Subject: Complaint Against State Farm Insurance Regarding Claim [Your Claim Number]
To Whom It May Concern,
I am writing to file a formal complaint against State Farm Insurance for their handling of my clients insurance claim 38-53D7-58R. I believe State Farm’s actions, or lack thereof, constitute a violation of the Unfair Insurance Practices Act as outlined in the Pennsylvania Code, Chapter 146.
Background of the Complaint:
On December 26th 2023, I submitted a comprehensive report outlining the insured's claim. The report included an inspection video, a repairability test, and information regarding the currently installed roof being three layers. In Pennsylvania, if a roof has more than two layers, it cannot be repaired but requires a complete re-roofing. The insureds policy, specifically under "Option OL - Building Ordinance or Law," clearly provides coverage on page 35 of the policy.
Violations Noted:
Failure to acknowledge pertinent communications (§ 146.5(c)): State Farm has failed to acknowledge pertinent communications. While State Farm Insurance acknowledged receipt of my report, reviewed it, and responded, they only addressed half of the report in their response and failed to address the most critical aspect of the report.
The most critical aspect of the report included pertinent information regarding the insured's policy and how it applies to the insured's claim. Specifically, the roof consists of three layers and, per local building code, cannot be repaired. The report also outlines which part of the policy provides coverage for this type of situation. However, this part of the report remains unacknowledged.
I asked for clarification as to why this aspect of my report has not been acknowledged, but I have not received a response. It has been more than 10 working days
Misrepresentation of Policy Provisions (§ 146.4(a)(b)): The insurer has not fully disclosed or addressed the policy provisions under "Option OL - Building Ordinance or Law" in their response, which provides coverage for this type of situation. By not advising the insured of this relevant option, State Farm has failed to disclose pertinent provisions and coverages, although it has been clearly demonstrated in my report.
I have attempted to address these issues directly with State Farm Insurance but have not received a response or resolution. Therefore, I seek the intervention of the Pennsylvania Insurance Department to address State Farms handling of the claim
Enclosed are copies of all relevant documents, including a (1) chain of events summary, (2) copy of insurance policy, (3) copy of submitted report, (4) link to report online, (5) correspondences with State Farm Insurance, and (6) copy of the relevant code which governs this loss.
I appreciate your attention to this matter and look forward to a resolution.
