When The Insurance Investigation Is Driven By Unfair Claim Delays

Unreasonable insurance investigations frequently stem from deliberate claim delays manipulated by unscrupulous insurance companies to circumvent payment of legitimate claim settlements.

These devious 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 the intended low ball offer. Unfair claims practices used for these purposes are sometimes dubbed "claims management" because generally they arise out of the most basic of claims handling methods.

It is clearly established that insurance companies are bound to responsibly and properly investigate all claims. Further, all insurance investigations are required to be conducted in a timely and reasonable manner.

But when claim handling processes become burdensome, taxing, and unreasonable, this can be a signal that a legitimate insurance investigation has turned to an illegitimate delay tactic. If you sense that this has occurred in the handling of your claim, you must protect yourself from probable lowball offers, or even a potential claim denial.

In order to protect yourself, you must assume the power to challenge the direction of the claim. You must arm yourself with the knowledge to distinguish the difference between a good faith claim investigation and an illegitimate claims handling scheme. Only by understanding the practices that are driving the direction of your insurance claim, can you expect to prevail in an insurance dispute.

Following are some basic insurance claim help tips to help identify some of the more common delay tactics that can negatively impact your insurance claim.

Your Duty to Cooperate
All insurance policies include a "Duties" clause which affirms your obligations to cooperate in the claim investigation. This clause, of course, only applies if you have filed a claim with your own insurance company.

Cooperation means adhering to an insurance company's reasonable requests for particular claim related items and documents. In the case of your own carrier, of course you must comply. But even if you have filed a liability claim with an at-fault, adverse carrier, it is always to your advantage to cooperate.

Nonetheless, if you sense that those requests are evolving into unreasonable demands, brace yourself for an insurance dispute in the settlement of your valid claim.

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 flawed policy interpretations, the process can result in lengthy claim delays and potentially unfair claim denials.

The Ongoing Claim Investigation
Ongoing insurance investigations are sometimes necessary, especially if parties are refusing to cooperate. As long as the insurance company is legitimately and actively investigating your claim, there is nothing improper about a more lengthy insurance investigation.

The "ongoing investigation" becomes alarming if your adjuster can offer no progress on the disposition of the insurance claim. This is not to say that you are entitled to every detail of the investigation, (although you can certainly try) but you are certainly entitled to a reasonable explanation of the claim delay.

If the claim is stalled with no sensible justification, prepare for the inevitable insurance dispute.  Preparation is knowledge.

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 a 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.

Special Investigations Unit (SIU) Referrals
The SIU investigation is a valid means for the investigation of suspected insurance fraud. These insurance investigations become troubling, however, when shady insurance companies utilize them as nothing more than a means to evade claim payments or to bolster claim denials.

Follow these basic insurance claim help tips if you sense you have been confronted with an unfair insurance investigation.

• Cooperate
  Use cooperation to your benefit. It is much more difficult for the insurance company to defend their actions if you have complied with all reasonable requests.

• Maintain Contact With Your Adjuster
  You need to be assertive yet courteous. Contact the adjuster as often as you feel is necessary. Collect as much information as possible regarding the status of your insurance claim, always documenting the results.

Insurance companies have an obligation to evaluate and investigate claims fairly in a timely manner. Conversely, insurance companies that utilize schemes designed to delay and deny valid insurance claims are behaving in a manner totally contrary to the requirements of good faith insurance claim handling.

Unreasonable demands must be met with determination and, most of all, the knowledge to overcome the obstacles that drive the insurance dispute.

A veteran of the insurance industry, former insurance investigator Jane Pytel's e-book Power To Profit enlightens readers to refuse to accept that the insurance company holds the power.  Now is the time for you to discover how you can protect yourself from an unfair insurance dispute. Join those who have already benefited from Jane's unique insurance claim help tactics.

© Jane Pytel 2010