Proof of Loss Requirements
Most of the first party property policies require the insured to submit a sworn proof of loss form to the insurer within a certain period, either after the loss or after the insurer has provided evidence of loss form. Insurers will often waive this requirement in the event of failures, primarily when total losses are incurred. Flood insurance policies that supplement the homeowner's policy require proof of loss within 60 days of the loss and are applied in a draconian fashion because flood insurance is a federal government program whose payments are ultimately paid from the U.S. Treasury.
Suppose the insured cannot provide proof of a flood loss within 60 days of the failure. In that case, it is essential for the insured to obtain an extension of time, in writing, from the adjuster or the insured to lose all rights under an indemnity policy. In most states, you are contractually obliged to provide the sworn proof of loss within the time limit (usually 60 days from the date of loss or request from the insurer). Many countries allow the insured to comply substantially with the requirement. Unless the insurer agrees to dispense with the sworn proof of loss or extend the time limit, the insured shall not submit the certified proof of loss to the insurer until the insured and the insurer have reached an agreement amount of loss and claims.
It is not unusual for the insurer to consider errors in the sworn proof of loss (because they are sworn under oath) as intentional distortions sufficient to allow the insurer to deny coverage of the claim. A statement made under oath cannot, by definition, contain an innocent misapprehension. A sworn proof of loss should never be signed by the insured, even if prepared by a lawyer until the insured has carefully read every word. The insured is sure that the statements made are correct. Some insurers believe that the insured will at some point refuse to comply with their requests.
Suppose the insured refuses to comply with reasonable requests for a documented statement. In that case, the EUO, the sworn proof of loss, or the documents reasonably related to the insurer's investigation may provide the insurer with a valid excuse to deny the claim based on the insured's breach of duty to cooperate or any other material condition preceding the policy indemnity. If the insured believes that any request made by the insurer is not reasonable, the insured should ask the insurer to explain the reason(s) for the request in writing. The prudent insured will err on the side of caution and provide all documents with an appropriate link to the policy or loss. Before giving the insurer a reason to deny a claim for failure to cooperate, the insured should consult the policyholder, the public administrator, or the State Department of Insurance before refusing a request that might turn out to have been reasonable.
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