My Insurer Won’t Return My Calls. Does That Mean They Are Not Working on My Case?
Your health insurer is responsible for communicating with you about your case on a regular basis. If your claims adjuster is ignoring your calls, they could be engaging in bad faith conduct geared toward getting you to drop your claim or accept a lowball settlement. They could also be violating state law. California insurers, for instance, are required to investigate claims in a timely manner and to communicate with you within certain time frames about your claim.
Learn about the applicable laws in your state, and don’t be afraid to assert your legal rights and hold your insurance company to any applicable timelines. If necessary, get an attorney to help you out. Often times, you can recover money damages on top of the insurance benefits you are owed.
Unreturned Calls is a Common Problem in the Insurance Industry
If you have filed any sort of insurance claim, be it health, disability, life, or auto, then you might have dealt with an insurance adjuster who refuses to give you the time of day. You are not alone. While there may be a legitimate reason that your insurance adjuster has not returned your calls–because they are busy, or because they do not have any new information to provide you about your claim–they might also be ignoring you on purpose.
Leaving you in the dark about your claim gives the insurance company leverage. It’s a negotiation tactic: It keeps the insured claimant on edge and makes them feel more pressured to either settle or drop their claim entirely. While an insurance company is not required by law to immediately respond to every phone call about a claim, they must follow certain requirements, and continually refusing to communicate with you may be evidence of bad faith.
Your Insurance Company Must Conduct a Timely Investigation of Your Claim
Federal and state laws require insurance companies to conduct a complete and timely investigation of any claim. The specific time limit varies depending on the type of insurance policy at stake (life, disability, health, etc.), whether the policy is governed by the federal Employee Retirement Income Security Act of 1974 (ERISA) or state law, and the circumstances of the claim (for example, whether you are seeking pre-approval for necessary medical treatment or are seeking reimbursement for treatment already obtained).
For example, under ERISA, a life insurance company must approve or deny a claim within 90 days of receipt of that claim. If the insurer needs additional time to review a claim, or if they need additional information from the claimant, they must inform the claimant within 90 days and specifically explain what delay is needed and why.
In California, life insurers must approve or deny a claim within 40 days of receipt of all necessary information. They may request additional information or an extension within 40 days of the initial claim filing. Moreover, they must provide an update to the claimant every 30 days about the investigation, indicating whether they need additional time to review the claim and explaining the reasons for the delay.
California Law Requires Insurers to Get Back to You
Your insurance company may not have to return your call immediately, but California law puts the burden on insurance companies to get back to you relatively quickly. According to California’s law, “upon receiving any communication from a claimant, regarding a claim, that reasonably suggests that a response is expected,” an insurer must respond as soon as possible, and no later than 15 days after receiving that communication. The rule does not apply to policies governed by ERISA, as discussed above, but applies to many other insurance policies. Failing to adhere to this time limit–repeatedly ignoring your letters or calls–is considered an unfair claims settlement practice and is prohibited by California law. Other states may have similar laws.
You Do Not Have to Face Bad Faith Insurance Companies Alone.
If you think you have experienced bad faith conduct committed by an insurance company, or if you have had an insurance claim denied by an insurance company, it’s often worthwhile to talk to an attorney. An experienced plaintiff-side insurance law firm will likely offer you a free consultation and take your case on a contingency fee basis, meaning they don’t charge you anything upfront and only take their fees as a portion of any settlement they recover for you. In a free consultation, an insurance lawyer can quickly review the facts of your case and let you know whether you might have a claim and what you can do to get the benefits you are owed as well as compensation for any harm an insurance company’s unreasonable delaying tactics may have caused you.
