Tornado Claim Reported Three Weeks Late

The file shows four immediate problems: no written acknowledgment of the claim, no documented investigation plan, no coverage decision or reservation of rights after the proof of loss, and no written explanation to the insured. Oklahoma's unfair claims settlement practices law, 36 O.S. Section 1250.1 and following, requires insurers to acknowledge and act promptly on claims, investigate reasonably, and affirm or deny coverage within a reasonable time. The 60-day proof-of-loss clause is a policy condition, but the insurer received the proof of loss on July 15 and still has not responded. I would send a written acknowledgment today identifying the claim number, adjuster, documents received, and next steps. I would open a reservation-of-rights letter covering late notice and possible pre-existing damage, calendar a decision date, and document every contact. I would not treat the missing acknowledgment as a defense. I would also confirm the public adjuster's authority and provide the claim-file materials the insured is entitled to, while protecting privileged or SIU material as permitted.

Late notice is a policy condition, but Oklahoma regulators and courts expect the insurer to show how the delay prejudiced its investigation before denying on that basis. Here the insured was out of state, returned June 10, called June 12, and submitted proof of loss July 15. That sequence is not automatic bad faith. The more important issue is causation: the inspection found tornado damage and also curled shingles and rotted fascia that may predate the storm. I would separate the loss into storm-created openings and direct damage, pre-existing wear or rot, and damage that cannot be attributed. I would obtain the agent's call log, the insured's travel records, weather data, and a roofing contractor's opinion on shingle age and damage pattern. If pre-existing conditions merely made the loss worse, the insurer may owe only the storm-related portion. If late notice prevented inspection of a disputed area, document that specific prejudice. Do not deny the entire claim based on a technical condition.

The written position should state the policy provisions at issue, the facts known and unknown, the coverage decision for each claimed item, and the reason for any reduction or denial. It should not be a bare citation to late notice or pre-existing damage. I would include an item-by-item table for roof, siding, screens, fascia, and interior water damage, showing amounts paid, amounts held pending documentation, and amounts denied. The file should contain the claim log, acknowledgment letter, reservation letter, inspection photos with timestamps, weather report, contractor estimates, proof of loss, and the insured's statement. For the OID complaint, I would send a factual chronology and copies of the written communications and never misstate the record. I would give the public adjuster the policy and claim-file materials consistent with the insured's authorization, and set a specific date for the next decision. If any portion is denied, the letter must explain the policy language and factual basis so the insured can respond.