Mass. Gen. Laws ch. 175, sec. 113O — MA Code / Part I / Title XXII / Chapter 175 / Section 113O
Fire and theft or comprehensive coverage; payments for loss or damage to insured vehicle; statements to police; claim forms; actions for nonpayment
Status: in_force

Section 113O. All policies providing fire and theft coverage or comprehensive coverage, so-called, shall pay for loss or damage to the insured vehicle under the terms of the policy up to a limit equal to the actual cash value of the vehicle, less a deductible of five hundred dollars. Insurers shall also make available additional coverage whereby the deductible of five hundred dollars is reduced to three hundred dollars, except that an insurer may refuse to issue such optional additional coverage on the basis of claims paid, provided that no insurer may refuse to issue such optional additional coverage because of age, sex, race, occupation or principal place of garaging of the vehicle. The charge for said additional coverage shall not exceed the actuarial cost of reducing the deductible from five hundred dollars to three hundred dollars. Notwithstanding the foregoing, insurers shall also make available, at the option of the policyholder, a one hundred dollar deductible applicable to damage to glass of any motor vehicle covered under the comprehensive coverage. Insurers shall also make available additional coverage to provide that, in determining actual cash value, no deduction for depreciation shall be allowed to reduce the value of the vehicle to less than an agreed value for that particular vehicle, provided the insurer is permitted to inspect the vehicle at the time of application for such additional coverage. No payment shall be made by the insurer of loss or damage to the insured vehicle on a claim for theft coverage, so-called, until the insured received notice from the appropriate police authority that a statement in conformity with the provisions of section twenty-nine of chapter two hundred and sixty-six has been filed. No payment shall be made by the insurer of loss or damage to the insured vehicle on a claim for fire coverage, so-called, until the insured has filed a statement in conformity with the provisions of section twenty-nine B of said chapter two hundred and sixty-six and the insurer has, within a reasonable time, reviewed said statement with the appropriate fire authority and determined no fraud was involved. If said insurer denies said fire coverage claim, then said insurer shall provide appropriate notice within a reasonable time of the denial of coverage to all lien holders, if any, of the insured vehicle. No insurer shall make any payments to the insured under a policy providing fire and theft coverage or comprehensive coverage, so called, unless it has received a claim form from the insured stating that the repair work described in an appraisal made pursuant to regulations promulgated by the auto damage appraiser licensing board has been completed, except for payments made in accordance with a plan filed and approved pursuant to the following paragraph. In any case, where the insurer fails to make payment within seven days of receipt of the above claim form, the insured may commence a civil action for payments claimed to be due. If the court determines that the insurer was unreasonable in refusing to pay said insured's claim, the claimant shall be entitled to recover double the amount of damage plus costs and reasonable attorneys' fees fixed by the court. If such claim form is not received by the insurer, the insurer shall pay to the insured only the decrease in actual value of the insured vehicle less any deductible. If the insured elects not to repair the vehicle, or if the insurer does not receive a claim form from the insured stating that the repair work has been completed, the insurer shall decrease the actual cash value of the insured vehicle by the amount of damage sustained. Notwithstanding the second paragraph or any other general or special law to the contrary, an insurer may file a plan for approval by the commissioner providing for direct payment by the insurer to the insured for the loss of or damage to the insured motor vehicle under fire and theft coverage or comprehensive coverage, so called, prior to receipt by the insurer of a claim form from the insured stating that the repair work described in an appraisal made pursuant to regulations promulgated by the auto damage appraisers licensing board has been completed. Such plan shall not be approved unless it: (a) provides for a procedure acceptable to the commissioner to resolve any dispute between the insured and the insurer as to the adequacy of the payment; (b) provides for adequate disclosure to the insured of his or her rights hereunder; and (c) contains such other terms and conditions as the commissioner shall prescribe. The commissioner may revoke approval for such a plan if he determines that the insurer is not complying with its terms or that the plan does not carry out the purposes of this section. If an insured under fire and theft coverage or comprehensive coverage, so called, elects not to repair an insured vehicle for which a claim payment has been made under one of said coverage or if the insurer does not receive a claim form from the insured certifying that the repair work has been done in accordance with an appraisal made pursuant to regulations promulgated by the auto damage appraisers licensing board, then the insurer and any successor insurer shall decrease the actual cash value of the insured vehicle by the amount of the claim payment plus any applicable deductible until such time as the insurer or any successor insurer receives a claim form with the certification described above; provided, however, that for at least seventy-five per cent of those claims where the appraisal indicates that the cost of repairs will exceed four thousand dollars and at least twenty-five per cent of those claims where the appraisal indicates that the cost of repairs will be four thousand dollars or less, a licensed auto damage appraiser shall reinspect the vehicle following completion of repairs and shall certify on the claim form that the work has been completed in accordance with an appraisal made pursuant to said regulations. The commissioner shall hold a hearing prior to approval of any such plan or plans. The commissioner may promulgate such rules and regulations as he deems necessary for the implementation of this paragraph. The commissioner may require any plan filed pursuant to the preceding paragraph to provide (a) that the insured will be given a list of at least five repair shops, geographically convenient for the insured, from which the insured may at his or her option select a shop which will without undue delay complete the repair work for the amount of the payment to the insured, plus any applicable deductible, that the insurer will guarantee the quality of the materials and workmanship used in making repairs if the repairs are performed at one of the repair shops so listed. (b) that in no event shall the selection of vehicles for reinspection be based on the age or sex of the policyholder or of the customary operators of the vehicle, or on the principal place of garaging the vehicle; and (c) that no insurer or appraiser shall require that repairs to any motor vehicle be made at any specific repair shop, or list of repair shops; and (d) that in determining which repair shops will be listed as described above, the insurer shall consider only the quality and cost of repairs at a particular shop, the quality of the service given the customer, the responsiveness of the shop to customers' needs, the ability of the shop to perform repairs without undue delay, the geographic convenience of the shop for the insured, cooperation of the shop with pre- and post-repair inspections, and the shop's compliance with applicable laws and regulations. A repair shop shall be included on the list prepared by the insurer if the shop agrees in writing to comply in full with the plan filed by the insurer and approved by the commissioner. An insurer may strike a shop from the list provided it files a statement with the commissioner specifying the nature of the shop's failure to comply with the plan. Such plan shall include a fair and adequate procedure for relief for repair shops improperly stricken from such list; and (e) no employee or agent of an insurer with responsibility for creating, managing or maintaining a list of repair shops as described above shall receive or ask for any payment, gift or other thing of value from any repair shop included, or seeking to be included, in the said list of repair shops, and no repair shop, or employee or owner thereof, shall give, pay or offer to give or pay any money or thing of value to any employee or agent of an insurer with responsibility for creating, managing or maintaining a list of repair shops. No repair shop, or employee, owner or agent thereof, shall give or pay, or offer to give or pay, any thing of value to any person in exchange for being included, or as an inducement to be included, on such a list of repair shops. For purposes of this paragraph, the words ''employee'', ''owner'' and ''agent'' shall also include any spouse or child of an employee, owner or agent. Violation of the provision of this paragraph may be grounds for revocation or suspension of any certificate of registration or license held pursuant to chapter one hundred A or this chapter. Insurers shall report the theft or misappropriation of a motor vehicle, including the vehicle identification number and such other information as may be required, to a central organization engaged in motor vehicle loss prevention, as designated by the commissioner, and the National Automobile Theft Bureau or its successor organization, in accordance with the regulations promulgated by the commissioner. Said organization shall, in cooperation with the division of insurance, establish a central index file of all reported motor vehicle thefts or misappropriations. All costs of administration and operation shall be borne by said insurers pursuant to regulations promulgated by the commissioner. The central organization designated by the commissioner and each insurer authorized to issue motor vehicle comprehensive insurance policies in the commonwealth shall, upon request of any appropriate law enforcement agency or other insurer, release information in its possession resulting from an investigation conducted by it pertaining to such comprehensive loss, including information as such agency or insurer deems related to its investigation. Whenever a central organization or the insurer has reasonable cause to believe that the loss was caused by any criminal or fraudulent act of any person, it shall notify the appropriate law enforcement agency or central organization engaged in motor vehicle loss prevention of that belief. Any information or evidence, whether oral or written, furnished pursuant to this section shall not be subject to public inspection for so long a period as the commissioner deems reasonably necessary to complete an investigation, to protect the person investigated from unwarranted injury, or to serve the public interest. Such evidence or information shall not be subject to subpoena or subpoena duces tecum until returned for public inspection by the commissioner, unless the commissioner otherwise consents or, after notice to the commissioner and a hearing, the superior court determines that the public interest and any ongoing investigation by the commissioner would not be unnecessarily jeopardized by obeyance of such a subpoena or subpoena duces tecum. No insurer or the central organization designated by the commissioner pursuant to this section, or their employees or agents, and no commissioner or employees of the commissioner, and no official or officer of any law enforcement agency, shall be subject to civil or criminal liability in a cause of action of any kind for furnishing any evidence or information to the commissioner, his employees or any law enforcement agency or any other insurer relating to an investigation conducted involving losses for motor vehicles. Nothing contained in this section shall relieve an insurer of its duty to report suspected violations of the law to appropriate law enforcement agencies. In the event of an insured fire or theft loss which would result in the payment of the total value of the insured vehicle, less salvage, the fire or theft coverage on any replacement vehicle may be suspended, and if suspended, shall not apply unless the insured has made the replacement vehicle reasonably available to the insurer, his agent or his representative for inspection by five o'clock post meridian of the second registry of motor vehicles' business day following the day of acquisition. The insurer may also require that in lieu of the deductible otherwise available, a deductible of ten per cent of the actual cash value of such replacement vehicle, but in no event less than three hundred dollars, shall apply unless the insured installs an approved anti-theft device in such replacement vehicle.

Section 113O. All policies providing fire and theft coverage or comprehensive coverage, so-called, shall pay for loss or damage to the insured vehicle under the terms of the policy up to a limit equal to the actual cash value of the vehicle, less a deductible of five hundred dollars. Insurers shall also make available additional coverage whereby the deductible of five hundred dollars is reduced to three hundred dollars, except that an insurer may refuse to issue such optional additional coverage on the basis of claims paid, provided that no insurer may refuse to issue such optional additional coverage because of age, sex, race, occupation or principal place of garaging of the vehicle. The charge for said additional coverage shall not exceed the actuarial cost of reducing the deductible from five hundred dollars to three hundred dollars. Notwithstanding the foregoing, insurers shall also make available, at the option of the policyholder, a one hundred dollar deductible applicable to damage to glass of any motor vehicle covered under the comprehensive coverage. Insurers shall also make available additional coverage to provide that, in determining actual cash value, no deduction for depreciation shall be allowed to reduce the value of the vehicle to less than an agreed value for that particular vehicle, provided the insurer is permitted to inspect the vehicle at the time of application for such additional coverage. No payment shall be made by the insurer of loss or damage to the insured vehicle on a claim for theft coverage, so-called, until the insured received notice from the appropriate police authority that a statement in conformity with the provisions of section twenty-nine of chapter two hundred and sixty-six has been filed. No payment shall be made by the insurer of loss or damage to the insured vehicle on a claim for fire coverage, so-called, until the insured has filed a statement in conformity with the provisions of section twenty-nine B of said chapter two hundred and sixty-six and the insurer has, within a reasonable time, reviewed said statement with the appropriate fire authority and determined no fraud was involved. If said insurer denies said fire coverage claim, then said insurer shall provide appropriate notice within a reasonable time of the denial of coverage to all lien holders, if any, of the insured vehicle.

No insurer shall make any payments to the insured under a policy providing fire and theft coverage or comprehensive coverage, so called, unless it has received a claim form from the insured stating that the repair work described in an appraisal made pursuant to regulations promulgated by the auto damage appraiser licensing board has been completed, except for payments made in accordance with a plan filed and approved pursuant to the following paragraph. In any case, where the insurer fails to make payment within seven days of receipt of the above claim form, the insured may commence a civil action for payments claimed to be due. If the court determines that the insurer was unreasonable in refusing to pay said insured's claim, the claimant shall be entitled to recover double the amount of damage plus costs and reasonable attorneys' fees fixed by the court. If such claim form is not received by the insurer, the insurer shall pay to the insured only the decrease in actual value of the insured vehicle less any deductible. If the insured elects not to repair the vehicle, or if the insurer does not receive a claim form from the insured stating that the repair work has been completed, the insurer shall decrease the actual cash value of the insured vehicle by the amount of damage sustained.

Notwithstanding the second paragraph or any other general or special law to the contrary, an insurer may file a plan for approval by the commissioner providing for direct payment by the insurer to the insured for the loss of or damage to the insured motor vehicle under fire and theft coverage or comprehensive coverage, so called, prior to receipt by the insurer of a claim form from the insured stating that the repair work described in an appraisal made pursuant to regulations promulgated by the auto damage appraisers licensing board has been completed. Such plan shall not be approved unless it: (a) provides for a procedure acceptable to the commissioner to resolve any dispute between the insured and the insurer as to the adequacy of the payment; (b) provides for adequate disclosure to the insured of his or her rights hereunder; and (c) contains such other terms and conditions as the commissioner shall prescribe. The commissioner may revoke approval for such a plan if he determines that the insurer is not complying with its terms or that the plan does not carry out the purposes of this section. If an insured under fire and theft coverage or comprehensive coverage, so called, elects not to repair an insured vehicle for which a claim payment has been made under one of said coverage or if the insurer does not receive a claim form from the insured certifying that the repair work has been done in accordance with an appraisal made pursuant to regulations promulgated by the auto damage appraisers licensing board, then the insurer and any successor insurer shall decrease the actual cash value of the insured vehicle by the amount of the claim payment plus any applicable deductible until such time as the insurer or any successor insurer receives a claim form with the certification described above; provided, however, that for at least seventy-five per cent of those claims where the appraisal indicates that the cost of repairs will exceed four thousand dollars and at least twenty-five per cent of those claims where the appraisal indicates that the cost of repairs will be four thousand dollars or less, a licensed auto damage appraiser shall reinspect the vehicle following completion of repairs and shall certify on the claim form that the work has been completed in accordance with an appraisal made pursuant to said regulations. The commissioner shall hold a hearing prior to approval of any such plan or plans. The commissioner may promulgate such rules and regulations as he deems necessary for the implementation of this paragraph.

The commissioner may require any plan filed pursuant to the preceding paragraph to provide (a) that the insured will be given a list of at least five repair shops, geographically convenient for the insured, from which the insured may at his or her option select a shop which will without undue delay complete the repair work for the amount of the payment to the insured, plus any applicable deductible, that the insurer will guarantee the quality of the materials and workmanship used in making repairs if the repairs are performed at one of the repair shops so listed.

(b) that in no event shall the selection of vehicles for reinspection be based on the age or sex of the policyholder or of the customary operators of the vehicle, or on the principal place of garaging the vehicle; and

(c) that no insurer or appraiser shall require that repairs to any motor vehicle be made at any specific repair shop, or list of repair shops; and

(d) that in determining which repair shops will be listed as described above, the insurer shall consider only the quality and cost of repairs at a particular shop, the quality of the service given the customer, the responsiveness of the shop to customers' needs, the ability of the shop to perform repairs without undue delay, the geographic convenience of the shop for the insured, cooperation of the shop with pre- and post-repair inspections, and the shop's compliance with applicable laws and regulations. A repair shop shall be included on the list prepared by the insurer if the shop agrees in writing to comply in full with the plan filed by the insurer and approved by the commissioner. An insurer may strike a shop from the list provided it files a statement with the commissioner specifying the nature of the shop's failure to comply with the plan. Such plan shall include a fair and adequate procedure for relief for repair shops improperly stricken from such list; and

(e) no employee or agent of an insurer with responsibility for creating, managing or maintaining a list of repair shops as described above shall receive or ask for any payment, gift or other thing of value from any repair shop included, or seeking to be included, in the said list of repair shops, and no repair shop, or employee or owner thereof, shall give, pay or offer to give or pay any money or thing of value to any employee or agent of an insurer with responsibility for creating, managing or maintaining a list of repair shops. No repair shop, or employee, owner or agent thereof, shall give or pay, or offer to give or pay, any thing of value to any person in exchange for being included, or as an inducement to be included, on such a list of repair shops. For purposes of this paragraph, the words ''employee'', ''owner'' and ''agent'' shall also include any spouse or child of an employee, owner or agent. Violation of the provision of this paragraph may be grounds for revocation or suspension of any certificate of registration or license held pursuant to chapter one hundred A or this chapter.

Insurers shall report the theft or misappropriation of a motor vehicle, including the vehicle identification number and such other information as may be required, to a central organization engaged in motor vehicle loss prevention, as designated by the commissioner, and the National Automobile Theft Bureau or its successor organization, in accordance with the regulations promulgated by the commissioner. Said organization shall, in cooperation with the division of insurance, establish a central index file of all reported motor vehicle thefts or misappropriations. All costs of administration and operation shall be borne by said insurers pursuant to regulations promulgated by the commissioner. The central organization designated by the commissioner and each insurer authorized to issue motor vehicle comprehensive insurance policies in the commonwealth shall, upon request of any appropriate law enforcement agency or other insurer, release information in its possession resulting from an investigation conducted by it pertaining to such comprehensive loss, including information as such agency or insurer deems related to its investigation. Whenever a central organization or the insurer has reasonable cause to believe that the loss was caused by any criminal or fraudulent act of any person, it shall notify the appropriate law enforcement agency or central organization engaged in motor vehicle loss prevention of that belief.

Any information or evidence, whether oral or written, furnished pursuant to this section shall not be subject to public inspection for so long a period as the commissioner deems reasonably necessary to complete an investigation, to protect the person investigated from unwarranted injury, or to serve the public interest. Such evidence or information shall not be subject to subpoena or subpoena duces tecum until returned for public inspection by the commissioner, unless the commissioner otherwise consents or, after notice to the commissioner and a hearing, the superior court determines that the public interest and any ongoing investigation by the commissioner would not be unnecessarily jeopardized by obeyance of such a subpoena or subpoena duces tecum.

No insurer or the central organization designated by the commissioner pursuant to this section, or their employees or agents, and no commissioner or employees of the commissioner, and no official or officer of any law enforcement agency, shall be subject to civil or criminal liability in a cause of action of any kind for furnishing any evidence or information to the commissioner, his employees or any law enforcement agency or any other insurer relating to an investigation conducted involving losses for motor vehicles.

Nothing contained in this section shall relieve an insurer of its duty to report suspected violations of the law to appropriate law enforcement agencies.

In the event of an insured fire or theft loss which would result in the payment of the total value of the insured vehicle, less salvage, the fire or theft coverage on any replacement vehicle may be suspended, and if suspended, shall not apply unless the insured has made the replacement vehicle reasonably available to the insurer, his agent or his representative for inspection by five o'clock post meridian of the second registry of motor vehicles' business day following the day of acquisition. The insurer may also require that in lieu of the deductible otherwise available, a deductible of ten per cent of the actual cash value of such replacement vehicle, but in no event less than three hundred dollars, shall apply unless the insured installs an approved anti-theft device in such replacement vehicle.