How Long Can an Insurer Take to Investigate Your Claim?

When you file an insurance claim after an accident, it’s natural to wonder how long you’ll be waiting for answers. How long does an insurance company have to investigate a claim? Commonly, depending on state-specific legislation, insurers must act within a reasonable timeframe, but what “reasonable” means can vary based on the specific laws in your state and the nature of the accident. We’ll explore these timelines, the claim filing process, insurance investigation procedures, common delays, practical tips to ensure a smooth claims experience, and how to negotiate effectively to overcome obstacles and maximize your compensation.

How Long Does an Insurance Company Have to Investigate a Claim?

If you’re involved in an accident and need to file an insurance claim, it’s important to know what kind of timeline to expect. Legally, insurers must act promptly and in good faith, but the actual duration often depends on the complexity of your case. Most insurance companies are typically given between 15 to 90 days to investigate a claim and accept or deny it, depending on the specific state regulations, the type of the claim, and the case’s complexity. For instance:

• Straightforward property damage claims may be resolved more quickly.
• Personal injury claims involving medical treatments or liability disputes can take longer.
• Claims involving disputes over fault or requiring additional evidence like medical records may face delays.
• Claims involving multiple parties or large settlements can extend the investigation process, requiring more thorough documentation and negotiation.
• Claims related to uninsured or underinsured drivers often require additional verification steps, which can cause delays.
• Claims involving specialized property, such as high-value items or rare vehicles, may require additional assessments and experts, adding to the investigation timeline.

Insurance claim investigations typically lead to either an approval or denial of the claim. If approved, compensation may cover medical bills, lost wages, and property damage. If denied, it usually means the insurer found insufficient evidence or inconsistencies. Shared fault could also reduce the compensation, depending on state laws. Additionally, delays can happen if disputes or appeals arise.

Being aware of these timelines and your role in the process can make a real difference. Let’s explore how different states handle these time limits, as variations can significantly affect your claim experience.

Claim Investigation Timelines in Florida, Tennessee, and Texas

When it comes to investigating insurance claims, each state has its unique rules and timelines, which can impact how long you might have to wait for a resolution.

Florida

In Florida, insurance companies are generally expected to complete their investigations within 90 days, as per Florida Statute § 627.70131. Under Florida law, insurers must act in good faith and aim to process claims promptly. In some cases, such as when there is a reasonable suspicion of fraud under Florida Statute § 626.989 or § 817.234, insurers have an initial 30 days to notify the claimant about the investigation for suspected fraud, followed by an additional 60 days to complete the fraud investigation. This makes the total investigation time up to 90 days.

Tennessee

In Tennessee, insurers typically aim to complete investigations within 30 to 60 days, as per Tennessee Code § 56-8-105. The state requires that insurers act promptly and not unreasonably delay the process. In certain cases, such as those involving complex liability issues or suspected fraud, insurers may require additional time to complete the investigation.

Texas

Texas requires insurers to acknowledge claims within 15 days and ideally resolve them within 45 days, as per Texas Insurance Code § 542.056. However, in more complicated scenarios—such as those involving suspected fraud or requiring additional expert opinions—this timeline can extend up to 90 days. Texas law emphasizes transparency and keeping claimants informed, requiring insurers to provide updates throughout the investigation.

Whether you’re dealing with Florida, Tennessee, or Texas, it’s important to understand the claim process, the insurance investigation steps, and what is the purpose of it as these factors directly impact the timeline.

Why Do I Need to Prove My Claim to the Insurance Company?

It might be an obvious question you’d like to have an answer to and it’s understandable to wonder why you need to prove your case when the accident wasn’t your fault.

The reality is that insurance companies have a duty to ensure that claims are valid, well-supported, and in line with policy terms. They are not there simply to pay out, but rather to evaluate each claim to prevent fraud, overpayment, or ineligible compensation. This means that even if you are entitled to compensation, it’s your responsibility to provide enough evidence to support your claim.

Insurance companies need to verify the cause of the accident, the extent of the damage, and the link between the accident and your injuries. This helps prevent fraudulent claims that can drive up costs for all policyholders. It’s about proving your damages fall within your policy’s scope. If you’re struggling, legal help can make a big difference, ensuring you get the payout you deserve without unnecessary delays.

How Does a Car Insurance Investigation Take Place?

The car insurance investigation process after an accident involves several important steps to determine the facts, verify the claim, and assess liability. These steps are designed to protect both you and the insurance company from fraudulent or exaggerated claims while ensuring that legitimate claims are resolved fairly. Here’s how it typically unfolds:

1. Initial Contact and Claim Review
   After you report the accident, the insurer will contact you for an initial review. The insurer is typically required to acknowledge receipt of your claim within 15 to 30 days, depending on state regulations. During this stage, the adjuster will gather essential information about the incident, such as accident location, vehicle damage, and the events leading up to the accident. They will also check whether your policy covers the type of claim being made.
2. Assigning an Adjuster, and What do they look for?
   An insurance adjuster will be assigned to your case. This usually occurs shortly after the initial acknowledgment, ensuring that the investigation process begins without unnecessary delays. The adjuster will act as your main point of contact and will begin collecting additional evidence to verify the claim. This can involve obtaining police reports, reviewing photographs of the accident scene, and interviewing witnesses.
3. Damage and Injury Assessment
   The adjuster will evaluate the physical damage to the vehicles involved and, if necessary, consult mechanics or damage appraisers to estimate repair costs. If personal injuries are involved, they may also review medical records or speak with healthcare providers to confirm the extent of injuries and ensure that the treatment is appropriate.
4. Determining Liability or Liability Investigation
   Establishing who is at fault is a key part of the investigation. The adjuster will examine all available evidence to determine which party is liable for the damages. This includes reviewing witness statements, accident reports, and any other relevant information. In some cases, they may assign partial fault to both parties, depending on state laws regarding comparative negligence.
5. Fraud Investigation (If Applicable)
   If there is suspicion of fraudulent activity, the insurer may conduct a deeper investigation. This could involve hiring special investigators, verifying the validity of claims, and cross-referencing with previous claims or records to detect inconsistencies. Fraudulent claims can significantly delay the investigation timeline.
6. Claim Resolution
   Once the investigation is complete, the insurance company will determine the validity of your claim and liability. If approved, you are entitled to compensation that may include medical bills, lost wages, and property damage. They are typically required to issue payment within 30 to 60 days, depending on state regulations, according to the policy terms. If there are disputes regarding the settlement offer, you have the right to negotiate or, if necessary, seek legal counsel to reach a fair resolution.

Each step affects how quickly the investigation moves forward. Factors like claim complexity, evidence availability, cooperation from everyone involved, and suspected fraud can all cause delays. Let’s now explore the common reasons for delays in PIP claims and how to overcome them.

What to Do if Your Insurance Company is Taking Too Long to Settle a Claim?

Insurance claim delays can happen for several reasons—some understandable, others frustrating. Common causes include incomplete documentation, ongoing liability disputes, waiting on medical records, or suspicion of fraud. Additionally, high caseloads at the insurance company or lack of cooperation from other parties involved can slow things down.

If your insurance company is taking too long, don’t sit back and wait. Start by contacting your adjuster to ask for an update and clarify what is causing the delay. Document every communication—you’ll need a record if further action becomes necessary. If the company remains unresponsive or the delay seems unjustified, you can file a complaint with your state’s insurance department. They are there to ensure that insurers act in good faith.

Another option is to hire an attorney to advocate on your behalf. Our lawyers can directly engage with the insurance company, ensuring that they comply with the legal deadlines for claim processing and avoid unnecessary delays. We can also gather and present additional evidence to address any disputed issues efficiently, which helps speed up the resolution. If the insurer continues to drag its feet, we can escalate the situation by filing complaints or even pursuing litigation to enforce timely compliance. Remember, you have the right to a fair and timely resolution, and our insurance claim lawyers team is here to ensure the process moves forward as swiftly as possible.

What to Do if You Do Not Agree with the Insurance Settlement

If you do not agree with the settlement offered by your insurance company, don’t feel pressured to accept it. Start by asking for a detailed breakdown of how the insurer calculated the settlement. This will help you identify any discrepancies or areas where you feel the compensation is inadequate. Once you have this information, formally dispute the offer by submitting a letter that outlines your concerns, along with any supporting evidence like medical bills, repair estimates, or expert opinions that justify a higher settlement amount.

You can also request a re-evaluation or an independent appraisal of your damages. If the negotiations are going nowhere, consider involving a lawyer. A personal injury lawyer can effectively communicate with the insurer, apply pressure where needed, and ensure all legal processes are followed. In some cases, filing a complaint with your state’s insurance department may be necessary to hold the insurer accountable. If needed, your lawyer may recommend litigation to ensure you receive fair compensation. Anyway, you are not obligated to accept an offer that doesn’t adequately cover your damages.

Summing up

If you are in an accident, your insurance company must investigate your claim thoroughly within a specific timeframe to ensure its validity. However, delays and unfair settlements can often occur due to insurance companies’ common practices of undercutting payouts. At Steinger, Greene & Feiner, we specialize in personal injury claims, and our accident lawyers can help keep your investigation on track, avoid delays, ensure deadlines are met, and help you get the compensation you deserve.