Will someone from SCPCIGA contact me about my claim?
We will try to contact each person who had an open claim on file with the impaired insurer. As soon as possible after we receive the claim files from the company's receiver, we will mail out letters detailing your rights under the Guaranty Act and letting you know how to contact us. If you do not hear from us within a month from the date the company became impaired, feel free to contact us. However, we will be unable to give you specific information about your claim or to make any payments until we have received your claim file from the receiver.
Will there be delays in the handling of my claim?
Some delays are likely since we must first obtain the files from the insolvent insurer and have time to review them. Oftentimes, the files are disorganized or in poor condition when we receive them. We will make every effort to quickly identify and expedite the handling of any hardship cases, such as when your auto is in the repair shop and can't be released until your claim is paid. Be patient, and we will handle your claim as soon as practicable. We will make every effort to ensure that workers compensation periodic indemnity claims continue to be paid without interruption.
Are there limits on the amount that SCPCIGA will pay?
Yes. Covered claims are paid according to policy contract amounts and state-established limits. Subject to policy contract provisions, conditions, deductibles, and limits, as well as those stated in South Carolina Law, Title 38, Chapter 31, the following limits may apply:
- Property Casualty Claim: Amount of each covered claim in excess of $250.00 and less than $300,000.00
- Worker' Compensation Claim: Statutory benefits
- Unearned Premium Claim: The association will pay only that amount which is in excess of $100.00
- Note: A first party claim cannot be made against the Association by an insured whose net worth exceeds ten million dollars on December 31st of the year preceding the date of insurer's insolvency. A person having a net worth of greater than twenty-five million dollars and having a claim against an insolvent insurer under any provision in an insurance policy may not make a claim against the Association.
What requirements must be met for my claim to be covered by SCPCIGA?
To be covered, a number of conditions must be met. At a minimum, the claim must:
- Be unpaid- that is, the claim must not have been previously paid by the insurance carrier or other party.
- Exist before the insolvency or arise within 30 days after the Order of Liquidation- the claim must arise while the policy is still in force.
- Be on a policy written by an insolvent insurer that was licensed to do business in the state, and in a line of business covered by the guaranty association. Policies sold by companies that are not members of the guaranty association are not covered.
- Be brought by a claimant or insured who is a resident of the state. Only claims brought by residents or insureds of the state, or where the claim relates to property located in the state, are covered by the state guaranty fund.
- Be filed with the guaranty association before the claims cut-off date. South Carolina Law requires that a claim must be filed within 18 months of the liquidation or earlier if required by the liquidation order. Your claim must be filed before that date to be covered.
- Not be covered by other insurance if there is other insurance from which your claim can be paid. You must first exhaust that coverage before the guaranty fund will pay any portion of the claim.
How long will it take for SCPCIGA to pay my claim?
The amount of time it takes to pay a claim can vary widely depending upon a number of factors, but claim payments usually begin as soon as possible following the Order of Liquidation. A period of 60-90 days is not uncommon. Many insurance carriers have their claims processed by a Third-Party Administrator (TPA). If this is true with your claim, the amount of time needed to get all claim information might be extended as files are gathered from TPAs and transmitted to the guaranty associations.
I already filed my claim with my insurance company; do I have to file it again with SCPCIGA?
So long as your claim appears in the company's records, SCPCIGA will have notice of your claim and there is no need to file it again. However, if it has been more than a month since your insurer became impaired and you have not yet heard from SCPCIGA, you should contact us to be sure we have a record of your claim.
Is there a deadline to file a claim with SCPCIGA?
Yes. The deadline for filing claims is determined by the Order of Liquidation. This is typically twelve to eighteen months after the date that the receivership court enters an order of liquidation. If you had already filed a claim with the insurer prior to receivership, SCPCIGA considers your claim to have been filed prior to the deadline.
I received a Proof of Claim, what should I do?
Proofs of Claim are sent by the receiver or liquidator of the insolvent insurer; they are not sent by SCPCIGA. Contact the receiver or liquidator if you have questions about whether to file a Proof of Claim.
Do I have to file a Proof of Claim with the Liquidator?
It is not necessary to file a Proof of Claim to assert a claim against SCPCIGA. However, you must file a Proof of Claim to protect your rights to share in any distribution from the receivership estate, particularly for claims that are not covered by SCPCIGA or that exceed our "cap."
What do I do if I receive notice of a new claim against me or if I am served with a lawsuit?
You should immediately contact SCPCIGA and send a copy of the claim and/or lawsuit to our office by facsimile and by certified mail.
Will SCPCIGA take over the defense of my pending lawsuit?
If the lawsuit is within the coverage of the applicable policy, SCPCIGA will continue to defend the insured to the extent of coverage under the policy and the Guaranty Act. SCPCIGA may choose to retain the same attorney, or we may decide to have the case referred to a different attorney.
Will SCPCIGA report claim payments under the new Medicare reporting law?
In compliance with the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), SCPCIGA will perform the appropriate CMS queries and serve as the Responsible Reporting Entity for any claim payments it makes that are subject to the MMSEA.
Why is SCPCIGA asking for my social security number?
SCPCIGA uses social security numbers only for certain claims-related activities. Beginning in 2011, the federal Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) will require that we also determine whether a person receiving a payment for bodily injury is a Medicare beneficiary. To do so, we must obtain the claimant's social security number. For more information on MMSEA, go to https://www.cms.gov.