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Good faith, or in Latin bona fides (bona fide means "in good faith"), is
good, honest intention (even if producing unfortunate results) or belief. In
law, it is the mental and moral state of honesty, conviction as to the truth or
falsehood of a proposition or body of opinion, or as to the rectitude or
depravity of a line of conduct. This concept is important in law, especially
equitable matters.[1][2]
fraud
is defined as an intentional deception designed to obtain a benefit or
advantage or to cause some benefit that is due to be denied.
http://www.casualtyclaim.com/goodfaith.htm
Good Faith Claim Handling
Following are some general guidelines that will assist in achieving good
faith claim handling. It is not intended to suggest that failure to follow
these guidelines means that the claim handler has acted in bad faith.
Respond to every communication in a timely fashion.
Take every allegation seriously.
Always act promptly and thoroughly.
Deny a claim, if proper, without undue delay.
Document all file activity by recording all phone conversations.
Confirmed with a letter.
Keep a record of each step of the investigation.
Be courteous and truthful at all times.
Investigate thoroughly.
Do not ignore suggestions or information provided by the
insured.
Pay promptly and fully once liability is established.
Follow company claim procedures, policies and manuals.
Seek appropriate expert or legal opinions promptly when
needed.
Never make a promise you cannot keep.
Never blame a delay on a fellow employee or home office.
Prepare every claim file as if it would eventually be read to a
Judge and/or jury.
Never hesitate to involve your supervisor or manager as soon as
a problem arises.
Notify the insured in writing of all coverage decisions.
Obtain copies of all pertinent documents upon which your decisions are based.
