Dealing with insurance claims can be stressful, especially when you rely on claim payouts to cover damages, medical bills, or lost income. Unfortunately, some insurance companies use delay tactics to avoid or reduce payouts, a practice known as “stalling.” If you suspect your insurance company is giving you the runaround, it’s important to understand your rights and the steps you can take. Being persistent and methodical in working on the issue can get your claim back on track.
The financial and emotional toll of an accident, injury, or property damage is bad enough without having to fight your insurance company every step of the way. By familiarizing yourself with common stalling techniques, communication best practices, and the escalation process, you’ll be equipped to deal with delays. You’ll also better understand various claim types, reasonable timeframes, and when to seek legal consultation. With patience and an understanding approach, many claim issues can be resolved directly with the insurance company. But knowing when to take more formal action is key to getting the payout you deserve.
Understanding the Role of Key Players
Several pivotal parties are involved in insurance claims processes. Understanding their roles equips you to communicate with the right people when issues arise.
Insurance Adjuster – The claims adjuster is an insurance company representative assigned to investigate, assess, and settle your claim. Communicating directly with your adjuster when concerns arise or your claim seems to have stalled is the first course of action.
Insurance Manager – If you are unable to resolve issues directly with the adjuster, escalating the issue to a manager is the next step. Familiarize yourself with the adjuster’s manager and their contact info early in the process.
State Insurance Department – Your state insurance oversight agency works to protect consumer interests in insurance transactions. Filing a complaint with the department is an option if you make no headway directly with the insurance company representatives.
Lawyer – Consulting a lawyer experienced in insurance disputes can help determine if legal action is warranted. Many claim delays can be worked out directly with the insurance company, but complex cases may require legal guidance.
The Signs of an Insurance Company Stalling
In a perfect world, insurers would handle every claim in a transparent, efficient manner. But much like some policyholders try to cheat the system, some insurers use questionable practices to avoid or delay payouts. Common warning signs your claim is being stalled include:
● Repeated requests for information you’ve already provided
● Denied claims due to minor technicalities or application errors
● Delayed responses to inquiries and claim status calls
● Transferred between departments or representatives frequently
● Changes in scope or criteria required for your claim
● Disputes over the extent of damages/injuries and repair/treatment costs
These tactics prey on frustrated policyholders abandoning their claims. Understanding common schemes better equips you to push back.
One of the most egregious stalling practices is denying rightful claims in “bad faith.” Insurers have a legal duty to deal ethically and in good faith with policyholders. Intentionally providing misinformation, unreasonable delays, or repeated unreasonable demands could constitute bad faith. Seeking legal counsel helps determine if bad faith is at play.
Effective Communication Methods
Much of working through claim delays comes down to clear, documented communication between you and insurance representatives. Mastering communication best practices helps you take control of the situation.
Call the Adjuster – Speaking directly with your claims adjuster, clearly expressing your concerns, and asking specific questions about claim status and next steps is your first line of defense. Repeat calls may be necessary if issues persist. Document details of each conversation.
Email the Manager – When phone calls with the adjuster are ineffective, email their manager detailing the claim history, gaps, and delays so the issue can be investigated. Ask for a direct response with resolution or escalation steps.
File a Formal Complaint – If communication with the adjuster and manager fails to resolve your concerns, file a written complaint with the insurer’s customer service department. Outline events in a timeline, provide supporting documentation, and request a written response from company leadership.
The key is keeping emotion out of communications so facts and events can speak for themselves. Polite yet assertive persistence is vital.
The Importance of Documentation
Meticulous record-keeping transforms a “he said, she said” situation into a detailed record that holds insurers accountable. Two documentation areas are key:
Collect All Relevant Paperwork – Retain all documents related to your policy and claim such as applications, policy documents, repair estimates, medical records, and any insurer correspondence. Organized paperwork strengthens your case.
Keep Communication and Event Records – Document every phone call, email, and interaction with insurer representatives noting dates, names, contact information, and discussion details. Also document claim-related events like home repairs, car rentals, medical treatments, etc.
Insurers often bet on policyholders’ poor organization and memory. Thorough documentation eliminates these advantages. Records also help identify stalling patterns.
Understanding the Escalation Process
When polite but assertive direct communication fails to resolve claim delays, formal complaint escalation is the next step. Typical escalation steps are:
- Speak with a Supervisor/Manager: Request to speak to the original representative’s supervisor or manager to investigate.
- Contact State Department of Insurance: Each state has a Department of Insurance to assist consumers with claim disputes by contacting the insurer or initiating an investigation.
- Consult an Insurance Lawyer: For complex cases or claim denials involving substantial damages, consulting an insurance lawyer helps determine if legal action like mediation or a lawsuit is warranted.
Ideally, most claim issues should be resolved at steps one or two by holding insurers accountable through regulatory channels. Understanding this process better equips you to threats of legal action as a last resort, not an intimidation tactic.
Different Claim Types
Tactics for expediting claim resolution can vary for different insurance lines like auto, home, health, business, and life insurance. Common claim categories include:
- Property Damage: Homeowners, renters, condo, auto, and business policies covering structure/vehicle repairs and replacement of damaged or stolen personal property.
- Liability Claims: Policies like auto, homeowners, and umbrella that cover policyholder liability for damage/injuries caused to others in incidents.
- Personal Injury: Auto, medical, and disability policies that cover policyholders’ medical treatment costs and lost wages from an accident or illness.
- Health Insurance: Health plans that cover costs like hospital stays, surgeries, tests, and prescription drugs per the policy’s terms.
- Life Insurance: Provide the deceased’s beneficiaries a lump-sum payout per the policy terms, provided death claim documentation meets eligibility standards.
Claim managers specialize in specific lines like auto or property. When contacting supervisors, reference your claim type for proper routing. Laws also vary regarding reasonable response times and bad faith claim handling for different products.
Timeframe Expectations
While claim complexities create variability, most states define a “reasonable response time” for insurance claim handling. This helps determine if your claim is truly stalled versus undergoing standard review. General timeframes are:
Acknowledgment of Claim Receipt: 24 – 48 hours
Initial Investigation Completion: 30 days
Resolution/Payout Offers: 30 – 60 days
Certain claims involving extensive damages, multiple parties, litigation, or complex medical issues can take 90+ days to resolve. However, the insurer must provide reasonable updates on the claim status. Blatantly disregarded response times are a red flag of intentional stalling. Leveraging timeline documentation holds insurers accountable.
Legal Aspects to Consider
Two pivotal legal components also come into play if claim delays persist. Understanding them helps determine the next steps.
Policy Terms and Conditions – Carefully review your policy paperwork as it forms the legal contract between you and the insurer. Check for provisions about reasonable response times, claim dispute resolution processes, and any rights waived by not following specified steps. Know the terms.
Statute of Limitations – Each state defines cutoff periods limiting how long policyholders have to take legal action against insurance denials or delays. Typically 1 to 3 years depending on policy type, understanding the statutes helps gauge if and when to pursue litigation. An insurance lawyer can provide specifics for your state and situation.
While most claims fall well short of litigation, knowing the legal landscape better informs your rights and decisions.
Leveraging Technology
Digital tools also help policyholders track claim processes and pinpoint stalls. Options to consider include:
Online Complaint Forms – Insurers and State Departments of Insurance provide online complaint forms detailing delays and attaching documentation. Copies are automatically generated for records.
Claim Tracking Apps – Apps like Claim Tracker Pro allow uploading policy and claim documents while logging associated dates, calls, notes, and tasks. Some even calculate response times against reasonable limits.
Portals – Many insurers now provide web-based claim tracking portals detailing status, dates, notes, and documents related to your claim in one easy-to-access location.
Embracing technology removes bottlenecks and gives greater transparency into delays while building your audit trail.
Key Qualities for Dealing with Delays
Finally, acknowledging that claim delays tap emotions like frustration and anger is important. While feeling this way is understandable and reasonable, keeping a level head and professional persistence are more effective approaches with insurance companies. Cultivating two vital qualities helps you work through delays:
Patience and Persistence – Insurance is a highly process-oriented industry. What seems like repetitive delays to you fit strict investigation rulesets insurers must follow. Remaining patient while methodically persisting with facts and records tends to bring the best results.
Negotiation Skills – Claim settlement inherently involves back-and-forth negotiation as assessors determine the extent of liability and damages while you justify your stances. Developing strong negotiation skills based on merit over emotion also smooths the process.
No one enjoys insurance delays, but settlement satisfaction often goes to the policyholder willing to professionally work at each stage. Bringing your best communication skills and patience to the table gets track of claims.
Alternative Claim Settlement Options
If definitive claim denials emerge despite exhaustive appeals directly with the insurer and regulatory bodies, alternatives like mediation or arbitration may be an option versus litigation.
Mediation involves hiring a neutral third-party mediator to review the claim facts objectively and broker a settlement between you and the insurer. While non-binding, the fresh perspective often provides resolution.
Binding arbitration is similar but the arbiter’s settlement decision becomes legally enforceable. Because arbitration waives court access rights, trying mediation first is generally preferred.
Wrapping Up
Dealing with insurance delays while recovering from illness, injury, or property loss only heightens distress. But understanding common stall tactics and your rights in the claims process levels the playing field. Armed with tips for clear communication, documentation, working the escalation continuum, and seeking legal consultation if warranted, you can get your claim back on track and receive a reasonable settlement.
With patience and professional persistence focused on the merit of facts instead of emotion, most claims can achieve equitable resolution directly with the insurer. But never hesitate to assert your rights if delays or bad faith seem evident. Being willing to hold insurers accountable earns far better outcomes than hopelessness or avoidance. You deserve integrity in the process.
Key takeaways:
● Recognize common insurance delay tactics
● Communicate clearly and document thoroughly
● Understand claim timeframes and escalation
● Know your legal rights and policy provisions
● Bring professionalism and patience to the process
Standing up to unreasonable claim delays or bad faith treatment enables you to get your fair recovery and holds insurers to ethical practices. With a greater understanding of the claims process from the consumer’s perspective, you can now manage delays while pursuing the maximum, rightful claim settlement you deserve.
FAQs
What to do if the life insurance company is stalling?
If a life insurer stalls on rightful death benefit payouts, first persistently communicate with your claims adjuster and their supervisor/manager. Document all interactions and timeframes. If unreasonable delays continue, file a complaint with your State Department of Insurance. Consult a life insurance attorney if bad faith seems evident so they can review policy terms and determine if litigation like mediation or a lawsuit is warranted before statutes of limitation expire.
List of life insurance companies not paying claims
While no life insurer is completely immune from consumer complaints, companies with higher-than-average dispute rates include Americo, Foresters Financial, Voya Financial, and Baltimore Life. However, state regulator complaints only show one side. Every company resolves some disputes in the policyholder’s favor. Understanding claim dispute remedies through supervisors, state regulators, and legal channels aids resolution.
What to do if an insurance company is stalling in Texas?
The Texas Department of Insurance is available to assist consumers who feel an insurer is unreasonably delaying or denying a rightful claim. Policyholders can call the Texas Consumer Help Line at 800-252-3439 or file an official complaint online at www.tdi.texas.gov which the TDI works to resolve often through direct insurer intervention. Consulting a Texas insurance attorney regarding bad faith laws and statutes of limitation for possible litigation is also an option if delays persist despite regulatory help.
