44 Cfr 206.20

Federal Emergency Management Agency, DHS
to the
trator.

Federal

Insurance

Adminis-

[43 FR 2573, Jan. 17, 1978. Redesignated at 44
FR 31177, May 31, 1979, as amended at 48 FR
44544, Sept. 29, 1983; 49 FR 4751, Feb. 8, 1984]

§ 62.5 Premium refund.
A Standard Flood Insurance Policyholder whose property has been determined not to be in a special hazard
area after the map revision or a Letter
of Map Amendment under part 70 of
this subchapter may cancel the policy
within the current policy year provided
(a) he was required to purchase or to
maintain flood insurance coverage, or
both, as a condition for financial assistance, and (b) his property was located in an identified special hazard
area as represented on an effective
FHBM or FIRM when the financial assistance was provided. If no claim
under the policy has been paid or is
pending, the full premium shall be refunded for the current policy year, and
for an additional policy year where the
insured had been required to renew the
policy during the period when a revised
map was being reprinted. A Standard
Flood Insurance Policyholder may cancel a policy having a term of three (3)
years, on an anniversary date, where
the reason for the cancellation is that
a policy of flood insurance has been obtained or is being obtained in substitution for the NFIP policy and the
NFIP obtains a written concurrence in
the cancellation from any mortgage of
which the NFIP has actual notice; or
the policyholder has extinguishing the
insured mortgage debt and is no longer
required by the mortgagee to maintain
the coverage. In such event, the premium refund shall be pro rata but with
retention of the expense constant.

§ 62.20

its servicing agent, but not with respect to policies of flood insurance
issued pursuant to Subpart C of this
part, shall not be less than $10 and is
computed as follows:
(1) In the case of a new or renewal
policy, the following commissions shall
apply based on the total premiums paid
for the policy term:
Premium amount

Commissions (percent)

First $2,000 of Premium ................
Excess of $2,000 ...........................

15
5

(2) In the case of mid-term increases
in amounts of insurance added by endorsements, the following commissions
shall apply based on the total premiums paid for the increased amounts
of insurance:
Premium amount

Commissions (percent)

First $2,000 of Premium ................
Excess of $2,000 ...........................

15
5

(b) Any refunds of premiums authorized under this subchapter shall not affect a previously earned commission;
and no agent shall be required to return that earned commission, unless
the refund is made to establish a common policy term anniversary date with
other insurance providing coverage
against loss by other perils in which
case a return of commission will be required by the agent on a pro rata basis.
In such cases, the policy shall be immediately rewritten for a new term with
the same amount(s) of coverage and
with premium calculated at the then
current rate and, as to return premium, returned, pro rata, to the insured based on the former policy’s premium rate.

[43 FR 2573, Jan. 17, 1978. Redesignated at 44
FR 31177, May 31, 1979, as amended at 49 FR
33658, Aug. 24, 1984; 53 FR 16279, May 6, 1988]

[46 FR 13515, Feb. 23, 1981, as amended at 53
FR 15221, Apr. 28, 1988; 57 FR 19541, May 7,
1992]

§ 62.6 Minimum commissions.
(a) The earned commission which
shall be paid to any property or casualty insurance agent or broker duly
licensed by a state insurance regulatory authority, with respect to each
policy or renewal the agent duly procures on behalf of the insured, in connection with policies of flood insurance
placed with the NFIP at the offices of

Subpart B—Claims Adjustment,
Claims Appeals, and Judicial
Review
§ 62.20

Claims appeals.

(a) Definitions.
Appeal decision means the disposition
of the appeal by the Federal Insurance
Administrator.

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§ 62.20

44 CFR Ch. I (10–1–11 Edition)

Decision means the insurer’s final
claim determination, which is the insurer’s written denial, in whole or in
part, of the insured’s claim.
(b) Appeal. A National Flood Insurance Program (NFIP) policyholder,
whether insured by a participating
Write-Your-Own (WYO) Company or directly by the Federal Emergency Management Agency (FEMA), may appeal a
decision, including a determination of
any insurance agent, adjuster, insurance company, or any FEMA employee
or contractor with respect to a claim,
proof of loss, and loss estimate. In
order to file an appeal, the insured
must comply with all requirements set
out in the Standard Flood Insurance
Policy (SFIP). This appeals process is
available after the issuance of the insurer’s final claim determination,
which is the insurer’s written denial, in
whole or in part, of the insured’s claim.
Once the final claim determination is
issued, an insured may appeal any action taken by the insurer, FEMA employee, FEMA contractor, insurance
adjuster, or insurance agent.
(c) Limitations on Appeals. The appeals process is intended to resolve
claim issues and is not intended to
grant coverage or limits that are not
provided by the SFIP. Filing an appeal
does not waive any of the requirements
for perfecting a claim under the SFIP
or extend any of the time limitations
set forth in the SFIP.
(1) Disputes that are or have been
subject to appraisal as provided for in
the SFIP cannot be appealed under this
section.
(2) When a policyholder files an appeal on any issue, that issue is no
longer subject to resolution by appraisal or other pre-litigation remedies.
(d) Litigation preclusion. An insured
who files suit against an insurer on the
flood insurance claim issue is prohibited from filing an appeal under this
section. All appeals submitted for decision but not yet resolved shall be terminated upon notice of the commencement of litigation regarding the claim.
(e) Procedures. To pursue an appeal
under this section a policyholder must:
(1) Submit a written appeal to FEMA
within 60 days from the date of the decision. The appeal should be sent to:

DHS/FEMA, Mitigation Directorate,
Federal Insurance Administrator, 1800
South Bell Street, Arlington, VA 20598–
MS3010;
(2) Provide a copy of the insurer’s
written denial, in whole or in part, of
the claim;
(3) Identify relevant policy and claim
information and state the basis for the
appeal; and
(4) Submit relevant documentation
to support the appeal. The policyholder
should submit only the documentation
that pertains to his or her claim. The
following are examples of the kinds of
documentation which FEMA will require to adjudicate the appeal: A copy
of the proof of loss submitted to the insurer as required in the policy; room by
room itemized estimates from the adjuster (includes contractors’ estimates), detailing unit cost and quantities for the items needing repair or
replacement; replacement cost proofs
of loss; Preliminary Report; Final Report; detailed damaged personal property inventories that include the approximate age of the items; completed
Mobile Home Worksheet; Mobile Home
Title, including Salvage Titles; real estate appraisals that exclude land values; advance payment information;
clear photographs (exterior and interior) confirming damage resulted from
direct physical loss by or from flood;
proof of prior repair; evidence of insurance and policy information , i.e. declarations page; Elevation Certificate, if
the risk is an elevated building; the
community’s determination made concerning substantial damage; information regarding substantial improvement; zone determinations; pre-loss
and post-loss inventories; financial
statements; tax records, lease agreements, sales contracts, settlement papers, deed, etc.; emergency (911) address
change information; salvage information (proceeds and sales); condominium
association by-laws; proof of other insurance, including homeowners or wind
policies and any claim information
submitted to the other companies;
Waiver, Letter of Map Revision
(LOMR) or Letter of Map Amendment
(LOMA) information; paid receipts and
invoices including cancelled checks
that support an insured’s out-of-pocket

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Federal Emergency Management Agency, DHS
expenses pertaining to the claim; underwriting
decisions;
architectural
plans and drawings; death certificates;
a copy of the will; divorce decree,
power of attorney; current lienholder
information; current loss payee information; paid receipts and invoices documenting damaged stock; detailed engineering reports specifically addressing flood-related damage and pre-existing damage; engineering surveys; market values; documentation of Flood Insurance Rate Maps (FIRM) dates; documentation reflecting date(s) of construction and substantial improvement; loan documents including closings; evidence of insurability as a Residential
Condominium
Association;
Franchise Agreements; letters of representation, i.e. attorneys and public
adjusters; any assignment of interest
in a claim; and, any other pertinent information which FEMA may request in
processing a claim.
(f) Appeal resolution. (1) FEMA will
acknowledge, in writing, receipt of a
policyholder’s appeal and include in
the acknowledgement contact information for a FEMA point of contact who
can advise the policyholder as to the
status of his or her claim.
(2) The Federal Insurance Administrator will review the appeal documents
and may notify the policyholder in
writing of the need for additional information. A request for the additional information will include the date by
which the information must be provided, and shall in no case be less than
14 calendar days. Failure to provide the
requested information in full, or to request an extension by the due date,
may result in a dismissal of the appeal.
A re-inspection of the policyholder’s
property may be conducted at the discretion of the Federal Insurance Administrator to gather more information.
The Federal Insurance Administrator will
ensure that all information necessary
to rule on the appeal has been provided
prior to making an appeal decision.
(3) The Federal Insurance Administrator will review the appeal documents, including any reinspection report, if appropriate. The Federal Insurance Administrator will provide specific information on what grounds the
claim was denied initially. The Federal
Insurance Administrator will provide

§ 62.22

an appeal decision in writing to the policyholder and insurer within 90 days
from the date that all information has
been submitted by the policyholder and
include specific information for the
resolution of the appeal. No further administrative review will be provided to
the insured.
(4) A policyholder who does not agree
with FEMA’s appeal decision should
refer to the SFIP, for options for further action (see Part 61, App. A(1)
VII.R., Part 61, App. A(2) VII.R., and
Part 61, App. A(3) VIII.R.). The oneyear period to file suit commences
with the written denial from the insurer and is not extended by the appeals process.
[71 FR 30298, May 26, 2006, as amended at 71
FR 60438, Oct. 13, 2006; 74 FR 56123, Oct. 30,
2009]

§ 62.21 Claims adjustment.
(a) In accordance with the Agreement, the servicing agent shall arrange
for the prompt adjustment and settlement and payment of all claims arising
from policies of insurance issued under
the program. Investigation of such
claims may be made through the facilities of its subcontractors or insurance
adjustment organizations, to the extent required and appropriate for the
expeditious processing of such claims.
(b) All adjustment of losses and settlements of claims shall be made in accordance with the terms and conditions
of the policy and parts 61 and 62 of this
subchapter.
§ 62.22 Judicial review.
(a) Upon the disallowance by the Federal Insurance Administration, a participating Write-Your-Own Company,
or the servicing agent of any claim on
grounds other than failure to file a
proof of loss, or upon the refusal of the
claimant to accept the amount allowed
upon any claim after appraisal pursuant to policy provisions, the claimant
within one year after the date of mailing by the Federal Insurance Administration, the participating Write-YourOwn Company, or the servicing agent
of the notice of disallowance or partial
disallowance of the claim may, pursuant to 42 U.S.C. 4072, institute an action on such claim against the insurer
only in the U.S. District Court for the

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