Run Unfair Claims Settlement Practices Compliance Checklist — Free

Audit Identification

Claim file identifier recorded

Enter the claim number or file reference reviewed.

Line of business identified

Select the claim type being audited.

Applicable state jurisdiction documented critical (required)

Enter the state governing the claim handling timeline review.

Audit date and reviewer recorded

Record when the audit was performed and by whom.

Note (optional)

Reference standard noted

Document the applicable state unfair claims settlement practices rule or NAIC model act reference used for the review.

Claim Acknowledgment and Initial Contact

Claim acknowledgment sent within required timeframe critical (required)

Confirm the first acknowledgment to the claimant or insured was issued within the applicable state deadline.

Yes No N/A

Acknowledgment date documented in file

Record the date and time the acknowledgment was sent or logged.

Note (optional)

Initial contact method appropriate and documented

Confirm the contact method used is documented and appropriate for the claim file.

Yes No N/A

Note (optional)

Required claim information request issued

Confirm any request for missing information or documentation was sent promptly and is retained in the file.

Yes No N/A

No unexplained delay in first response

Rate whether the file shows any avoidable delay in the first response to the claim.

Note (optional)

Investigation and Communication

Investigation initiated within required timeframe critical (required)

Confirm investigation activity began within the applicable state or company standard.

Yes No N/A

Relevant facts and documents obtained critical (required)

Confirm the file contains the key statements, records, photos, estimates, or other evidence needed to support the claim decision.

Yes No N/A

Status updates provided at required intervals critical (required)

Confirm the claimant or insured received timely status updates when the investigation was pending.

Yes No N/A

Requests for additional information were specific and documented

Confirm any follow-up requests clearly identified what was needed and why.

Yes No N/A

Investigation notes support claim handling decisions

Rate the adequacy of documentation supporting the adjuster's conclusions and actions.

Note (optional)

Coverage, Liability, and Decision Basis

Coverage position documented critical (required)

Confirm the file clearly states the coverage determination and basis for that position.

Yes No N/A

Liability or causation analysis documented where applicable critical (required)

Confirm the file includes a reasonable analysis of liability, causation, or compensability as applicable to the claim type.

Yes No N/A

Denial or partial denial supported by facts and policy language critical (required)

Confirm any denial, reservation, or partial denial is supported by documented facts and the applicable policy or statutory basis.

Yes No N/A

Decision communication sent promptly critical (required)

Confirm the decision was communicated within the required timeframe after the investigation was complete.

Yes No N/A

Payment Timeliness and Settlement Handling

Undisputed payment issued within required timeframe critical (required)

Confirm any undisputed amount was paid within the applicable state deadline after receipt of sufficient proof of loss or agreement on amount.

Yes No N/A

Payment date documented

Record the date payment was issued or authorized.

Note (optional)

Settlement offer amount documented when applicable

Enter the settlement offer or paid amount reviewed.

Note (optional)

No unreasonable delay in payment processing

Rate whether the file shows avoidable delay in issuing payment or settlement.

Note (optional)

Release or settlement documentation complete

Confirm any release, settlement agreement, or closure documentation is complete and retained in the file.

Yes No N/A

Exceptions, Deficiencies, and Corrective Actions

Deficiencies identified

Select all compliance deficiencies observed during the audit.

Note (optional)

Corrective action documented critical (required)

Describe the corrective action, owner, and due date for any identified non-conformance.

Inspector signature critical (required)

Inspector signs to confirm the audit findings are complete and accurate.

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Run: Unfair Claims Settlement Practices Compliance Checklist

Audit Identification

Claim Acknowledgment and Initial Contact

Investigation and Communication

Coverage, Liability, and Decision Basis

Payment Timeliness and Settlement Handling

Exceptions, Deficiencies, and Corrective Actions

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