Insurance Bad Faith Demand Letter - Kentucky

INSURANCE BAD FAITH DEMAND LETTER

Commonwealth of Kentucky

[LAW FIRM LETTERHEAD]

FOR SETTLEMENT PURPOSES — KRE 408 AND FED. R. EVID. 408 MAY LIMIT SPECIFIED USES OF DISPUTED-CLAIM NEGOTIATIONS

This label does not create a privilege or make every statement inadmissible.

VIA CERTIFIED MAIL, RETURN RECEIPT REQUESTED
AND VIA EMAIL TO: [ADJUSTER_EMAIL]

Date: [__/__/____]

[INSURANCE_COMPANY_NAME]
[________________________________]
[CITY], [STATE] [ZIP]

Attention: [ADJUSTER_NAME], [ADJUSTER_TITLE]
Re: FORMAL BAD FAITH DEMAND — COMMONWEALTH OF KENTUCKY
Insured: [________________________________]
Claimant: [________________________________]
Policy Number: [________________________________]
Claim Number: [________________________________]
Date of Loss: [__/__/____]
Policy Limits: $[________________________________]
Response Deadline: [__/__/____] (TIME-LIMITED DEMAND)

Dear [ADJUSTER_NAME]:

I. INTRODUCTION AND NATURE OF DEMAND

This firm represents [CLIENT_NAME] ("our client" or "the Claimant") in connection with the above-captioned insurance claim arising in the Commonwealth of Kentucky. This letter constitutes a formal, time-limited demand for payment of policy benefits wrongfully withheld and serves as written notice of [INSURANCE_COMPANY_NAME]'s ("the Company" or "[CARRIER_SHORT_NAME]") violations of the Kentucky Unfair Claims Settlement Practices Act (KRS 304.12-230) and Kentucky common-law duty of good faith.

Kentucky is one of a minority of states that permits both first-party and third-party claimants to bring private civil actions for insurance bad faith. See State Farm Mut. Auto. Ins. Co. v. Reeder, 763 S.W.2d 116 (Ky. 1988). The legal framework is well settled. The Company's claim-handling obligations are statutory, regulatory, and common-law — not matters of corporate preference. The Company's conduct to date falls substantially short of those obligations.

This is a time-limited demand. [CARRIER_SHORT_NAME] has until [__/__/____] to tender the full amount owed of $[DEMAND_AMOUNT] and resolve all claims arising from this loss. Failure to do so will result in the immediate filing of a civil action in Kentucky Circuit Court seeking contract damages, consequential damages, punitive damages under KRS 411.184, attorney's fees, and prejudgment interest.

II. KENTUCKY BAD FAITH LAW

A. The Wittmer v. Jones Three-Element Test

To prevail in a bad faith action under Kentucky law, the insured/claimant must prove three elements, as unified by the Kentucky Supreme Court in Wittmer v. Jones, 864 S.W.2d 885 (Ky. 1993):

1. The insurer must be obligated to pay the claim under the terms of the policy;
2. The insurer must lack a reasonable basis in law or fact for denying the claim; and
3. The insurer must know there is no reasonable basis for denying the claim, or must act with reckless disregard for whether such a basis existed.

Wittmer synthesized two earlier Kentucky Supreme Court decisions:

• Common-law first-party bad faith: Curry v. Fireman's Fund Ins. Co., 784 S.W.2d 176 (Ky. 1989), overruled Federal Kemper Ins. Co. v. Hornback, 711 S.W.2d 844 (Ky. 1986), and incorporated the dissent's common-law framework.
• Statutory third-party bad faith: State Farm Mut. Auto. Ins. Co. v. Reeder, 763 S.W.2d 116 (Ky. 1988), applies KRS 446.070 to UCSPA; Wittmer itself involved a third-party claim.

B. Statutory Bad Faith — KRS 304.12-230 + KRS 446.070

Kentucky's Unfair Claims Settlement Practices Act ("KUCSPA") does not contain its own private enforcement provision. Instead, under State Farm Mut. Auto. Ins. Co. v. Reeder, 763 S.W.2d 116 (Ky. 1988), KUCSPA is enforced privately through KRS 446.070, which provides that "a person injured by the violation of any statute may recover from the offender such damages as he sustained by reason of the violation."

KUCSPA was amended effective July 15, 1988 to eliminate the former "general business practice" requirement. A claimant need not prove a pattern, but a technical violation alone is insufficient; the claimant must satisfy the Wittmer bad-faith standard and prove resulting injury.

C. Third-Party Standing

Kentucky permits a third-party claimant within the protected class to bring a private UCSPA action against an insurer through KRS 446.070. State Farm v. Reeder, 763 S.W.2d 116 (Ky. 1988). Davidson v. American Freightways, Inc., 25 S.W.3d 94 (Ky. 2000), separately limits UCSPA liability to insurers and others engaged in the insurance business.

D. The "Tall Burden" — Post-Mosley Developments

The Kentucky Supreme Court's recent decisions, including Mosley v. Arch Specialty Ins. Co., 626 S.W.3d 579 (Ky. 2021), and Indiana Ins. Co. v. Demetre, 527 S.W.3d 12 (Ky. 2017), confirm that while the burden on a bad-faith plaintiff is significant, it is far from insurmountable where the record reflects: (i) clear coverage obligation, (ii) unjustified denial or delay, and (iii) knowledge or reckless disregard of the lack of basis. In this claim, all three elements are abundantly documented, as detailed below.

E. Punitive Damages — KRS 411.184

Kentucky's punitive damages statute, KRS 411.184, permits punitive damages upon clear and convincing evidence that the defendant acted with:

• Oppression: conduct specifically intended to subject the plaintiff to cruel and unjust hardship;
• Fraud: intentional misrepresentation, deceit, or concealment of material fact; OR
• Malice: conduct specifically intended to injure, or carried out with flagrant indifference to the rights of the plaintiff with subjective awareness of harm.

The statute does not require all three — any one suffices. Kentucky does not impose a statutory cap on punitive damages. Instead, Kentucky courts apply the due-process analysis set forth in BMW of North America, Inc. v. Gore, 517 U.S. 559 (1996), and State Farm Mut. Auto. Ins. Co. v. Campbell, 538 U.S. 408 (2003), typically tolerating ratios up to single digits where warranted by egregious conduct. Kentucky juries have returned substantial bad-faith verdicts against insurers, and punitive damages are specifically available for bad-faith conduct. See Wittmer v. Jones; Anthem Health Plans of Ky., Inc. v. Cornett, 2022 Ky. Unpub. opinions applying KRS 411.184 to insurer misconduct.

F. Conditionally Authorized Attorney's Fees and Consequential Damages

Attorney's fees are not automatic in every Kentucky bad-faith action. KRS 304.12-235(3) conditionally authorizes reasonable fees for a named insured or health-care provider when settlement is delayed beyond the statutory period without reasonable foundation. Other fee requests require an independently applicable statute, rule, or contract.

Consequential damages include economic loss caused by delay, emotional distress and mental anguish, damage to credit and reputation, and other foreseeable harms proximately caused by the insurer's unreasonable conduct.

III. POLICY AND COVERAGE

A. Policy Details

B. Coverage Analysis

The policy insuring agreement provides coverage for [DESCRIBE_COVERED_LOSS]. The loss unambiguously falls within the insuring agreement, and no exclusion applies. Under Kentucky's long-standing interpretive rules, any ambiguity must be construed against the drafter-insurer and in favor of coverage. Kemper Nat'l Ins. Cos. v. Heaven Hill Distilleries, Inc., 82 S.W.3d 869 (Ky. 2002); Simon v. Continental Ins. Co., 724 S.W.2d 210 (Ky. 1986) (reasonable expectations doctrine).

Having [acknowledged coverage / received proof of loss / completed its investigation], [CARRIER_SHORT_NAME] is obligated under Kentucky law to:

• Conduct a thorough, fair, and objective investigation based on all reasonably available information;
• Evaluate the claim in good faith using reasonable claim-handling standards;
• Promptly tender all amounts owed once liability is reasonably clear;
• Communicate transparently, respond to inquiries within 15 calendar days, and provide reasons for any denial;
• Refrain from compelling litigation through unreasonable conduct.

IV. FACTUAL BACKGROUND AND CHRONOLOGY OF BAD FAITH

A. The Underlying Loss

On [__/__/____], [DESCRIBE_LOSS_EVENT]. [ADDITIONAL_DETAIL]. Liability and coverage are — and have been from the outset — reasonably clear.

B. Chronology of Company Conduct (Bad Faith Timeline)

V. SPECIFIC BAD FAITH CONDUCT

A. Unreasonable Delay — KRS 304.12-230(2), 806 KAR 12:095 § 5

[CARRIER_SHORT_NAME] has unreasonably delayed investigation, evaluation, and payment:

• [DESCRIBE_SPECIFIC_DELAY_1]
• [DESCRIBE_SPECIFIC_DELAY_2]
• [DESCRIBE_SPECIFIC_DELAY_3]

806 KAR 12:095 requires acknowledgment within 15 days under § 5. Section 6 separately requires payment due within 30 calendar days after proof of loss or a reasoned additional-time notice within that period, followed by reasoned 45-calendar-day letters while the investigation remains incomplete. Identify the specific missed requirement and facts rather than treating 30 days as a universal investigation-completion deadline.

B. Inadequate Investigation — KRS 304.12-230(3), (4)

[CARRIER_SHORT_NAME] failed to conduct the reasonable, thorough, and objective investigation Kentucky law requires:

• [INVESTIGATION_FAILURE_1]
• [INVESTIGATION_FAILURE_2]
• [INVESTIGATION_FAILURE_3]

C. Unreasonably Low Offers — KRS 304.12-230(7), (8)

The Company's offers have been grossly inadequate, designed to compel litigation:

This pattern is the textbook definition of the KRS 304.12-230(7) violation: "Compelling insureds to institute litigation . . . by offering substantially less than the amounts ultimately recovered."

D. Misrepresentation of Policy or Facts — KRS 304.12-230(1)

[DESCRIBE_MISREPRESENTATIONS], including:

• [MISREP_1]
• [MISREP_2]

E. Failure to Provide Reasonable Explanation — KRS 304.12-230(14)

[DESCRIBE_FAILURE_TO_EXPLAIN_DENIAL]

F. Failure to Communicate — KRS 304.12-230(2)

• [COMMUNICATION_FAILURE_1]
• [COMMUNICATION_FAILURE_2]

VI. APPLICATION OF THE WITTMER TEST

Element 1 — Obligation to Pay

Coverage is unambiguous. [EXPLAIN_WHY_COVERAGE_APPLIES]. No reasonable coverage dispute exists.

Element 2 — No Reasonable Basis

There is no reasonable basis in law or fact for [CARRIER_SHORT_NAME]'s denial/delay/underpayment:

• The evidence overwhelmingly supports the claim;
• Kentucky coverage-construction rules require resolution in favor of the insured;
• The Company's stated reasons are pretextual, contradictory, or unsupported by the record;
• [ADDITIONAL_EXPLANATION]

Element 3 — Knowledge or Reckless Disregard

The claim file, adjuster notes, and internal communications — which the Company is obligated to preserve (see Section XI) — will reveal that [CARRIER_SHORT_NAME] either knew its position lacked a reasonable basis or acted with reckless disregard of that fact. Indicia include:

• Internal reserves set at values substantially above the offers made;
• Supervisor notations reflecting coverage acknowledgment;
• Disregard of independent reports favorable to the Claimant;
• Repeated failures to follow internal claim-handling guidelines;
• [OTHER_INDICIA]

VII. DAMAGES

A. Contract Damages

B. Consequential Damages

C. Emotional Distress / Mental Anguish

Kentucky permits recovery of emotional distress damages in bad-faith actions without a physical-impact requirement. Osborne v. Keeney, 399 S.W.3d 1 (Ky. 2012) (clarifying emotional distress damages standard); Motorists Mut. Ins. Co. v. Glass, 996 S.W.2d 437 (Ky. 1997). Our client has suffered [DESCRIBE_EMOTIONAL_DISTRESS].

D. Punitive Damages — KRS 411.184

Punitive damages are warranted and provable by clear and convincing evidence. The Company's conduct satisfies one or more of the KRS 411.184 predicates:

• Oppression: [EXPLAIN]
• Fraud: [EXPLAIN]
• Malice / flagrant indifference: [EXPLAIN]

Aggravating factors under KRS 411.186 that support a substantial punitive award include:

• Likelihood that serious harm would result from the conduct;
• Profitability of the misconduct;
• Duration of the misconduct and concealment;
• Actions or inactions by the insurer upon discovery of the misconduct;
• Financial condition of the Company.

E. Attorney's Fees — Include Only When Independently Authorized

If the claimant is a named insured or health-care provider and the facts satisfy KRS 304.12-235(3), list reasonable fees incurred because settlement was delayed without reasonable foundation. Otherwise identify the specific statute, rule, or contract authorizing fees, or omit this component.

F. Interest — Claim-Specific Analysis Required

KRS 304.12-235(2) conditionally provides twelve-percent interest for specified first-party claims when its predicates are met. Any other prejudgment-interest request requires a separate liquidated-claim and rate analysis; KRS 360.010 is not a blanket entitlement and KRS 360.040 governs judgment interest.

VIII. FORMAL DEMAND

A. Monetary Demand

We hereby demand that [CARRIER_SHORT_NAME] pay the total sum of $[TOTAL_DEMAND_AMOUNT] as follows:

B. Settlement Terms

In addition to monetary payment:

• Full release of all claims against the Claimant (and insureds, where applicable) arising from the loss;
• Correction of any adverse information reported to CLUE, NICB, ISO, or similar industry databases;
• Confidentiality (optional, subject to KRS and public-policy limits);
• Payment to be tendered within [____] days of acceptance by wire or certified funds.

IX. TIME-LIMITED NATURE AND CONSEQUENCES

THIS DEMAND EXPIRES AT 5:00 P.M. EASTERN TIME ON [__/__/____].

If [CARRIER_SHORT_NAME] fails to accept this demand by the deadline, the Claimant will:

1. File suit immediately in [COUNTY] Circuit Court, Commonwealth of Kentucky, alleging breach of contract, statutory bad faith under KRS 304.12-230 and KRS 446.070, common-law bad faith under Wittmer v. Jones, violation of 806 KAR 12:095, and seeking punitive damages under KRS 411.184;
2. Withdraw this demand and seek full damages without the constraint of the current demand amount, including:
   - Full policy benefits plus prejudgment interest at the statutory rate;
   - All consequential and emotional distress damages;
   - Punitive damages without statutory cap (subject only to constitutional due-process limits);
   - Attorney's fees as bad-faith damages;
3. File a formal regulatory complaint with the Kentucky Department of Insurance, 500 Mero Street, 2 SE, Frankfort, KY 40601 (phone 502-564-3630) and request investigation under 806 KAR 12:095. KY DOI can impose administrative penalties, market-conduct examinations, and corrective action against licensed insurers;
4. Preserve this demand letter and the Company's response (or lack thereof) as Exhibit A in the bad-faith action, and move in limine for its admission as evidence of the Company's reckless disregard;
5. Notice depositions of the adjuster, supervisor, and claim-handling decision makers in the Kentucky action.

X. KUCSPA VIOLATIONS — COMPLETE LIST

[CARRIER_SHORT_NAME]'s conduct violates KRS 304.12-230 subsections:

☐ (1) Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue
☐ (2) Failing to acknowledge and act reasonably promptly upon communications with respect to claims
☐ (3) Failing to adopt and implement reasonable standards for the prompt investigation of claims
☐ (4) Refusing to pay claims without conducting a reasonable investigation based upon all available information
☐ (5) Failing to affirm or deny coverage within a reasonable time after proof-of-loss statements
☐ (6) Not attempting in good faith to effectuate prompt, fair, and equitable settlements when liability is reasonably clear
☐ (7) Compelling insureds to institute litigation by offering substantially less than amounts ultimately recovered
☐ (8) Attempting to settle for less than amount a reasonable person would believe entitled
☐ (9) Attempting to settle based on an application altered without notice/consent
☐ (10) Making a claim payment not accompanied by a statement of coverages
☐ (11) Making known a policy of appealing arbitration awards to compel settlement
☐ (12) Delaying investigation or payment by requiring duplicate verifications
☐ (13) Failing to promptly settle under one portion of the policy, where liability is reasonably clear, to influence settlement under another portion
☐ (14) Failing to promptly provide a reasonable explanation of the policy, facts, or applicable-law basis for denial or compromise

XI. DOCUMENT PRESERVATION AND LITIGATION HOLD

[CARRIER_SHORT_NAME] is hereby on formal notice to preserve all documents, ESI, and physical materials related to this claim, including but not limited to:

• Complete claim file (all versions and drafts);
• Adjuster notes, diaries, activity logs, and claim system entries;
• All internal communications, e-mails, instant messages, and Teams/Slack messages regarding this claim;
• Reserve history, reserve changes, and explanations for changes;
• Supervisor notes and approvals;
• Quality assurance reviews, market conduct reports, and audits;
• All third-party vendor reports (engineers, estimators, investigators, attorneys);
• Photographs, videos, drone footage, and scene documentation;
• Recorded statements and transcriptions;
• Claim-handling manuals, bulletins, and training materials;
• SIU investigation materials (if any);
• Reinsurance communications;
• Payment ledgers and checks;
• Structured data from claim systems (Guidewire, Duck Creek, or proprietary).

Destruction or alteration may result in spoliation sanctions under CR 37, adverse-inference instructions, and enhanced punitive damages.

XII. CONCLUSION

[CARRIER_SHORT_NAME]'s handling of this claim represents precisely the type of conduct that Kentucky's bad-faith jurisprudence was designed to prevent and punish. Kentucky law is clear: insurers owe their policyholders — and in appropriate cases, third-party claimants — duties of good faith, prompt investigation, fair evaluation, and honest communication. Those duties have been breached. The Claimant has attempted to resolve this dispute amicably. This demand represents one final opportunity for the Company to avoid the substantial exposure a Kentucky jury is empowered to impose.

Please direct all further communications regarding this matter to the undersigned.

Respectfully submitted,

[LAW_FIRM_NAME]

By: _______________________________
[ATTORNEY_NAME]
KBA Bar Number: [____]
[ADDRESS]
[CITY], KY [ZIP]
Tel: [____]
Email: [____]

Counsel for [CLIENT_NAME]

ENCLOSURES:

• Policy declarations page and all relevant policy forms
• Correspondence chronology
• Damage documentation / evidence of loss
• Medical records (if applicable)
• Expert reports (if applicable)
• Photographs / videos
• Prior communications with Company

CC:

• [CLIENT_NAME]
• Kentucky Department of Insurance (upon regulatory complaint)

KENTUCKY BAD FAITH QUICK REFERENCE

SOURCES AND REFERENCES

• KRS 304.12-230 — Unfair Claims Settlement Practices Act: https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=17037
• KRS 304.12-235 — Time of Payment of Claims: https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=17038
• KRS 411.184 — Punitive Damages Definitions: https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=17783
• KRS 411.186 — Factors for Punitive Damages
• KRS 446.070 — Private Right of Action for Statutory Violations
• 806 KAR 12:095 — Unfair Claims Settlement Practices Regulation: https://apps.legislature.ky.gov/law/kar/titles/806/012/095/
• Wittmer v. Jones, 864 S.W.2d 885 (Ky. 1993)
• Federal Kemper Ins. Co. v. Hornback, 711 S.W.2d 844 (Ky. 1986)
• Curry v. Fireman's Fund Ins. Co., 784 S.W.2d 176 (Ky. 1989)
• State Farm Mut. Auto. Ins. Co. v. Reeder, 763 S.W.2d 116 (Ky. 1988)
• Mosley v. Arch Specialty Ins. Co., 626 S.W.3d 579 (Ky. 2021)
• Indiana Ins. Co. v. Demetre, 527 S.W.3d 12 (Ky. 2017)
• Motorists Mut. Ins. Co. v. Glass, 996 S.W.2d 437 (Ky. 1997)
• Davidson v. American Freightways, Inc., 25 S.W.3d 94 (Ky. 2000)
• Osborne v. Keeney, 399 S.W.3d 1 (Ky. 2012)
• Kemper Nat'l Ins. Cos. v. Heaven Hill Distilleries, Inc., 82 S.W.3d 869 (Ky. 2002)
• Simon v. Continental Ins. Co., 724 S.W.2d 210 (Ky. 1986)
• Kentucky Department of Insurance: https://insurance.ky.gov