It is important for policyholders to know and understand the steps they must complete before filing a complaint when an insurance claim has been delayed, denied and bad treated by an insurance company. As mentioned in a previous post, (please see my blog on this topic published on December 5, 2018: Puerto Rico Approves Amendments to the Insurance Code to Protect Policyholders and Improve Claim Handling Procedures), Puerto Rico’s Insurance Commissioner has established new requirements for the process of filing a complaint against an insurance company when it has delayed, denied, and treated their insured badly.
Under the new amended Law 2471 every insured should first submit a form as a notification of your insurance claim to the Insurance Commissioner’s Office. Here is the link to obtain the PDF form you need to fill out and submit to the Insurance Commissioner before filing a complaint:
http://www.ocs.gobierno.pr/ocspr/files/Formulario_Art__27_164_revisado.pdf
This is a brief two-page PDF form in which the insured should explain the facts related to their insurance claim and the violations made by their insurance company. Once the form is submitted it will be reviewed by the Insurance Commissioner and he will notify the insureds if the notification of violation is sufficient against the insurance company.
The PDF form should be mailed to the following address:
Oficina del Comisionado de Seguros
División de Investigaciones
B5 Calle Tabonuco
Suite 216, PMB 356
Guaynabo, PR 00968-3029
If the notification is sufficient, a sixty (60) day period will start for the insurer to resolve the claim. This process will interrupt for sixty-five (65) days any prescriptive term for actions in court. If the claim is not resolved within the sixty (60) day period, the insured can proceed to file a complaint in the court of jurisdiction.
If you have any questions about the process of filing the notification related to your insurance claim and/or filing a complaint, you can contact the Puerto Rico Insurance Commissioner’s Office at (787) 304-8686.
________________________________________________
1 Puerto Rico Insurance Code, 26 L.P.R.A. Article 38.050, Civil Remedies (as amended by Senate Bill 1727 – approved October 18, 2018).