| Insurance claim delay tactics are the most common | | | | Requirement for a follow-up recorded statement. In |
| obstacles utilized by insurance companies to avoid | | | | your legitimate claim, follow up statements should not |
| payment of claims. | | | | be necessary. |
| Disreputable insurance claim delay tactics are based | | | | Ongoing investigation. While the adjuster has the |
| largely on the premise that that by forcing you to | | | | duty to properly investigate the claim, likewise the |
| wait for settlement of your claim, you will eventually | | | | adjuster has the obligation to keep you abreast of |
| give up. Giving up translates to less or no money | | | | the status of your insurance claim. If your legitimate |
| for the claim payment and thus more money for the | | | | questions are met simply with "your claim remains |
| insurance company. In furtherance of this endeavor, | | | | under investigation", assume that you have a |
| carriers will utilize a variety of tactics to delay your | | | | problem. |
| claim via a process dubbed "claim management". | | | | Referral to the Special Investigations Unit (SIU). SIU |
| Insurance consumers must arm themselves with | | | | referrals are legitimately a means to investigate |
| sufficient knowledge to identify the difference | | | | potential insurance fraud. Illegitimate SIU referrals |
| between legitimate insurance claim investigations and | | | | represent a process designed to avoid payment of |
| illegitimate claim delays. | | | | insurance claims. |
| An insurance company has a right, a duty in fact, to | | | | Examination Under Oath (EUO). The EUO is a formal |
| conduct insurance claim investigations. The key here | | | | proceeding taken under oath in front of a court |
| is that the investigation must be reasonable and | | | | reporter. Used properly, an EUO is convened when |
| timely. | | | | the carrier legitimately requires additional detailed |
| Insurance policies require that the insured must | | | | information from the policyholder in order to make a |
| cooperate with the carrier in matters concerning a | | | | coverage decision. Used illegitimately, EUO's are set |
| claim. These conditions are generally included in the | | | | to unfairly target claims for denial. In either event, if |
| portion entitled "Duties". | | | | you are called for an EUO, there is a problem with |
| Accordingly, it is reasonable for your insurer to ask | | | | your claim. |
| you for specific documents or items related to your | | | | Consider the following sampling of insurance claim |
| claim. By all means, comply with requests for | | | | solutions to unfair claim delays. |
| relevant information and data. | | | | - Continue to cooperate. You want to assume the |
| Likewise, cooperate with the request for your | | | | position that you have cooperated to the fullest |
| recorded statement and proof of loss documents or | | | | extent possible. This places additional burdens on |
| affidavits. If you fail to comply with reasonable | | | | the insurance company. They cannot argue that |
| requests, you are putting yourself in jeopardy of a | | | | their processes were delayed solely because you |
| lengthy investigation and a probable claim denial. | | | | "failed" to cooperate. |
| If you have fully cooperated and your insurance claim | | | | - Call the adjuster every few days - every day if |
| remains unreasonably delayed, compare your | | | | necessary. Always behave courteously. Be |
| circumstances with some of the following common | | | | prepared to ask specific questions about the |
| delay tactics. | | | | progress of your claim. Always offer to provide any |
| Confirmation of coverage. Your adjuster has been | | | | additional information needed. |
| taught to "confirm coverage" based on the terms of | | | | - An insurance company's failure to properly conclude |
| the insurance policy. Flawed, faulty, or unfair policy | | | | your legitimate insurance claim suggests the essence |
| interpretation is one of the more common examples | | | | of unfair claims handling. Document all activities in |
| of unfair tactics insurance companies will use to delay | | | | anticipation of unfair settlement offers or an outright |
| claims. This process is frequently no more than a | | | | denial. Your claim delay has qualified as a claim |
| search for reasons not to pay claims. | | | | dispute. |