The commissioner of insurance has published a long list of guidelines which dictate the conduct of insurers during the underwriting process – including guidelines for the drafting of an insurance programme – and the claims handling process.
On March 28 2011 the commissioner published detailed guidelines on the documents involved in the claims handling process (ie, the dates and information which should be provided to the insured or third party).
On September 16 2015 the commissioner published a draft annex to the above guidelines. According to the commissioner, the necessity for further guidelines arose following audits carried out on several insurers.
The guidelines and the annex are relevant to all entities that file claims or demands against insurers, including:
- beneficiaries; and
- third parties that were injured by an insured.
The draft annex's main guidelines include the following:
- When a claim is filed with the insurer, the plaintiff will be entitled to choose the mode of communication (ie, mail, email, fax or other method of communication).
- No handwritten messages will be transferred to the plaintiff.
- A letter of declination will refer to an expert opinion filed by the plaintiff, including an explanation as to why it was not accepted.
- A letter of declination will reference the circumstances taken into account in reaching the decision to decline as well as the documents that the insurer relied on. The plaintiff will be allowed to view the documents in question.
- Insurers may not decline coverage based on an allegation of non-disclosure if the insured was not specifically asked about the issue or was asked but did not answer.(1)
- When a claim is declined based on an allegation of fraudulent non-disclosure, the insurer will specifically mention that fraud is the reason for declination as well as the implications of the declination. Further, the insurer will mention the sub-section of the law that it relied on in this regard.
- Private investigators will not be paid based on the results of the investigation and are not permitted to present themselves as public employees or as acting on behalf of a company which provides a vital service. Insurers which base their decision on a private investigator's report will detail the main findings revealed during the investigation.
- Insurers will not deduct amounts from third-party claims based on allegations of contributory blame without detailing the facts and circumstances which form the basis of the allegation.
The commissioner invited insurers to submit their remarks no later than October 29 2011. Discussions regarding the draft guidelines will be held between November 8 and 10 2015.
For further information on this topic please contact Tammy Greenberg at Levitan, Sharon & Co by telephone (+972 3 688 6768) or email (firstname.lastname@example.org). The Levitan, Sharon & Co website may be accessed at www.levitansharon.co.il.
(1) This guideline is contrary to Clause 6(c) of the Insurance Contracts Law 1981, which provides that the concealment by the insured, with fraudulent intent, of something that he or she knows to be a material matter will be treated as giving a reply which is incomplete and not straightforward.
This article was first published by the International Law Office, a premium online legal update service for major companies and law firms worldwide. Register for a free subscription.