Insurance DOI Complaint and Bad-Faith Demand — Ohio

comments before sending. -->

Insurance DOI Complaint and Bad-Faith Demand (OHIO)

Quick-Reference Summary

PART A — DOI COMPLAINT COVER LETTER

Sender Letterhead

[ATTORNEY OR FIRM / INSURED NAME]
[STREET ADDRESS]
[CITY], OH [ZIP]
Phone: [____________]
Email: [____________]
Ohio Bar Reg. No. (if attorney): [____________]

Date and Recipient

Date: [__/__/____]

Sent Via:
☐ ODI online complaint portal (https://insurance.ohio.gov/about-us/complaint-center)
☐ U.S. Certified Mail, Return Receipt Requested (Tracking No. [____________])
☐ Fax to Consumer Services Division

To:
Ohio Department of Insurance
Consumer Services Division
50 West Town Street, Third Floor / Suite 300
Columbus, OH 43215

Subject: Consumer Complaint Against [INSURER LEGAL NAME], NAIC No. [_____] — Unfair Claims Settlement Practices Under R.C. § 3901.21 and Ohio Adm. Code 3901-1-54; Claim No. [____________]

I. Insured / Complainant Information

II. Carrier and Policy Information

III. Claim Background

[Dated chronology of communications, document submissions, inspections, EUO/IME demands, partial payments, denials, and delays.]

[____________________________________________________________]
[____________________________________________________________]
[____________________________________________________________]
[____________________________________________________________]

IV. Specific Unfair Claims Practices Alleged

The conduct described above violates one or more provisions of R.C. § 3901.21 and Ohio Adm. Code 3901-1-54, including:

☐ R.C. § 3901.21(B) — Failure to acknowledge and act reasonably promptly upon communications
☐ R.C. § 3901.21(C) — Failure to adopt and implement reasonable standards for prompt investigation
☐ R.C. § 3901.21(D) — Refusal to pay claims without conducting a reasonable investigation
☐ R.C. § 3901.21(E) — Failure to affirm or deny coverage within a reasonable time after proof-of-loss completed
☐ R.C. § 3901.21(F) — Failure to attempt in good faith to effectuate prompt, fair, and equitable settlement where liability is reasonably clear
☐ R.C. § 3901.21(G) — Compelling insured to litigate by offering substantially less than amounts ultimately recovered
☐ R.C. § 3901.21(N) — Failure to promptly provide reasonable explanation of basis for denial or compromise
☐ R.C. § 3901.21(P) — Pattern settlement / using predetermined formula without case-specific investigation
☐ Ohio Adm. Code 3901-1-54(H)(7) — Improper total-loss valuation methodology
☐ Ohio Adm. Code 3901-1-54(H)(7)(g) — Failure to honor 35-day right to renegotiate
☐ Other: [____________________________________________________________]

V. Documents Enclosed

☐ Declarations page and complete policy
☐ Sworn statement / proof of loss
☐ Notice of loss / first report of claim
☐ Estimates, invoices, repair / valuation documentation
☐ Medical records and bills (if PI/UM/health)
☐ Photos / video of damage
☐ All correspondence with insurer and adjuster
☐ Denial / reservation-of-rights letter(s)
☐ Total-loss comparable report (if applicable)
☐ Authorization for ODI to obtain claim file (signed)
☐ Other: [____________________________________________________________]

VI. Requested ODI Action

The Insured respectfully requests that the Department:

1. Open a formal investigation under R.C. § 3901.20–.22 and Ohio Adm. Code 3901-1-54;
2. Require [INSURER] to provide a written explanation of its handling of Claim No. [____________];
3. Determine whether the insurer's conduct constitutes an unfair or deceptive act or practice;
4. Take appropriate administrative action, including a market-conduct examination if a pattern is identified.

The Insured understands that ODI cannot act as legal counsel, render coverage opinions, or order payment of disputed amounts, and that this complaint does not toll any contractual or statutory limitations period.

VII. Authorization

I, [INSURED NAME], authorize the Ohio Department of Insurance to obtain from [INSURER] the complete claim file, underwriting file, and all related correspondence concerning Claim No. [____________] under Policy No. [____________], and to share information with [INSURER] necessary to investigate this complaint.

VIII. Signature

Respectfully submitted,

_______________________________
[INSURED OR COUNSEL NAME]
Date: [__/__/____]

---

PART B — BAD-FAITH DEMAND LETTER TO CARRIER

Sender Letterhead

[ATTORNEY OR FIRM NAME]
[STREET ADDRESS]
[CITY], OH [ZIP]
Phone: [____________]
Email: [____________]
Ohio Bar Reg. No.: [____________]

Date and Recipient

Date: [__/__/____]

Sent Via:
☐ U.S. Certified Mail, Return Receipt Requested (Tracking No. [____________])
☐ FedEx / UPS Overnight (Tracking No. [____________])
☐ Email to [____________] (read-receipt requested)
☐ Hand delivery

To:
[INSURER LEGAL NAME]
Attn: General Counsel / Claims Director
[STREET ADDRESS]
[CITY], [STATE] [ZIP]

cc: [Claims Adjuster], [Adjuster Email]
cc: Statutory Agent for Service in Ohio — [____________]

Re: Demand for Payment and Notice of Common-Law Bad Faith (Hoskins v. Aetna)
Insured: [____________]
Policy No.: [____________]
Claim No.: [____________]
Date of Loss: [__/__/____]

SETTLEMENT COMMUNICATION — Subject to Ohio Evid. R. 408

I. Parties

The undersigned represents [INSURED LEGAL NAME] ("Insured") in connection with the above-captioned insurance claim against [INSURER LEGAL NAME] ("Insurer"), a [domestic/foreign] insurer authorized to transact insurance in Ohio (NAIC No. [_____]).

II. Claim Background and Insurer Response History

[Narrative summary of carrier's handling — what was demanded, what was provided, what payment (if any) was made, and what remains in dispute.]

[____________________________________________________________]
[____________________________________________________________]
[____________________________________________________________]

III. Violations of the Ohio Unfair Claims Practices Act and Ohio Adm. Code 3901-1-54

Insurer's conduct constitutes one or more unfair or deceptive acts or practices under R.C. § 3901.21 and Ohio Adm. Code 3901-1-54:

• R.C. § 3901.21(D) — refusing to pay without conducting a reasonable investigation;
• R.C. § 3901.21(F) — failure in good faith to effectuate prompt, fair, and equitable settlement where liability is reasonably clear;
• R.C. § 3901.21(N) — failure to promptly provide a reasonable explanation of the basis for denial or compromise;
• R.C. § 3901.21(P) — pattern settlement: imputing value through a predetermined formula without case-specific investigation;
• Ohio Adm. Code 3901-1-54(H)(7) — improper total-loss valuation outside the closed list of permitted methods;
• Ohio Adm. Code 3901-1-54(H)(7)(g) — failure to honor the 35-day right to renegotiate when no comparable vehicle is available at the offered price.

Although R.C. § 3901.20–.22 does not create a private right of action (Strack v. Westfield Cos., 33 Ohio App. 3d 336), evidence of these violations is admissible and probative of Insurer's lack of reasonable justification under Hoskins.

IV. Common-Law Bad Faith Under Hoskins v. Aetna

The Ohio Supreme Court in Hoskins v. Aetna Life Ins. Co., 6 Ohio St. 3d 272 (1983), recognized a first-party tort of insurance bad faith independent of breach of contract. The standard, refined in Zoppo v. Homestead Ins. Co., 71 Ohio St. 3d 552 (1994), is whether the insurer's refusal to pay was predicated upon circumstances providing "reasonable justification." An insurer's intent to deny is irrelevant; lack of reasonable justification suffices to submit bad faith to the jury.

Insurer's conduct here lacks reasonable justification because:

[Bullet specific facts: ignored objective evidence; relied on unsupported expert opinion; failed to investigate; misrepresented policy terms; etc.]

• [____________________________________________________________]
• [____________________________________________________________]
• [____________________________________________________________]
• [____________________________________________________________]

Compensatory damages recoverable on a Hoskins claim include all consequential losses caused by Insurer's bad-faith conduct, including emotional-distress damages, loss-of-credit damages, and attorney fees incurred in pursuing the policy benefits. Punitive damages are available on a showing of actual malice, fraud, or insult. Zoppo, supra; Furr v. State Farm, 128 Ohio App. 3d 607 (1998).

V. Pre-Litigation Notice

This letter constitutes formal written notice that, unless full payment is tendered, Insured will pursue a Hoskins bad-faith tort claim in addition to breach of contract. A copy of this demand and Insurer's response will be tendered as evidence at trial on the issue of reasonable justification.

VI. Demand for Payment

Insured demands payment of the following within THIRTY (30) DAYS of Insurer's receipt of this letter:

Response deadline: [__/__/____]

Payment must be by company check or wire to: [____________________________________________________________].

VII. Consequences if Not Resolved

If Insurer does not tender full payment by the deadline, Insured will, without further notice:

1. File suit in the [Court of Common Pleas, ____________ County, Ohio / U.S. District Court for the ____________ District of Ohio];
2. Plead (a) breach of contract; (b) common-law bad faith under Hoskins; (c) declaratory judgment on coverage; and (d) punitive damages where the facts support actual malice;
3. Seek prejudgment interest under R.C. § 1343.03(A);
4. Submit a copy of this demand and Insurer's response to the Ohio Department of Insurance for market-conduct review; and
5. Seek all consequential damages, including emotional-distress damages and attorney fees recoverable under bad-faith jurisprudence.

VIII. Litigation Hold

Insurer is hereby placed on formal litigation hold. Preserve all documents and ESI relating to this claim, including:

• Complete claim file and activity / diary notes (electronic and paper);
• All recorded statements, IME / EUO transcripts, and SIU files;
• Underwriting file and policy administration records;
• Reserve worksheets, indemnity / expense reserves history, and committee minutes;
• All communications (email, chat, voicemail, telephony metadata) with the Insured, counsel, experts, and reinsurers;
• Claims handling manuals, bulletins, scripts, and training materials in effect on the date of loss;
• All third-party vendor files (independent adjusters, engineers, contractors, appraisers, medical reviewers, Audatex / CCC / Mitchell valuation files).

Insurer is reminded that auto-deletion policies must be suspended for the duration of this dispute.

IX. Response Deadline

Please direct your written response to the undersigned no later than [__/__/____].

Nothing in this letter waives, modifies, or releases any right, claim, defense, or remedy of the Insured, all of which are expressly reserved.

X. Signature

Respectfully,

_______________________________
[ATTORNEY NAME]
[FIRM NAME]
Ohio Bar Reg. No. [____________]
Counsel for [INSURED]

Enclosures: Declarations page; sworn proof of loss; correspondence file; valuation evidence; itemization of damages

---

PART C — Pre-Filing Checklist

A. Coverage and Policy

☐ Full certified copy of the policy in effect on the date of loss obtained
☐ All endorsements / exclusions reviewed
☐ Premium-paid status confirmed
☐ Named insureds, additional insureds, loss payees identified
☐ Other potentially applicable policies (umbrella, excess, UM/UIM, employer) identified

B. Claim Process and Conditions Precedent

☐ Notice of loss documented (date, method, recipient)
☐ Sworn proof of loss timely submitted (or excuse documented)
☐ Cooperation clause complied with (recorded statements, EUO, document production)
☐ IME / EUO transcripts obtained
☐ Contractual SOL / suit-limitation clause calendared (Ohio enforces shorter periods; Sarmiento v. Grange Mut.)
☐ Appraisal clause analyzed (invoke / waive considered)

C. Damages Documentation

☐ Itemized scope of loss / estimate from qualified expert
☐ Total-loss comparable valuation analyzed against Adm. Code 3901-1-54(H)(7)
☐ Medical records and bills (if PI/UM/health)
☐ Lost-income documentation
☐ Consequential / emotional-distress damages itemized
☐ Photographs / video of loss

D. Carrier Conduct — Bad-Faith Evidence (Hoskins / Zoppo)

☐ Timeline of all communications memorialized
☐ Adjuster diary / claim notes requested
☐ Reservation-of-rights and denial letters preserved
☐ Comparison of insurer's offer(s) vs. independent valuation prepared
☐ Pattern-settlement evidence under R.C. § 3901.21(P) considered
☐ Reasonable-justification analysis under Hoskins / Zoppo documented
☐ Punitive-damages predicate (actual malice / fraud / insult) considered and evidence gathered if applicable

E. Regulatory and Procedural

☐ ODI complaint filed (Part A) or strategic decision documented not to file
☐ Authorization for ODI to access claim file signed
☐ Venue, jurisdiction, removal analysis complete
☐ Statute of limitations and any contractual shorter period calendared
☐ Litigation hold sent to insurer (Part B § VIII)
☐ Pre-suit Rule 408 designation on all demand correspondence

Sources and References

• Ohio Department of Insurance — Complaint Center: https://insurance.ohio.gov/about-us/complaint-center
• Ohio Rev. Code § 3901.20 (Unfair acts or practices prohibited): https://codes.ohio.gov/ohio-revised-code/section-3901.20
• Ohio Rev. Code § 3901.21 (Unfair acts or practices defined): https://codes.ohio.gov/ohio-revised-code/section-3901.21
• Ohio Rev. Code § 3901.22 (Course of conduct): https://codes.ohio.gov/ohio-revised-code/section-3901.22
• Ohio Adm. Code 3901-1-54 (Unfair Claims Settlement Practices): https://codes.ohio.gov/ohio-administrative-code/rule-3901-1-54
• Hoskins v. Aetna Life Ins. Co., 6 Ohio St. 3d 272 (1983)
• Zoppo v. Homestead Ins. Co., 71 Ohio St. 3d 552 (1994)
• Strack v. Westfield Cos., 33 Ohio App. 3d 336 (1986) (no private UCPA right)
• Furr v. State Farm Mut. Auto. Ins. Co., 128 Ohio App. 3d 607 (1998)
• NAIC Consumer Insurance Search: https://content.naic.org/cis_consumer_information.htm