Insurance DOI Complaint and Bad-Faith Demand — Washington

Insurance DOI Complaint and Bad-Faith Demand (WASHINGTON)

Quick-Reference Summary

Part A — OIC Complaint Cover Letter

Sender Letterhead

[LAW FIRM OR INDIVIDUAL NAME]
[Street Address]
[City], Washington [ZIP]
Telephone: [(___) ___-____]
Email: [______________________]
[WSBA No. (if attorney): ____________]

Date and Recipient

Date: [__/__/____]

VIA OIC ONLINE PORTAL AND U.S. MAIL

Office of the Insurance Commissioner
Consumer Advocacy Division
P.O. Box 40256
Olympia, WA 98504-0256
Online: https://www.insurance.wa.gov/file-complaint-or-check-your-complaint-status

Re Block

Re: Complaint Against [CARRIER LEGAL NAME] (NAIC # [_____])
Insured: [INSURED FULL NAME]
Policy No.: [______________]
Claim No.: [______________]
Date of Loss: [__/__/____]

Body

Dear Consumer Advocacy Division:

I request that the OIC investigate the handling of the above-captioned claim by [CARRIER LEGAL NAME] ("Carrier"). Carrier's conduct violates one or more provisions of chapter 284-30 WAC and RCW 48.30.010, and is the subject of a contemporaneous IFCA Notice of Potential Lawsuit under RCW 48.30.015(8) (Part B-1, transmitted herewith).

1. The Policy and the Loss. Insured holds Policy No. [______] issued by Carrier with effective dates [__/__/____] to [__/__/____]. On [__/__/____] Insured suffered a covered loss consisting of [DESCRIBE LOSS]. Notice was tendered on [__/__/____]; sworn proof of loss was submitted on [__/__/____].

2. Specific WAC 284-30 Violations Alleged.

☐ WAC 284-30-330(1) — misrepresenting pertinent facts or policy provisions
☐ WAC 284-30-330(2) — failing to acknowledge and act reasonably promptly upon communications
☐ WAC 284-30-330(3) — failing to adopt and implement reasonable standards for prompt investigation
☐ WAC 284-30-330(4) — refusing to pay claims without conducting a reasonable investigation based on all available information
☐ WAC 284-30-330(6) — not attempting in good faith to effectuate prompt, fair and equitable settlement where liability is reasonably clear
☐ WAC 284-30-330(7) — compelling insureds to institute litigation by offering substantially less than amounts ultimately recovered
☐ WAC 284-30-330(13) — failing to promptly provide a reasonable explanation of the basis for denial
☐ WAC 284-30-360 — failure to acknowledge within 10 working days
☐ WAC 284-30-370 — failure to complete investigation within 30 days
☐ WAC 284-30-380 — failure to affirm or deny within 15 working days after proof of loss
☐ Other: [DESCRIBE]

3. Chronology.

4. Requested Action. Insured asks the OIC to (a) open a complaint and require Carrier's written response; (b) examine whether Carrier has violated chapter 284-30 WAC and RCW 48.30.010; (c) consider market-conduct examination, fines, or referral; and (d) maintain the file as evidence in any subsequent IFCA / CPA / common-law bad-faith litigation.

5. Enclosures.

☐ Declarations page and certified policy
☐ Notice of loss and proof of loss
☐ Adjuster correspondence; reservation of rights / denial
☐ Estimates, photographs, expert reports
☐ Copy of contemporaneous IFCA Notice (Part B-1)
☐ Authorization for OIC to communicate with counsel and share documents with Carrier

Respectfully submitted,

_________________________________
[NAME], [TITLE / WSBA No.]
Counsel for / on behalf of [INSURED NAME]

Part B-1 — IFCA NOTICE OF POTENTIAL LAWSUIT (RCW 48.30.015(8))

IFCA CLAIM NOTIFICATION — NOTICE OF POTENTIAL LAWSUIT

Pursuant to RCW 48.30.015(8)

Date of Notice: [__/__/____]
Effective Date (deemed receipt, 3 business days after mailing): [__/__/____]
Earliest Filing Date (20 days after deemed receipt): [__/__/____]

TO:
[CARRIER LEGAL NAME]
Attn: Claims Director and General Counsel
[Address from OIC's Agent and Company Lookup tool]
[City], [State] [ZIP]

AND TO:
Office of the Insurance Commissioner
Attn: IFCA Notice Processing
P.O. Box 40256
Olympia, WA 98504-0256
Email: [email protected]

METHOD: Certified mail, return receipt requested

FROM:
[Insured Full Name], [Address]
By Counsel: [Firm Name], [Address], WSBA No. [____]

Policy No.: [______________]
Claim No.: [______________]
Date of Loss: [__/__/____]

Statement of the Basis for the IFCA Cause of Action

Pursuant to RCW 48.30.015(8)(a), this notice sets forth the basis for an Insurance Fair Conduct Act cause of action against Carrier. If Carrier fails to resolve the basis for the action within twenty (20) days after this notice (deemed received three business days after mailing), Insured will file suit without further notice. RCW 48.30.015(8)(b).

1. First-Party Claimant. Insured is a "first party claimant" within the meaning of RCW 48.30.015(4): an individual / entity asserting a right to payment as a covered person under the above-referenced insurance contract.

2. Coverage Sought. [Describe coverage(s) at issue: e.g., dwelling, business income, UIM, ALE.]

3. The Loss. [Date, cause, scope, and amount of loss. Identify proof of loss.]

4. Unreasonable Denial of Coverage or Payment of Benefits. Carrier has unreasonably denied a claim for coverage and/or payment of benefits under RCW 48.30.015(1), evidenced by:

• [Fact A — e.g., flat denial issued without inspection]
• [Fact B — e.g., Carrier ignored independent expert report confirming covered cause]
• [Fact C — e.g., partial payment grossly understates documented loss]

5. Specific Regulatory Violations (RCW 48.30.015(5)). Carrier has violated one or more of the WACs that trigger IFCA treble-damages exposure:

☐ WAC 284-30-330 — specific unfair claims settlement practices
☐ WAC 284-30-350 — misrepresentation of policy provisions
☐ WAC 284-30-360 — failure to acknowledge pertinent communications
☐ WAC 284-30-370 — standards for prompt investigation
☐ WAC 284-30-380 — standards for prompt, fair and equitable settlements

6. Damages Sought Under IFCA.

7. Resolution Sought Within 20 Days. Carrier may resolve the basis of this notice by (a) tendering full benefits owed plus interest; (b) issuing a written, claim-specific explanation curing the regulatory violations identified above; and (c) confirming preservation of the claim file.

8. Reservation. This notice is not exhaustive of all claims, theories, or damages. Insured reserves all rights under common law (Safeco v. Butler), the Consumer Protection Act (chapter 19.86 RCW), and all other available statutes.

Respectfully,

_________________________________
[NAME], Esq., WSBA No. [____]
Counsel for [INSURED NAME]

Part B-2 — Bad-Faith Demand Letter to Carrier (Common Law / CPA)

Sender Letterhead

[LAW FIRM OR INDIVIDUAL NAME]
[Street Address]
[City], Washington [ZIP]
Telephone: [(___) ___-____]
Email: [______________________]

Date and Recipient

Date: [__/__/____]

VIA CERTIFIED MAIL, RETURN RECEIPT REQUESTED, AND EMAIL

[CARRIER LEGAL NAME]
Attn: Claims Director and General Counsel
[Carrier Claims Address]
Email: [______________________]

Re Block

Re: Common-Law Bad-Faith and Consumer Protection Act Demand
(Accompanies IFCA Notice of [__/__/____])
Insured: [INSURED FULL NAME]
Policy No.: [______________]
Claim No.: [______________]

Body

To the Claim Department and General Counsel:

Without prejudice to the IFCA Notice served concurrently, Insured asserts common-law bad faith under Safeco v. Butler, 118 Wn.2d 383 (1992); Smith v. Safeco, 150 Wn.2d 478 (2003); and a per-se Consumer Protection Act violation under Coventry Assocs. v. Am. States Ins. Co., 136 Wn.2d 269 (1998), arising from the chapter 284-30 WAC violations enumerated in the IFCA Notice.

Effect of bad-faith finding. Under Butler, proof of insurer bad faith creates a rebuttable presumption of harm and may result in coverage by estoppel for matters where the duty to defend was breached. Under Smith, an insurer "must give equal consideration in all matters to the first party claimant's interests as it does to its own."

CPA elements (Hangman Ridge). Insured pleads each Hangman Ridge element: (1) unfair or deceptive act or practice; (2) in trade or commerce; (3) public interest impact (presumed where claim arises from regulated insurance practices, Indus. Indem. Co. v. Kallevig, 114 Wn.2d 907 (1990)); (4) injury to business or property; and (5) causation. CPA remedies include actual damages, treble damages up to $25,000, and reasonable attorneys' fees and costs under RCW 19.86.090.

Damages Sought (in addition to IFCA exposure).

Litigation Hold. Carrier shall preserve the claim file, diary, supervisory and reinsurance notes, IME/EUO recordings, vendor estimates, training materials, claim-handling bulletins, voicemail and SMS, and any AI / algorithmic decision-support outputs (with model identifiers, prompts, version history) used on this claim.

Respectfully,

_________________________________
[NAME], Esq., WSBA No. [____]
Counsel for [INSURED NAME]

Part C — Pre-Filing Checklist

IFCA Notice Compliance (RCW 48.30.015(8)) — CRITICAL

☐ Drafted cover sheet titled "IFCA Claim Notification" — exact title required
☐ Identified insurer mailing address using OIC Agent and Company Lookup
☐ Mailed to insurer AND OIC by certified mail, return receipt requested
☐ Calendared deemed-receipt date (mailing + 3 business days)
☐ Calendared earliest filing date (deemed receipt + 20 days = ~23 days from mailing)
☐ Confirmed claim is NOT a "health plan" excluded by RCW 48.30.015(7)
☐ Saved certified mail receipts and tracking for both recipients
☐ Confirmed SOL has not expired (otherwise tolling under (8)(d) inapplicable)

Factual Development

☐ Confirmed first-party claimant status under RCW 48.30.015(4)
☐ Obtained full certified policy with endorsements
☐ Documented loss with photographs, expert reports, and contemporaneous records
☐ Submitted timely sworn proof of loss
☐ Preserved physical evidence and ESI
☐ Logged every communication with Carrier

Legal Triage

☐ Pleaded each Butler and Smith element for common-law bad faith
☐ Pleaded each Hangman Ridge element for CPA claim
☐ Verified 6-year contract SOL (RCW 4.16.040)
☐ Verified 3-year tort/CPA SOL (RCW 4.16.080)
☐ Evaluated Olympic Steamship fee entitlement for coverage disputes
☐ Considered Insurance Commissioner's Mediation Program where applicable
☐ Considered appraisal demand where policy provides

Filing Logistics

☐ Drafted OIC complaint via online portal AND mailed copy
☐ Sent IFCA Notice with cover sheet to insurer and OIC; saved tracking
☐ Calendared 20-day cure window (with 3-day deemed-receipt buffer)
☐ Issued internal litigation hold; sent hold letter to Carrier
☐ Identified venue (RCW 4.12.025)
☐ Drafted complaint shell: breach of contract, IFCA, Butler-style bad faith, CPA, Olympic Steamship fees, declaratory judgment

Damages Workup

☐ Quantified contract benefits with line-item proof
☐ Quantified consequential damages (loss of use, ALE, business income)
☐ Computed potential IFCA treble exposure (3x actual)
☐ Computed potential CPA treble ($25k cap) plus fees
☐ Documented attorneys' fees and Olympic Steamship applicability

Sources and References

• RCW 48.30.015 (IFCA) — https://app.leg.wa.gov/rcw/default.aspx?cite=48.30.015
• RCW 48.30.010 — https://app.leg.wa.gov/rcw/default.aspx?cite=48.30.010
• WAC 284-30-300 et seq. — https://app.leg.wa.gov/wac/default.aspx?cite=284-30
• RCW 19.86 (Consumer Protection Act) — https://app.leg.wa.gov/rcw/default.aspx?cite=19.86
• Safeco Ins. Co. of Am. v. Butler, 118 Wn.2d 383, 823 P.2d 499 (1992)
• Smith v. Safeco Ins. Co., 150 Wn.2d 478, 78 P.3d 1274 (2003)
• Coventry Assocs. v. Am. States Ins. Co., 136 Wn.2d 269, 961 P.2d 933 (1998)
• Indus. Indem. Co. of the Nw. v. Kallevig, 114 Wn.2d 907, 792 P.2d 520 (1990)
• Olympic S.S. Co. v. Centennial Ins. Co., 117 Wn.2d 37, 811 P.2d 673 (1991)
• Hangman Ridge Training Stables, Inc. v. Safeco Title Ins. Co., 105 Wn.2d 778, 719 P.2d 531 (1986)
• OIC IFCA Page — https://www.insurance.wa.gov/laws-rules/insurance-fair-conduct-act-ifca
• OIC 20-Day IFCA Notice FAQ — https://www.insurance.wa.gov/how-file-20-day-insurance-fair-conduct-act-ifca-notice-potential-lawsuit
• OIC File a Complaint — https://www.insurance.wa.gov/file-complaint-or-check-your-complaint-status
• OIC Agent & Company Lookup — https://www.insurance.wa.gov/agent-and-company-lookup
• Consumer Advocacy hotline: 1-800-562-6900