Insurance Claim Delay

It is understood that insurance companies have a duty to fairly investigate and settle insurance claims.  During the course of good faith claims handling, and legitimate insurance investigations, it is not unreasonable to assume that there could be some delays in the process.

But unfortunately some insurance companies are more interested in the bottom line than in fair claims handling.  Intentional insurance claim delays are one tactic that unscrupulous insurance companies will use to manipulate or circumvent legitimate insurance claim settlements.

Some of the more common insurance claim delay tactics include flawed and unfair policy interpretations, unjustified coverage decisions, unreasonable requests for supporting documents, and extended, "ongoing investigations".

These devious claim delay tactics are often driven by the theory that if you experience long delays in the processing of an insurance claim, you will simply give up and take a lowball offer.  Or, in the face of an extended delay, you may not protest too strongly an actual insurance claim denied.  The tactics are designed to intimidate, and to wear you down.

After weeks and months of delays, there no explanations, no justifications, and you have no idea if your valid insurance claim will be fairly resolved  or unjustly denied.

What do you do?

If you begin with an understanding of some of the more common insurance claim delay tactics that follow,you are more likely to succeed in challenging them.

Confirmation of Coverage

Confirming that there is coverage for a loss is one of the most basic of claims handling procedures.  Coverage is based in the terms of the insurance policy.
Yet while this practice is clearly legitimate at its core, when "coverage investigations" are used as a basis for unfair or faulty policy interpretations, the process can result in lengthy insurance claim delays and potentially unfair claim denials.

Unreasonable Demands

Consider that the basic rule of thumb dictates that all insurance company requests for supporting information and documentation should be directly related to the claim.  For example, if you have filed a valid personal injury claim, is it warranted that the insurance company should be requiring your income tax returns?

If you have filed an auto theft claim, is it reasonable that the insurance company should demand a statement from your employer?

Follow-up Recorded Statements

When filing through your own insurance carrier, you are obligated to provide a recorded statement if so requested.  In the case of an insurance claim settlement with an adverse carrier, these requirements do not apply.  In that event, use your best judgment as your guideline.

Nonetheless, in either case requests for follow-up statements must be thoroughly explained by the adjuster, and must be reasonable.

"Ongoing Investigation"

Perhaps the most common of all insurance claim delay tactics is the "ongoing investigation".  Suspect that this is the case if your adjuster cannot provide you with any specific details as to why your valid insurance claim settlement has not been honored.  "Ongoing investigations" serve to stop your claim in its tracks.  There are no settlement offers and no legitimate explanations for the delay.

Even if there are valid concerns related to the processing of your insurance claim, the company cannot simply stop the process.  If the insurance contends that you have failed to cooperate, or that you have failed to produce related documents, they need to inform you.  If the insurance company suspects insurance fraud, there are investigative processes that must be performed.  While the company is under no obligation to keep you abreast of the details of that investigation, they must at least refer your claim to their investigative department, known as the Special Investigations Unit (SIU).  In the course of that insurance investigation, proper procedures would dictate that you would receive contact from the investigator.

Those involved in insurance fraud should proceed at their own risk.  For the majority of claimants who are not submitting fraudulent claims, a vague "ongoing investigation" or suggestions that the claim has been referred to SIU should be of great concern.  Insurance companies should not knowingly pay for fraudulent claims, but if your valid insurance claim is being targeted with excessive claim delays you should beware of either a quick lowball resolution or a claim denied.  There are no circumstances that would justify non-resolution of the claim.

If you suspect your valid insurance claim is at risk of an unfair claim denial or an unjust "ongoing insurance investigation", consider our eBook,Power To Profit.  Solid claim help from an insurance expert.

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