There is a time limit established for how long an insurance company has to investigate a claim. This generally stands at a limit of 30 days from the submission date of the claim. Different states have different laws on the length of this time period.
If there are unforeseen circumstances that limit the insurance company’s ability to do this, they must give you a written explanation of why this is. After this letter has been sent out, the claimant is responsible for sending the insurance provider case updates every 45 days.
In circumstances where the investigation seems to be prolonged unnecessarily, you can request an attorney to help speed up the process.
Why do claims need investigating?
Any claims made need investigating to prove that you are not complicit in fraudulent activity. You will need to prove any expenses or losses on your behalf, to ensure that you are fairly and justly compensated.
Someone known as an adjuster from the insurance company will come to see you and be responsible for investigating your claim. This is to identify the liable party in the claim.
They will also have to collect a compilation of evidence to support your claim. Finally, they will create a document to prove any personal or commercial losses and expenses as a result of the incident in question.
So what are some of the states’ time restrictions?
California has a Code of Regulations. Section 2695.7, subsection d states that a thorough, fair and objective investigation should be conducted.
Section 2695.5.b. states that anything received from the claimant that reasonably suggests a response is required should be responded to within 15 calendar days. This should inform the claimant of all of the facts as known by the insurer.
Florida’s statute 627.70131 states that investigations should be started within 10 working days after proof of loss has been received. The only exception to this is if “factors beyond the control of the insurer” prevent this investigation being conducted.
Communications from the claimant should also be responded to within 14 days.
Maryland has legislation known as COMAR (Code of Maryland Regulations). Section 31.13.07.04 states that insurers must complete a first party claim investigation within 45 days of the date they are made aware.
The insurer must send out written notices to the claimant after every further 45 day period until the claim is denied or approved.
New York’s legislation is called the New York Codes, Rules and Regulations.
Section 11.IX.216.5.a.1. states that investigations should start within 15 working days of the receiving the claimant’s notice.
Texas has an Insurance Code. Section 542.003(b)(3) states that there should be a prompt investigation carried out.
Section 542.055(a)(1)-(3) states that an investigation should begin within 15 days (or in some cases, 30 business days) of receiving notice.
Virginia has an Administrative Code. Section 14VAC5-400-60 states that insurers have 15 days to accept or deny your claim once proof has been received. If you have not got evidence, or an investigation has not been carried out, the insurer has 45 days to do so.
Similarly to Maryland, the insurance company must issue a written notice every further 45 day period. This should explain to the claimant why they need more time to perform the investigation.
Washington’s legislation is known as the code of the District of Columbia. Section 31-2231.17 discusses the issue of unfair claim settlement practices. This does not specify a time period, but does state you must investigate claims promptly.
They tend to take between 30 and 45 days to investigate, and again must notify the claimant of the reason it is taking longer.
What happens if they take longer than this time period?
As specified in most of the states’ legislation, your insurer will need to provide you with regular written updates on the investigation and status of your claim. If they fail to do this after a 45 day period has elapsed, you should reach out to your insurer.
They are not allowed to delay without a just cause, and are prohibited from keeping you in the dark about the status of your claim. If you find yourself at the hands of an insurer who is doing any of these things, you may be a victim of insurance bad faith.
What is insurance bad faith?
This essentially means your insurance provider is acting illegally or unjustly towards you or others. If you suspect this is the case, we would recommend speaking to a bad faith insurance attorney.
They may be doing this to avoid issuing payouts to their clients, meaning that the insurance company turns over a larger profit.
What could delay an investigation?
Your case could simply be very complicated and difficult to find evidence for. Crucial information may be missing, or there may be liability disputes involved.
In order for a full investigation to be conducted the insurer must speak to witnesses and potentially even gather medical evidence. This can often cause hold ups in the investigation.
How to tell a full investigation has been conducted
Your insurer should contact you and request access to all evidence and information you have on the incident in question.
They should make an appointment for you to discuss your claim and the incident. This is likely to be in a neutral location, unless the incident occurred on your property, as they will need to see the impact.
They are likely to ask for permission to discuss your claim with friends and family that have knowledge of the incident or its impact on your life. They may also request access to social media sites you use frequently.
We suggest that you do not post on social media about the incident, as insurers can dig this up and use it to weaken your claim.
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