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

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/

Question by K: How much money does a top claims executive make?
How much money does a top claims executive make?

Working in either the risk management department of a company or for an insurance company?

1. Claims Manager
2. Executive Claims Manager
3. Vice President of Claims
4. Chief Claims Officer

Also – How respected are top claims professionals in their companies?

Also – How secure are these jobs?

Finally – And if you are working for the risk management department of a company as a claims coordinator – do you think a certificate in risk management will give you the credentials and experience you need to get more into risk and out of claims?

Best answer:

Answer by mbrcatz
www.salary.com

Using the title is pretty useless, as each company can make up it’s own title.

The positions are respected, the jobs are secure.

But risk management and claims are two completely different things.

Add your own answer in the comments!
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