When Does an Insurance Claim Delay Become an Insurance Claim Dispute?

<h1>When Does an Insurance Claim Delay Become an Insurance Claim Dispute?</h1>Author: <a title="Jane Pytel" href="http://www.articlesbase.com/authors/jane-pytel/91916.htm">Jane Pytel</a> Insurance claim delay tactics are the most common obstacles utilized by insurance companies to avoid payment of claims.  Disreputable insurance claim delay tactics are based largely on the premise that that by forcing you to wait for settlement of your claim, you will eventually give up.  Giving up translates to less or no money for the claim payment and thus more money for the insurance company.  In furtherance of this endeavor, carriers will utilize a variety of tactics to delay your claim via a process dubbed "claim management".  Insurance consumers must arm themselves with sufficient knowledge to identify the difference between legitimate insurance claim investigations and illegitimate claim delays. An insurance company has a right, a duty in fact, to conduct insurance claim investigations.  The key here is that the investigation must be reasonable and timely. Insurance policies require that the insured must cooperate with the carrier in matters concerning a claim.  These conditions are generally included in the portion entitled "Duties". Accordingly, it is reasonable for your insurer to ask you for specific documents or items related to your claim.  By all means, comply with requests for relevant information and data.  Likewise, cooperate with the request for your recorded statement and proof of loss documents or affidavits.  If you fail to comply with reasonable requests, you are putting yourself in jeopardy of a lengthy investigation and a probable claim denial. If you have fully cooperated and your insurance claim remains unreasonably delayed, compare your circumstances with some of the following common delay tactics. Confirmation of coverage.  Your adjuster has been taught to "confirm coverage" based on the terms of the insurance policy.  Flawed, faulty, or unfair policy interpretation is one of the more common examples of unfair tactics insurance companies will use to delay claims.  This process is frequently no more than a search for reasons not to pay claims. Requirement for a follow-up recorded statement.  In your legitimate claim, follow up statements should not be necessary. Ongoing investigation.  While the adjuster has the duty to properly investigate the claim, likewise the adjuster has the obligation to keep you abreast of the status of your insurance claim.  If your legitimate questions are met simply with "your claim remains under investigation", assume that you have a problem. Referral to the Special Investigations Unit (SIU).  SIU referrals are legitimately a means to investigate potential insurance fraud.  Illegitimate SIU referrals represent a process designed to avoid payment of insurance claims.  Examination Under Oath (EUO).  The EUO is a formal proceeding taken under oath in front of a court reporter.  Used properly, an EUO is convened when the carrier legitimately requires additional detailed information from the policyholder in order to make a coverage decision.  Used illegitimately, EUO's are set to unfairly target claims for denial.  In either event, if you are called for an EUO, there is a problem with your claim.  Consider the following sampling of insurance claim solutions to unfair claim delays. <ul> <li>Continue to cooperate.  You want to assume the position that you have cooperated to the fullest extent possible.  This places additional burdens on the insurance company.  They cannot argue that their processes were delayed solely because you "failed" to cooperate. </li> <li>Call the adjuster every few days - every day if necessary.  Always behave courteously.  Be prepared to ask specific questions about the progress of your claim.  Always offer to provide any additional information needed. </li> <li>An insurance company's failure to properly conclude your legitimate insurance claim suggests the essence of unfair claims handling.  Document all activities in anticipation of unfair settlement offers or an outright denial.  Your claim delay has qualified as a claim dispute. </li> </ul>About the Author: Join those who have already utilized Jane Pytel's expertise to effectively manage an insurance claim, how to identify what is going on behind the scenes, and how to overcome the patterned obstacles insurance companies will use to delay, devalue, or deny your insurance claim. Visit Jane at <a href="http://solutionsforyourinsuranceclaim.com/"><a target="_blank" href="http://solutionsforyourinsuranceclaim.com/">http://solutionsforyourinsuranceclaim.com/</a></a>Article Source: <a href="http://www.articlesbase.com/">ArticlesBase.com</a> - <a href="http://www.articlesbase.com/insurance-articles/when-does-an-insurance-claim-delay-become-an-insurance-claim-dispute-736003.html" title="When Does an Insurance Claim Delay Become an Insurance Claim Dispute?">When Does an Insurance Claim Delay Become an Insurance Claim Dispute?</a>

Insurance claim delay tactics are the most common obstacles utilized by insurance companies to avoid payment of claims.

Disreputable insurance claim delay tactics are based largely on the premise that that by forcing you to wait for settlement of your claim, you will eventually give up. Giving up translates to less or no money for the claim payment and thus more money for the insurance company. In furtherance of this endeavor, carriers will utilize a variety of tactics to delay your claim via a process dubbed "claim management".

Insurance consumers must arm themselves with sufficient knowledge to identify the difference between legitimate insurance claim investigations and illegitimate claim delays.

An insurance company has a right, a duty in fact, to conduct insurance claim investigations. The key here is that the investigation must be reasonable and timely.

Insurance policies require that the insured must cooperate with the carrier in matters concerning a claim. These conditions are generally included in the portion entitled "Duties".
Accordingly, it is reasonable for your insurer to ask you for specific documents or items related to your claim. By all means, comply with requests for relevant information and data.

Likewise, cooperate with the request for your recorded statement and proof of loss documents or affidavits. If you fail to comply with reasonable requests, you are putting yourself in jeopardy of a lengthy investigation and a probable claim denial.

If you have fully cooperated and your insurance claim remains unreasonably delayed, compare your circumstances with some of the following common delay tactics.

Confirmation of coverage. Your adjuster has been taught to "confirm coverage" based on the terms of the insurance policy. Flawed, faulty, or unfair policy interpretation is one of the more common examples of unfair tactics insurance companies will use to delay claims. This process is frequently no more than a search for reasons not to pay claims.

Requirement for a follow-up recorded statement. In your legitimate claim, follow up statements should not be necessary.

Ongoing investigation. While the adjuster has the duty to properly investigate the claim, likewise the adjuster has the obligation to keep you abreast of the status of your insurance claim. If your legitimate questions are met simply with "your claim remains under investigation", assume that you have a problem.

Referral to the Special Investigations Unit (SIU). SIU referrals are legitimately a means to investigate potential insurance fraud. Illegitimate SIU referrals represent a process designed to avoid payment of insurance claims.

Examination Under Oath (EUO). The EUO is a formal proceeding taken under oath in front of a court reporter. Used properly, an EUO is convened when the carrier legitimately requires additional detailed information from the policyholder in order to make a coverage decision. Used illegitimately, EUO's are set to unfairly target claims for denial. In either event, if you are called for an EUO, there is a problem with your claim.

Consider the following sampling of insurance claim solutions to unfair claim delays.

Continue to cooperate. You want to assume the position that you have cooperated to the fullest extent possible. This places additional burdens on the insurance company. They cannot argue that their processes were delayed solely because you "failed" to cooperate.

Call the adjuster every few days - every day if necessary. Always behave courteously. Be prepared to ask specific questions about the progress of your claim. Always offer to provide any additional information needed.

An insurance company's failure to properly conclude your legitimate insurance claim suggests the essence of unfair claims handling. Document all activities in anticipation of unfair settlement offers or an outright denial. Your claim delay has qualified as a claim dispute.

Join those who have already utilized Jane Pytel's expertise to effectively manage an insurance claim, how to identify what is going on behind the scenes, and how to overcome the patterned obstacles insurance companies will use to delay, devalue, or deny your insurance claim. Visit Jane at http://solutionsforyourinsuranceclaim.com/

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Article Tags: Insurance Claim, Insurance Claim Delay, Claim Delay, Insurance Claim Investigation, Insurance Claim Dispute, Unfair Claim

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1. J Pytel (18:13, 23.06.2009)

Hello, Jason
There are issues here. While I am in Florida, I can tell you that all states follow the same general rules of good faith practices, the NAIC guidelines.

First, you should not be signing any releases until you know your property damages are adequate. If you sign a release and there is more damage once the car is torn down will they pay the additional? You might actually be getting less than 45% in that case.

Once they have determined liability, which seems pretty basic here, someone else's PD release has nothing to do with you unless the coverage is less than the total damages. In that case, they need to split the coverage among the parties. I cannot understand why you would get 45% and the other driver more. Did you ask them why?
As far as the rental car, they are obligated to pay you. Forcing you to sign a BI (Injury) release is improper.
If they persist, you could seek legal representation. You can report the incident to the state insurance agency, however, the state has no power to make them pay your claim.

2. Jane Pytel (14:22, 29.06.2009)

I'm not sure I understand all the details, but sounds like the PD is settled. I assume you are only receiving 45% of 2700. Do you have collision insurance on your own policy?
If you are not injured, the BI is a moot point. They do owe you a rental.

3. jason (05:15, 27.06.2009)

Hi again thanks for the response. I have already signed both releases becuase the payout was more then enough for the damages since I am going to just fix them myself. I basically need a new bumper and exhaust. The PD was more then the coverage she only had state min which is 5000, the middle car was totaled and I had minor damage but with all the paint/Factory only parts/labor my estimate came to 2700.. But they already determined exactly how much they were paying out to each party at this point what does my check have to do with the other person wither way they sent me a document saying if I sign this ill receive x amount of dollars... how would that ever change regardless of what happened with the other person involved?

4. jason (03:06, 23.06.2009)

Hi, I have a question along these lines. I have recently been involved in a 3 car accident I was the front vehicle at a complete stop. another vehicle was behind me and the at fault vehicle rear ending the middle vehicle in turn pushing them into me. All three vehicles had damage. I have signed both releases for settlement amounts based on estimates. They sent me to BI check right away but they are "waiting for the other party to send in their PD release" then they say they will notify me within 30 days oce this happens.

Is this legal? What does my vehicle damage have to do with the other car. They already determined the pay out percentages and the total damage was about 1000 more than the at fault drivers coverage. but I was offered 45% of the covered amount and the other driver 65%... all the kept telling me was they will only pay a certain amount and i would have to take the driver to court to retrieve the rest... then when they finally give me a specific amount and I accept it they are delaying based on the other driver?? what does it matter if they are only paying a certain amount no matter what anyways.

I should mention I am in California because we have different or more strict laws then other states with many things. If this is legal how long may I have to wait? and If its not legal who do I contact to report this.

one other note. I needed a rental car to get to and from work.. when i asked for one to be provided they told me they could get me 250 bucks for one if i signed my BI release. Isn't that some form of blackmail? Ive already signed the release for a larger amount to get my vehicle taken care of sooner then later but seems like this could be illegal.

thanks a lot

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