November 5, 2024
The Problem of Delayed and Denied Insurance Claims
Insurance companies deny many claims even though they know they will end up paying them in the long run. Unfortunately, delayed and denied insurance claims are a common problem faced by many in Oklahoma and across the country. Individuals purchase their insurance policies in good faith; they believe their claims will be paid completely, in accordance with policy language, in a timely fashion. Unfortunately, this is not how the insurance industry operates. In an effort to maximize profitability by minimizing expenses, insurance companies throughout the state regularly deny claims either hoping their policyholders accept their word as final or to gain the financial advantage of holding onto the monies owed longer.
Multiple problems occur when insurance claims, in all industries, are delayed and denied.
Below are some of the most common in three popular industries.
- Health Insurance Industry: Individuals whose claims are delayed or denied find themselves paying out of pocket for necessary treatment. The high cost of medical care can negatively impact their financial position; some may even face bankruptcy. In certain cases, individuals simply cannot afford the help they need and their health will suffer significantly. Finally, when payment (or preauthorization) is delayed, many people don’t get the care they need in a timely fashion, resulting in more serious illness, injury, and even death.
- Auto Insurance: Vehicular accidents are a common occurrence in Oklahoma and across the country. When auto insurance companies delay and deny damage claims, individuals are forced to assume financial responsibility for repair or replacement of their vehicles, a costly proposition at best.
- Property Insurance: An individual’s home is, in most cases, their most valuable asset. Delays on paying homeowners insurance claims can often result in additional damage. Homeowners cannot make repairs to their property until their claims are settled, so something like untreated water damage can lead to black mold, which is incredibly costly to treat.
While some delays and initial denials occur because of misinformation or simple errors, others are the result of bad faith actions by the insurance companies. If you believe your insurance company is acting inappropriately, contact a bad faith insurance claims attorney right away.
Common Delay Tactics Used by Insurance Companies
Recognizing and understanding your insurance company’s behaviors is key to determining whether they are acting fairly. In fact, many of the tactics they use to delay the payment of a claim are common — they do the same things over and over again. And, to be honest, they often work; there is little incentive for them to change their behaviors.
Some of the most often-used delay tactics include:
- Failing to conduct a reasonable and timely investigation of the submitted claim
- Requesting additional, unnecessary information from the policyholder
- Assigning new claims adjusters, repeatedly
- Untruthfully stating they never received necessary information or documentation
- Misrepresenting policy coverage
- Ignoring presented evidence
- Offering low-ball settlement offers
- Intentionally prolonging the claims process
- Outright denying the claim.
These actions are not in the best interests of an insurance company’s policyholders; they are used to delay claims and can be considered bad faith.
Why Insurance Companies Use Delay Tactics
In a perfect world, insurance companies would be committed to the well-being of their policyholders and would work tirelessly to review, investigate and pay their claims in full and in a timely fashion. Unfortunately, we don’t live in a perfect world and insurance companies’ loyalties lie with their shareholders, not their policyholders.
Insurance is a for-profit business, and insurance company executives must answer to their boards of directors and, ultimately, their shareholders. Their revenues come in the form of the premiums paid by policyholders. Conversely, every paid claim is an expense. Thus, they work hard to minimize these claims by delaying, denying, or underpaying them. While they may have cause to do any of these three, quite often they don’t, and individuals who submitted valid claims simply do not receive what they are owed.
How to Fight Back Against Insurance Company Delay Tactics
Dealing with delayed claims is purposefully time consuming and complicated. In reality, these delays are, more often than not, successful strategies for the insurance company. Many people simply become frustrated while pursuing their compensation and give up, assuming the costs themselves. Others get so tired of waiting that when the insurance company makes a lowball offer, they accept it just to be done with the process.
Unfortunately, not everyone understands that they can take action against their insurance company if its actions are inappropriate; and some of those who do don’t recognize the value in engaging a seasoned bad faith attorney.
If you believe your insurance company’s actions were in bad faith, you should first engage legal counsel. They will:
- Review your policy and submitted claim to determine if you made any errors
- Analyze your insurance company’s response
- Investigate the details surrounding your claim
- Draft an appeals letter
- Quantify damages resulting from the delay
- Negotiate with your insurance company on your behalf
- Represent you in court, if necessary.
If you begin the appeals process yourself, keep track of all communications, in writing if possible. If you do have telephone conversations, keep notes and send an email confirmation to the insurance company recapping what was discussed as soon as possible following your call.
Doug Terry Law Can Help Address Denied and Delayed Insurance Claims
When to Hire an Insurance Lawyer
The question of timing in terms of engaging legal representation with regard to denied claims is one raised quite often. The answer, in most cases, is as soon as possible. The claims appeal process is incredibly time consuming and complicated — the insurance companies structure it this way on purpose. The more difficult it is to appeal, the fewer people will follow through.
If your claim has been unreasonably delayed, you understand the value of time. You need your claim to be reimbursed appropriately to move forward with your life.
The sooner you hire an insurance lawyer, the sooner they can begin work on your behalf.
Contact Doug Terry Law Today
Doug Terry leads a team of experienced professionals with a reputation for successfully handling delayed insurance claims. His experience is considerable, and he is widely recognized for his knowledge of state and federal insurance law.
Equally as important is his firm’s recognition of the stress delayed claims have on insurance policyholders. Waiting for positive news every day while worrying about their future is overwhelming. Because of this, Mr. Terry and his team are ready to go to work for you immediately. In order to alleviate any concerns, they offer all potential clients a free consultation during which they can gain an understanding of your issues and you can learn more about their approach and see, firsthand, how they interact with their clients.
Reach out to them today at
Attorney Doug Terry
After 25 years practicing in a larger firm, Doug chose to open his own practice in Oklahoma City. He brings his wealth of knowledge and his skills as a litigator to bear for his clients in matters of insurance bad faith, personal injury cases and class actions. He won $200 million and $25 million verdicts for clients in cases in which an insurer denied a health insurance claim. Doug has the distinction of being awarded a Martindale-Hubbell “AV Preeminent” rating from his peers in the legal community. He has also been selected as an Oklahoma Super Lawyer. [Attorney Bio]
