Dealing with insurance can be frustrating for many reasons, not the least of which is the amount of time it can take to resolve a claim. Various factors such as the type of insurance claim (e.g. medical, automobile, or property), and the nature of the injuries or losses, will affect the timeline.
Ultimately, your goal is to receive a fair payout for your damages or losses so your claim can be closed and you can move on with your life. Although every case is different, hiring a seasoned insurance claim lawyer can expedite the process. Find out why so many clients trust Wallace Law.
How Long Medical Claims Take to Process
To answer this question, it helps to know more about how doctors and other medical practices process insurance claims. A medical or health insurance claim is a bill that the doctor, hospital, or other provider or facility sends to the insurance company to reimburse the services rendered to the patient. The “cleaner” the claim – meaning, the fewer errors and unnecessary complications – the quicker it takes the claim to be processed, and for the patient to know once and for all that insurance has covered the medical procedure.
Healthcare providers have an interest in submitting clean claims because they are a significant part of how they get paid. These are ways they work to ensure expeditious processing of health insurance claims:
- Avoiding errors in the paperwork, such as incorrect patient details
- Avoiding omissions which could trigger a denial based on insufficient information provided to the insurer
- Timely submitting claims to the insurance company
- Submitting claims properly and to the correct individual or department
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The Steps for Submitting a Medical Insurance Claim
These are the general steps in submitting medical insurance claims:
- Properly registering the patient during the intake procedure by gathering their name, personal details, and insurance information.
- Verifying that the patient’s insurance will cover the services, whether deductibles have been met, whether any prior authorizations have been sent, and that the co-pay is accurate.
- Properly coding the patient’s medical procedure.
- Calculating the total charges for the medical services and sending them to the insurance company.
- Waiting for the insurance company to review the claim and decide whether and how much to reimburse the provider.
- Billing the patient for anything not paid by insurance.
It may take up to 30 days for the insurer to review the claim and make a decision. Additional time may be necessary if the patient decides to appeal the insurance company’s decision or take legal action.
Average Time for Property Insurance Claims to Settle
Property insurers may take weeks or months to resolve an insurance claim and pay for the policyholder’s loss. There are various factors which affect the time frame that you can expect:
- The amount and nature of the damage that was done to the property
- Whether the claim is covered, which may be a complicated question (for instance, if water damage was involved, what was the source of the water?)
- State laws that mandate a maximum amount of time for the insurer to accept or deny the claim
- Whether the property damage was the result of a major natural disaster, which equates to numerous claims that the insurance company must process
- Whether the policyholder accepts the insurance company’s payout or contests it
The Steps for Submitting a Property Damage Claim
The basic steps involved in a property damage claim are:
- The policyholder should document the existing damage and mitigate additional damage.
- The policyholder must contact the insurance company to open a claim.
- An insurance adjuster will be assigned to the claim and begin assessing the damage.
- Once the assessment is done, the insurance company will make a payout offer.
- The policyholder will either accept the offer or negotiate a better one.
If a claim cannot be settled, the policyholder may seek legal counsel to allege bad faith or pursue other causes of action.
Average Time for a Car Insurance Claim to Settle
Car insurance claims are some of the most complex because they involve physical injury, mental and emotional injury, lost time from work, future damages like lost earning capacity, and – on top of these – property damage. It may take anywhere from 9 to 18 months to finally resolve a claim, and the following factors will prove relevant to the timeline:
- The nature of the victim’s physical, mental, and emotional injuries
- The value of reasonably projected future damages that the victim may claim
- The amount of property damage
- The number of victims and potential defendants
- The willingness of the insurance companies and lawyers to negotiate
- Any allegations of contributory negligence made against the victim
- The strength of the evidence
The Steps for Submitting a Car Insurance Claim
You should also be aware of the steps involved in an automobile insurance claim and how the above factors may affect them. After an accident, the victim should:
- Call law enforcement and their automobile insurance company to inform them of the accident
- Begin gathering evidence and documentation of the accident, such as photographs and the identities of witnesses
- Contact an attorney, who will investigate the accident and eventually send the insurance company a demand letter
The insurance company and the victim may settle in mediation; otherwise, litigation will be necessary and will extend the timeline.
Average Time for a Life Insurance Claim to Settle
A life insurance company may take between 14 and 60 days to pay the beneficiary the death benefits from the deceased person’s policy. There are various steps the insurer must take such as investigating the circumstances surrounding the decedent’s death and reviewing the terms of the policy to determine the payout amount and other details. Also, the insurer must obtain a copy of the death certificate and may need time to locate the decedent’s beneficiaries.
As with other insurance claims, some factors could alter the above timeline. More specifically, you can expect delays in the claim settlement if:
- Information is missing: Missing, inaccurate, and incomplete documents will delay the claim. For example, the insurer cannot do anything until it has the death certificate.
- Suspicious death: If the death of the individual appears to be suspicious, the life insurance company must investigate further. Evidence that suggests homicide, for instance, may ultimately result in the insurer refusing to pay.
- Evidence of fraud: Since life insurance fraud is relatively common, the insurer may spend more time verifying the claim. A delay may be likely even in the absence of actual fraud simply because the insurer must do its due diligence.
Contestability: Life insurance policies include contestability periods, during which time the insurer can closely examine a claim to make sure there is no fraud or misrepresentation. This can cause significant delays.
What You Can Do to Speed Up the Process
Nobody wants to spend more time than is necessary dealing with insurance companies. To avoid many of the delays and issues mentioned above, Wallace Law recommends you do the following:
- Organize all documents related to your claim: For instance, in an automobile accident case, start documenting the work you miss and your medical records.
- Take initiative and respond quickly: Call your insurance company regularly to check the status of your claim and respond promptly to any of their requests for additional information.
- Follow instructions and rules exactly: Your insurance company will use any excuse to deny or delay your claim, so follow all rules, deadlines, and instructions.
- Know the details of your policy: If you have never read your insurance policy closely, now is the time to understand its terms, exemptions, exclusions, and other critical details.
- Reach out to an attorney: Do not hesitate to contact an attorney if the insurance company is taking too much time or otherwise not treating you fairly.
An Insurance Claim Lawyer Can Speed Things Up Even Further
Our seasoned insurance claim attorney can expedite the claims process and assist you by:
- Reviewing the details of your policy and explaining complicated clauses and language
- Investigating the circumstances of the accident or loss and acquiring evidence to substantiate your claim
- Leveraging our experience negotiating with insurance companies and contesting the schemes and tricks they commonly use to deny or underpay claims
- Demanding the maximum payout amount, one that fairly compensates you for your losses
- Mediating and negotiating with the insurance company and handling all communications with them
- Filing a lawsuit and taking your insurance claim to court if necessary
Can You Sue an Insurance Company for Taking Too Long to Pay Out?
You do have the right to sue an insurer if it takes too long to pay on a claim. In Wisconsin, an insurance company is required to promptly pay each claim. The insurance claim will be deemed overdue if it is not paid within 30 days after being notified of the policyholder’s loss.
Talk to a Lawyer at Wallace Law for Help Today
At Wallace Law, we work hard to resolve all types of insurance claims quickly and in favor of our clients. We have the experience it takes to negotiate with your insurance company and advocate effectively for you so you can receive the payout you deserve and begin recovering from your loss. Reach out to us today to get started with your claim.
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