When you’ve been in an accident, you want to get back to normal life as soon as possible. The one thing that can hold you up is an insurance company that doesn’t cooperate with a timely pay-out. Are they allowed to keep you waiting? In most states, insurance companies
can wait as long as 45 days to handle your claim. If you’re frustrated by your insurance company not responding to claim correspondence, keep in mind that these five things may be holding up the process. The most innocuous reason for a lack of communication is that your insurance
company is simply waiting for more information. Perhaps the adjuster has yet to file their paperwork or they need to contact the other party’s insurance company. If the insurance company is waiting for more information, you as a policyholder can inquire about the missing information and help the insurance company to obtain it. You may also be in a lurch because a formal investigation has not been completed. While it would be nice for your insurance
company to contact you regardless of the status, they may feel that there is no reason to contact you when there aren’t any updates to share. Keeping after an insurance company can be tedious and time-consuming, which is why it’s good to have an attorney on your side to help get things done. If the other party in the accident is contesting your account of the facts, or your version doesn’t match the official police report — the claims process
may be held up. Your insurance company may keep you on ice while they try to sort out the truth, and sorting out the truth can take weeks or even months. You could also experience a lack of response when the claim is being denied. In those cases, you could receive formal written communication explaining why the claim was rejected. Why do insurance companies deny claims? There are a variety of reasons, such as insufficient coverage to pay for the type of
accident that occurred and a determination that you were at fault (in certain states). The final, and most troubling reason your insurance company may be avoiding you is that they are operating in bad faith. This means your insurer is not operating within the
contract you signed, and you’re being denied the compensation you deserve. In this case, you almost certainly need a lawyer to ensure you get the money you’re owed. Do you need help learning how to negotiate insurance settlements or getting your insurer to take you seriously? Reach out to South Dakota insurance claim lawyers at Turbak Law today at (866) 231-0914 to request a consultation. Why might your insurance claim be rejected?There are several reasons why a claim could be rejected, fairly or otherwise. Some are highlighted below. Incorrect informationYou might have given incomplete or inaccurate details during your claim, intentionally or by mistake. For example, how something happened or got damaged. The insurer thinks you didn’t take ‘reasonable care’Most policies include a ‘reasonable care’ or ‘duty of care’ clause that requires you to take steps to prevent a claim from arising. For example, if you left your valuables on display in your car or your mobile phone on the bus, your insurer might see this as a reason to contest your claim. Omissions or inaccuracies in your insurance applicationThe insurer can reject your claim if they have reason to believe you didn’t take reasonable care to answer all the questions on the application truthfully and accurately. A common example is failure to disclose a pre-existing medical condition. Technical ‘sticking points’Insurers can sometimes find contentious ‘small print’ reasons to challenge your claim. For example, they might contest whether a lost or stolen item was used for personal or business purposes. If it’s the latter, it might not be covered by the policy. The proper claims process wasn’t followedInsurers often expect customers to go exactly by the letter and might use evidence of you not following their claims process closely enough as justification for turning it down. The insurer insists it only has to pay part of your claimThis can happen, for example, if your policy doesn’t give you enough insurance to cover all your losses. You’ll have to pay an excess if the insurer believes you’ve overstated the value of your claim. If you’re not happy with the reasons given by the insurance company for rejecting your claim, you have a right to complain. What to do if you feel your claim shouldn’t have been rejectedCheck your policy documentsCheck the details of your policy to see if the facts fit the reason for the rejection. It’s worth challenging it if you believe it was unfairly rejected. This is because these decisions can sometimes be overturned (often after taking it to the Financial Ombudsman Service – find out more on this below):
Then find any other documentation that relates to your policy. For example, if you sent your insurance company a letter advising them of a change in your circumstances (this is your responsibility), try to find a copy of the letter. Contact the insurance companyWhen you’ve taken a look at your policy, it’s time to get in touch with the insurance company. You can phone the company and speak to their complaints handlers or write a formal letter of complaint and send it to the contact given in the company’s complaints procedure. Your complaint should then go through the insurer’s internal review process. You can ask for details of this if you want to. If you bought your policy through an insurance broker, they might make your complaint for you – it’s worth asking, to save yourself the hassle. How to write a formal complaint letterHere are some useful tips to write your letter of complaint:
Get an independent assessmentIf the problem is technical or specialist, it might help to get an independent assessment. For example, if your insurer is arguing that damage to your property was as a result of wear and tear and you’re arguing that it was accidental damage. It’s worth getting a loss assessor (not to be confused with a loss adjuster, who works for the insurance company) to look at the damage and send their report to the insurance company as evidence. Be aware that they’ll charge a fee for representing you. Even if it doesn’t change the insurance company’s mind, it might be useful information to have later on. Go to the Financial Ombudsman ServiceIf you’re still unhappy after going through the insurance company’s complaints process, you have a right to take your complaint to the Financial Ombudsman Service. The Financial Ombudsman Service is an independent, free service that investigates complaints from individuals about financial companies. If you take your complaint to them, they’ll consider both sides of the story, look at the documentation and attempt to find a fair outcome based on the facts and common sense. You can only make a complaint when you’ve received what’s called a ‘final response’ from your insurance company, or eight weeks have passed and you haven’t received a response from them. If they decide your claim was wrongly rejected, the Financial Ombudsman Service have the power to make the insurance company:
Send it off with a copy of the final response letter from your insurance company and any other documents you have that support your case. Do I need an ‘expert’ to help with my complaint?No, you shouldn’t need any special help or support if you complain. The Financial Ombudsman Service is a free and informal service and would prefer hear from you in your own words. Everyone has the right to have someone else to act on their behalf. Some people might like to have someone from their local Citizens Advice or a relative or friend to help them with their complaint. But if you decide to employ someone to present your case for you – for example, a claims management company – you might have to pay their costs yourself. This could mean paying them part of any compensation you’re awarded. Was this information useful? Thank you for your feedback. We’re always trying to improve our website and services, and your feedback helps us understand how we’re doing. Share this with Copy this link  Looking for us? Now, we’re MoneyHelper MoneyHelper is the new, easy way to get clear, free, impartial help for all your money and pension choices. Whatever your circumstances or plans, move forward with MoneyHelper. Continue to website Do not show this message again for Money Advice Service Looking for us? Now, we’re MoneyHelper MoneyHelper is the new, easy way to get clear, free, impartial help for all your money and pension choices. Whatever your circumstances or plans, move forward with MoneyHelper. Continue to website Do not show this message again for The Pensions Advisory Service Looking for us? Now, we’re MoneyHelper MoneyHelper is the new, easy way to get clear, free, impartial help for all your money and pension choices. Whatever your circumstances or plans, move forward with MoneyHelper. Continue to website Do not show this message again for Pension Wise |
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