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DHS FEMA NFIP Services - eWaterwark
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Improving the Appeals Process
The NFIP claims appeals process is being strengthened, and Program policyholders are now receiving
new documents that will explain these improvements.
Traditionally, FEMA used an informal process for handling appeals regarding decisions made about NFIP
coverage or claims. However, Section 205 of the Flood Insurance Reform Act of 2004 required FEMA to
establish a formal process for policyholders who are dissatisfied with a decision to deny a claim.
The appeals process is an adjunct to a policyholder's right to file a lawsuit in Federal district
court for the disallowed portion of the claim, or to invoke the appraisal provision of the Standard
Flood Insurance Policy (SFIP)--a procedure to resolve disputes about the actual value of covered
losses.
The new appeals rule provides a process that enables policyholders to formally appeal the decisions of
any insurance agent or adjuster, insurance company, FEMA employee, or contractor with respect to their
SFIP claims, proofs of loss, and loss estimates. The rule's effective date is November 13, 2006.
A policyholder can initiate this formal appeals process after his or her insurance company issues its
final determination in the form of a written denial--in whole or in part--of the claim. The appeal must
be filed within 60 days of receiving the insurance company's final claim determination. FEMA will
acknowledge receipt of an appeal in writing and advise the policyholder if additional information is
required for full consideration of the appeal. Next, FEMA will review documentation submitted by the
policyholder, and conduct any additional investigation needed. Finally, the policyholder and his or her
insurance company will be advised of FEMA's decision regarding the appeal.
The formal appeals process outlined in this rule does not abolish or replace the right to file a lawsuit
against the insurance company, nor does it expand or change the 1-year statute of limitation to file
suit against the insurer for the disallowed portion of the insured's claim. To avoid potentially
conflicting results as well as duplication of effort, a policyholder who files suit against an
insurance company based on the denial of a claim or who has been subject to appraisal, is prohibited
from filing an appeal under this process.
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| Business-Driven Technologies.
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| Last Modified:
Tuesday, 27 May 2008 |
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