system.
AIBoth parties, not just the insurer, must now bear the cost of conducting these proceedings, replacing the old rule that put the entire expense of mediation conferences on the insurer.
AIAn administrative law judge must dismiss any petition, or the deficient part of one, that does not itemize specific required information on its face, including the policyholder's name, address, phone number, and Social Security number.
AIEvery petition must include a certification that the policyholder, or their attorney, made a good-faith effort to resolve the dispute with the insurer and was unable to do so.
AIOnce a petition is filed, the insurer has 14 days to either pay the claim outright or file a response explaining, item by item, why it is not paying.
AIThe administrative law judge must rule on coverage within 60 days of the petition, then issue a binding final determination of the total amount owed within 180 days of filing.
AISections 627.70151, 627.70152, 627.70153, and 627.70154, which set out the prior mediation and appraisal alternative-dispute-resolution framework, are repealed in their entirety.
AIAn insurer that fails to appear must now always pay the policyholder's actual cash expenses from attending, since the prior exception for a good cause acceptable to the department is gone.