Proof of Loss Obligations

When an insured has suffered a loss and wants to prove coverage under an automobile insurance policy, the insured must show the issuance and delivery of the policy, payment of the premium, a loss caused by a risk insured against, and notice and proof of loss to the insurance company. The proof of loss must give the insurance company adequate data from which it can determine its liability under the policy. The proof of loss must be in writing and set forth the injuries or damage sustained. A valuation of the loss should also be provided.

An insured can take a damaged automobile to an insurance company’s adjuster for an estimate of repair. The insurance company will then submit a proof of loss to the insured based on the adjuster’s contract for repairs. An insurance agent who issues an automobile insurance policy has no authority to waive a written proof of loss. An insured should not rely on such a “waiver.”

Insurance coverage can be forfeited if an insured fraudulently misrepresents items in a proof of loss. This forfeiture is authorized by statute. The fraud must be a deliberate false assertion of facts in the proof of loss. An inflated valuation of a claim is not necessarily fraud.

The proof of loss should contain whatever is required by the insurance policy. However, an insurance company cannot reject a written proof of loss because it does not contain a policy number or any other information that the insurance company already has. The failure of an insured to provide a proof of loss has been held to preclude recovery under the insurance policy.

Copyright 2012 LexisNexis, a division of Reed Elsevier Inc