Is Your Insurance Company Stalling on Your Health Insurance Claim? Here’s What to Do.
Health insurance providers are required by state law to process your claim for coverage within a reasonable time. However, sometimes insurance companies might seem like they are deliberately delaying making a final decision on coverage in order to pressure you into accepting a smaller payout. If true, this is a bad faith tactic designed to wrongfully minimize or deny you coverage. When you need coverage for a medical issue, you might not have time to wait, and any delay might seem unreasonable. If you think your insurer is taking too long to come around and is deliberately stringing you along to get you to give up or give in, here are some things you can do to assert your rights.
Why is Your Insurance Company Stalling?
After you file a claim, you might get a notice from your insurance provider that your investigation is still pending. Insurance companies might prolong an investigation for one of a few reasons, but not all of them are legitimate. For instance:
- The insurer is waiting on additional examinations or documentation, such as your medical records or an accident report.
- The insurer believes your claim may be fraudulent and is conducting a thorough investigation before making a decision.
- The insurer is acting in bad faith, delaying its investigation and final decision so that you will either accept a smaller settlement than your claim is rightfully worth or give up and drop your claim altogether.
Insurance Companies Must Decide Within a Certain Time Limit
In most states, insurers cannot delay indefinitely, but must instead make a decision within certain time limits. For example, here are the timelines insurance companies must follow in California, according to state law:
- Within 15 days of receiving notice of a claim, the insurer must acknowledge receipt of the claim, provide the insured with all necessary forms and instructions, and begin their investigation.
- Insurers must respond within 15 days of any inquiry from the insured and within 21 days of any inquiry from the California Department of Insurance.
- Within 40 days of receiving notice of a claim, the insurer must issue a decision accepting or denying in whole or in part the claim coverage. If the insurer needs more time to make a decision, they must inform the insured party of the reasons for the delay and they must update the insured at least once every 30 days of the continued need for delay and the reasons.
- Once a claim has been accepted or a settlement reached, claims must be paid within 30 days.
What Can You Do When Your Claim is Delayed?
If your insurer fails to meet any of the above deadlines, contact an insurance bad faith attorney (if you haven’t done so already), and let them know immediately. They will contact the insurer on your behalf and let them know that they are in violation of their duties and that you can take legal recourse to force them to make a decision.
In the meantime, make sure that you collect all documentation relating to your claim, including your medical records, medical bills, accident reports, police reports, statements from your employer, and anything else that has been generated in connection with your injury or illness. You will be ready at a moment’s notice to provide any documentation your claims adjuster says that the insurer needs, which will deny them additional excuses to delay your investigation.
Keep notes on every call or communication you have with the claims adjuster or other insurance representative. These will come in handy down the line if you need to claim that the insurer was acting in bad faith. Cooperate with their requests in a timely fashion to ensure that you are complying with all of your contractual duties.
Most importantly, do not give up. You have the right to coverage of proper claims. As soon as you sense any delay tactics, it is worth discussing your case with an insurance bad faith attorney. They will help you maximize your coverage, avoid a lowball settlement, and get paid more quickly. Your attorney can talk to the insurance company for you to make sure they are not stalling for bad faith reasons. You should be able to find a highly qualified lawyer who will review your claim for free and take your case on a contingency fee basis without charging you any money upfront.
