Why Claims Get Delayed

When you have filed a claim you expect that it will move along quickly, cleanly and without delay.  It can become very frustrating when the process comes to a grinding halt as it often does. Oftentimes, policy holders think that the delays are personal that their insurance company is interested in denying the claim or they are functioning in bad faith.  This leads to suspicion and less information flow, which can often lead to further delays. Remember that claims function as very specific workflows. They require certain information and steps to move forward, and often without the appropriate information you will find that the workflow comes to a stop. The truth is that most claim delays are procedural. Once you have identified what point in the process is broken, it becomes much easier to fix and get the claim process moving again.

Delay Reason #1: Missing Information

The most common reason that claims are delayed is missing information. Without the information, no decisions can be made to move the claim forward. Usually, adjusters will be looking for: photos, statements, details about the vehicle (VINs, license plate numbers) or contact information for one or more parties. Without the additional information certain steps are halted due to lack of information.

For example, one of the first steps in getting your claim process started (and in particular a liability investigation) is to give a recorded or written statement. The statement will provide certain factual information your adjuster will be looking for in order to make an informed decision regarding a liability decision. People will often delay making a statement due to busy schedules or life interruptions and are surprised when no decision has been made without it.  Although you write a short description of your accident when filing online, or you speak with someone that notes certain details when you file online, you will find your adjuster is often looking for much more detailed and nuanced information. Delaying on providing a statement will often delay a liability decision, impacting whether your deductible will be due or not, what additional information will be needed to enter the subrogation process if necessary, and in some cases whether your claim will be covered at all.

This applies equally to other types of information regarding your claim. Scene photos are often critical to determining what happened and how, vehicles details often provide information regarding insurance policies and whether coverage is available or not, and details for all of the parties involved is important in determining whether there were injuries, or if there are additional pertinent details regarding the accident itself. Each of these plays a part in the process of your claim and can explain why adjusters will often reach out with follow up questions.

Delays #2: Coverage Reviews

Before there is any movement on your claim a coverage review must be completed.  A coverage review will determine: that coverage is available; that it applies to the current claim and how it applies to the current claim. If your adjuster has to conduct an in-depth coverage review, it can often slow claim progress and bring it a halt until the review is complete.

Issues that can often trigger an intensive coverage review are:

·        Recent policy changes;

·        Questions about who is or isn’t covered under the policy;

·        The loss type doesn’t match the type if damage reported.

When you have recently started a policy, coverage will be reviewed to determine whether the coverage would actually apply to the loss.  If you started a policy yesterday, and have an accident today, that will often trigger a review of your coverage, the loss as reported and confirmation of timing regarding the incident. There are people who have an accident, start a policy after the accident, and then attempt to get coverage for an incident that occurred prior to the policy becoming effective. This is a form of insurance fraud and is well monitored by most insurance companies. 

Another delay you will often see in coverage reviews are questions about who is or isn’t covered under the policy. Some policies include excluded drivers, if an excluded driver is driving a vehicle at the time of the accident, that accident will not be covered under that policy. If there is an unlisted driver, there will often be investigations that determine who the driver is, whether they had permission to drive the vehicle and how often they are driving the vehicle to confirm whether coverage will be afforded.

Delay Reason #3: Damage That Doesn’t Match the Story

Equally, sometimes damages will be reported that do not match the facts of the loss. Adjusters are looking for consistency between what you say happened and what the damage shows happened. Those attempting to use their comprehensive coverage sometimes describe collision damage as a flying object. If the damage doesn’t match the facts of the accident, that will slow the claim down as it will bring into question whether the damage can in fact be covered and whether your statement was misleading.  

You will note that there is a delay in getting damages covered in cases where:

·        Damage looks older;

·        Multiple impacts appear;

·        The timeline is unclear.

When you report a claim, be honest. If your story doesn’t match the damage it will trigger an investigation of your claim and that may result  in your losing coverage for this claim or your policy altogether. Insurance fraud is real and not an issue you want to get caught up in.

Delay Reason #4: Waiting on Third Parties

Adjusters rely on multiple types of information when making determinations about claim. A claim can often stall when adjusters are waiting on police reports, other drivers, other party’s insurance companies, witnesses and even repair shops. Unfortunately, even in cases where you have provided all the information you have as quickly as possible, the claim may be stopped due to waiting for information for any or all of these other parties. 

Delay Reason #5: Prior Damage and Prior Claims

When an adjuster reviews your claim, they must separate damage related to the current claim and damage which may be related to a prior claim. This could include a review of those damages by an appraiser or a repair shop and may take additional time to complete. While often damages are evaluated at the same time, if you fail to disclose prior damage or your insurance company is preparing a virtual estimate and the photos are not clear enough, it could extend the amount of time it takes to complete your estimate and continue with your repair process.

Delay Reason #5: High Volume Periods

As most people who’ve filed a claim at a particularly busy period can attest, there are some times when there are so many claims that are filed at the same time that your claim unfortunately ends up in a very long queue. Claims are usually triaged in order of seriousness (injuries, non-drivable vehicles etc.) and that can end up pushing your claim further down the line for review and handling.  These situations include:

• Weather events (storms, tornadoes, hurricanes, winter storms, etc)
• Holidays
• Regional claim spikes

Keep in mind that your adjuster is likely handling hundreds of claims at once, and these volumes increase quickly during the times listed above. If you find that you have to file a claim during one of these times of year, try to provide as much information as possible quickly and efficiently, and handle as much as you can on your insurance app or website. It will go a long way to moving your claim along when others appear to be stuck waiting on their adjuster.

What Doesn’t Usually Cause Delays

There are many reasons that your claim can be delayed, but there are many myths as to why your claim can be delayed as well. First, filing a claim doesn’t automatically slow it down. Adjusters will typically attempt to resolve your claim as quickly as possible. They will often attempt to get statements from all parties, get information and photos added to your claim file as quickly as possible after your claim is filed.  Claims never stop coming in so they will normally resolve claims as soon as they come in and be ready for the next claims in queue.

Myth 2, being polite will not hurt your claim. As with everything in life, the more you are liked the more likely that others will help you. Your adjuster will want to answers your questions and help you as much as possible because they are there to help you. Although sometimes that will involve letting you know that you are at fault for an accident, you typically have an advocate on your side who wants to move your claim along and get things resolved as quickly as possible. This is as good for them as it is for you. Your adjuster is not looking to stall your claim they want it to be resolved as much as you do.

How to Keep Your Claim Moving

To keep your claim moving be proactive! Give your statement as soon as practicable. Respond to requests promptly, send in your photos and answer all questions fully. Follow up professionally, you do not have to follow up with your adjuster every day. Whenever there has been movement on your claim your adjuster will reach out to follow up, sometimes via phone and sometimes digitally.

When a Delay Is a Problem

Although most delays are procedural and will resolve once certain information is provided, there are definitely signs when a delay needs an escalation. Examples of this include:

·        No contact for extended periods

·        Repeated unanswered inquiries

·        Conflicting explanations

In cases where you haven’t been able to get a clear answer on your claim within a reasonable timeframe, it may be time to escalate your request.

Closing: Delays Are Frustrating — But Usually Fixable

Sometimes your claim will be delayed and it will be out of your control. Do the best you can to provide the information required of you and leave it to your adjuster to resolve issues as they come up. If you need updates on the progress, let your adjuster know how best to contact you and you can be sure they will do their best to keep you updated. Just know that you are not powerless and you can be involved in your claim and are often in the best position to be most helpful.

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This content is for educational purposes only and does not constitute legal or insurance advice.