- investigation by insurer required
- minimum standards for investigation
(1)If, after a diligent investigation by an insured of the insured’s own records, including computer records and the records of past and present agents of the insured, the insured is unable to reconstruct a lost policy, the insured may provide a notice of a lost policy to an insurer.
(2)An insurer must investigate thoroughly and promptly a notice of a lost policy. An insurer fails to investigate thoroughly and promptly if the insurer fails to provide all facts known or discovered during an investigation concerning the issuance and terms of a policy, including copies of documents establishing the issuance and terms of a policy, to the insured claiming coverage under a lost policy.
(3)An insurer and an insured must comply with the following minimum standards for facilitating reconstruction of a lost policy and determining the terms of a lost policy as provided in this section:
(a)Within 30 business days after receipt by the insurer of notice of a lost policy, the insurer shall commence an investigation into the insurer’s records, including computer records, to determine whether the insurer issued the lost policy. If the insurer determines that it issued the policy, the insurer shall commence an investigation into the terms and conditions relevant to any environmental claim made under the policy.
(b)The insurer and the insured shall cooperate with each other in determining the terms of a lost policy. The insurer and the insured:
(A)Shall provide to each other the facts known or discovered during an investigation, including the identity of any witnesses with knowledge of facts related to the issuance or existence of a lost policy.
(B)Shall provide each other with copies of documents establishing facts related to the lost policy.
(C)Are not required to produce material subject to a legal privilege or confidential claims documents provided to the insurer by another policyholder.
(c)If the insurer or the insured discovers information tending to show the existence of an insurance policy applicable to the claim, the insurer or the insured shall provide an accurate copy of the terms of the policy or a reconstruction of the policy, upon the request of the insurer or the insured.
(d)If the insurer is not able to locate portions of the policy or determine its terms, conditions or exclusions, the insurer shall provide copies of all insurance policy forms issued by the insurer during the applicable policy period that are potentially applicable to the environmental claim. The insurer shall state which of the potentially applicable forms, if any, is most likely to have been issued by the insurer, or the insurer shall state why it is unable to identify the forms after a good faith search.
(4)Following the minimum standards established in this section does not create a presumption of coverage for an environmental claim once the lost policy has been reconstructed.
(5)Following the minimum standards established in this section does not constitute:
(a)An admission by an insurer that a policy was issued or effective; or
(b)An affirmation that if the policy was issued, it was necessarily in the form produced, unless so stated by the insurer.
(6)If, based on the information discovered in an investigation of a lost policy, the insured can show by a preponderance of the evidence that a general liability insurance policy was issued to the insured by the insurer, then if:
(a)The insured cannot produce evidence that tends to show the policy limits applicable to the policy, it shall be assumed that the minimum limits of coverage, including any exclusions to coverage, offered by the insurer during the period in question were purchased by the insured.
(b)The insured can produce evidence that tends to show the policy limits applicable to the policy, then the insurer has the burden of proof to show that a different policy limit, including any exclusions to coverage, should apply.
(7)An insurer may claim an affirmative defense to a claim that the insurer failed to follow the minimum standards established under this section if the insured fails to cooperate with the insurer in the reconstruction of a lost policy under this section.
(8)The Director of the Department of Consumer and Business Services shall enforce this section and any rules adopted by the director to implement this section.
(9)Violation by an insurer of any provision of this section or any rule adopted under this section is an:
(a)Unfair environmental claims settlement practice under ORS 465.484 (Unfair environmental claims settlement practices); and
(b)Unfair claim settlement practice under ORS 746.230 (Unfair claim settlement practices).
(10)As used in this section, “notice of a lost policy” means written notice of the lost policy in sufficient detail to identify the person or entity claiming coverage, including information concerning the name of the alleged policyholder, if known, and material facts concerning the lost policy known to the alleged policyholder. [2003 c.799 §4; 2013 c.350 §3]
Section 465.479 — Lost policies; investigation by insurer required; minimum standards for investigation,