Insurance Claim Notifications Prior to Filing Complaint

As mentioned in my earlier blog post, How to File a Complaint with the Insurance Commissioner Office About Your Delaying, Denying, and Bad Treating Insurance Company, Article 27.164 of the Puerto Rico Insurance Code requires an insured to notify the Insurance Commissioner of any incompliance, delay, unpaid, under paid or unjust claim management by the insurer prior to filing suit in court. This law applies to Hurricane Maria claims and all insureds that did not file suit prior to the effective date of Article 27.164 must to comply with this new requirement.

This is the issue the Court of Appeals discussed in Consejo de Titulares del Condominio Magdalena Park v. MAPFRE Praico Insurance Company,1 where the trial court granted a partial summary judgment for the insured and the insurer appealed.

As a previous condition to filing an insurance claim in court insureds must give a written notification to the Insurance Commissioner and the Insurer. This will interrupt the filing of a claim in court for 65 days. Upon notification the Insurer will then have 60 days to solve the claim. The Insurance Commissioner will evaluate if the written notification is insufficient or vague and if such, will return the notification to the insured and the 60-day term will not begin until the insured has corrected the deficiency in the written notification.

In this case, the appellant did comply with the written notification and triggered the 65 days to file a complaint in court, however, the appellant filed suit a week before the 65-day term was completed. The court of appeals reversed the trial courts judgment because Article 27.164 was applied erroneously as the insured had prematurely filed the complaint in court.
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1 Consejo de Titulares del Condominio Magdalena Park v. MAPFRE Praico Ins. Co., 2020 WL 8090942 (P.R. Cit. Oct. 29, 2020).