- Proof without a "Proof of Loss"
- March 13, 2012 | Author: Gina M. Rossi
- Law Firm: Johnson & Bell, Ltd. - Chicago Office
Any insurance policy you come across these days will contain a suit filing deadline, but in Illinois that deadline is more often than not tolled by section 143.1 of the Illinois Insurance Code. 215 ILCS 5/143.1 (West 2006). Section 143.1 is a statutory restriction on contractual limitation provisions that was designed to prevent insurance companies from depriving an insured of her day in court by sitting on a claim and allowing the limitation period to run out. Trinity Bible Baptist Church v. Federal Kemper Insurance Co., 219 Ill. App. 3d 156, 160-61 (1991). Section 143.1 provides that “the running of such [limitation] period is tolled from the date proof of loss is filed, in whatever form is required by the policy, until the date the claim is denied in whole or in part.” 215 ILCS 5/143.1 (West 2006).
Section 143.1 seems simple enough, but things get tricky when there is no specific “Proof of Loss” form filled out by an insured. The Illinois Appellate Court recently addressed this issue in American Access Causality Company v. Tutson, 409 Ill. App. 3d 233 (1st Dist. 2011). In American, the defendant was a passenger in a vehicle involved in a hit-and-run car accident. Id. at 234. Following the accident, the defendant filed a claim with the driver of her vehicle’s insurer, American Access. Id. American Access received a lien notifying it of the defendant’s claim from the defendant’s attorney approximately 3 months after the accident. Id.
American Access then sent an “Accident Report Form” to the defendant’s attorney seeking basic information about the claim. Id. The defendant never completed the form. Id. About a year later, American Access notified the defendant that it was in possession of the police report from the traffic accident. Id. at 235. The defendant then sent American Access her medical bills and records and a written demand for the policy’s $20,000 limit. Id. The defendant then sat for an examination under oath at American Access’s request. Id. Following the examination under oath, American requested some additional documentation so that it would be “in a position to evaluate your client’s personal injury claim.” Id. The defendant provided the requested documentation, but never heard from American Access regarding her demand. Id.
After the expiration of the policy’s two-year limitation period, the defendant made a demand for arbitration under the policy. Id. American Access filed a complaint for declaratory judgment arguing that the arbitration demand was untimely. Id. at 236. The defendant claimed that the two-year limitation period was tolled by section 143.1 either when she sent her medical bills, gave her sworn statement or provided additional records following her sworn statement. Id. at 237. American Access claimed that the defendant never filed a proof of loss because she did not return the “Accident Report Form.” Id.
The court agreed with the defendant and held that at the very least, the period was tolled when the defendant supplied the additional documents following her sworn statement. Id. at 238-39. At that time American Access had sufficient information to satisfy the notice provision of the policy and the limitation period was tolled until American Access denied the claim. Id. at 239. American Access never denied the claim and thus the defendant’s demand for arbitration was timely. Id.
The court noted, however, that the notice provision in the policy did not describe a specific form or reference the “Accident Report Form.” Rather, it merely required that a claimant provide “written notice containing particulars sufficient to identify the insured and also reasonable obtainable information with respect to the time, place and circumstances thereof...” Id. at 237, 239. This suggests that the court’s analysis may have changed had the notice provision described a specific form that the claimant was to submit. The other caveat to this case is that American Access was held to have waived compliance with the proof of loss requirement because it never denied the defendant’s claim and it failed to raise the defendant’s failure to complete the “Accident Report Form” as a ground for relief in its declaratory judgment action. Id. at 239. Regardless though, American holds that where a claimant provides sufficient information to satisfy a proof of loss provision, without necessarily providing a specific form supplied by the insurer, section 143.1 will toll the limitation period from the date the claimant satisfied the provision until the date the claim is denied.