Jason Stephens | July 24, 2023 | Personal Injury
If you suffered a personal injury (a broken leg in a slip-and-fall accident, for example), your compensation will most likely come from an insurance company. As such, it really matters how long it will take the insurance company to respond to your claim. To promptly resolve your claim, you need to know your rights against an insurance company.
The First 15-Day Window
Regardless of whether you are claiming compensation for a car accident or a dog bite, the insurance company must normally acknowledge their receipt of your claim within 15 days after they receive it. Within this 15-day window, they must also begin an investigation into your claim, and they must ask you for anything they need to help them process your claim.
Once the insurance company provides you with these requests, the ball is in your court as long as the requests are reasonable. It is up to you to supply the insurance company with all of the information and documentation they requested.
If you unreasonably delay providing this information, you will only be delaying the resolution of your claim. A lawyer can help you determine whether the insurance company’s information requests are reasonable.
The Second 15-Day Window
After the insurance company receives all of the information from you that they reasonably requested, they have another 15-day window to either accept or deny your claim. If they accept your claim, the 5-day deadline kicks in (see below).
If they deny your claim, they must give you a written reason. In many cases, the insurance company will send you a counteroffer (for a lower amount). Legally, this functions like an outright denial of your claim followed by an offer.
The 45-Day Extension
The insurance company can invoke a 45-day extension on the time they have to resolve your claim if they have a good reason to do so. Typical “good reasons” include:
- The insurance company is “snowed under” with a large volume of claims.
- Your particular claim is exceedingly complex or, for some other reason, justifies extending the insurance company’s time to investigate.
The insurance company must notify you in writing that they are invoking the 45-day extension.
The 5-Day Window
Once the insurance company approves your claim, they must actually pay it within five days of their approval. This deadline sets a 35-day minimum for the resolution of your claim after you file it (the first 15-day window, the second 15-day window, and the 5-day window).
The insurance company might resolve your claim in less than 35 days, but you cannot compel a response from them that is any faster than 35 days after you file your claim with them.
Maximum Medical Improvement (MMI)
Before you file a claim with an insurance company, you need to know how much your claim is worth. This is difficult to determine if you are still receiving medical treatment at the time you file your claim. You can’t know for sure how many more medical bills will pile up, and it could be difficult to rely on speculation to determine the true value of your claim.
Instead, under most circumstances, you should wait until you reach maximum medical improvement (MMI) before you file your claim. MMI is the point at which your doctor confirms that your condition has already improved as much as it ever will. Depending on the seriousness of your injuries, waiting for MMI before you file your claim could delay claim processing for weeks or even months.
Insurance Bad Faith Claims
“Insurance bad faith” is a civil claim you can file against an insurance company that deals with you improperly, such as by unreasonably delaying your claim.
If the insurance company deals with your personal injury claim in bad faith, you have both a personal injury claim and an insurance bad faith claim. In this way, you can recover far more than the amount necessary to compensate you for your injuries.
Texas recognizes two types of insurance bad faith claims: common law bad faith and statutory bad faith.
Common Law Bad Faith
Common law bad faith claims are based on the implied covenant of good faith and fair dealing. This is court-made law, not statutory law. To win, you must prove that the insurance company unfairly delayed or denied your claim. You must also prove that the insurance company knew or should have known that their behavior lacked a reasonable basis.
Statutory Bad Faith
Texas insurance statutes set forth many requirements that companies must adhere to. Following is an abbreviated list of possible statutory bad faith claims:
- Failure to acknowledge that they have received your claim;
- Canceling your insurance after you file a claim;
- Misrepresenting the terms of your policy;
- Failing to thoroughly investigate your claim;
- Unreasonably delaying acceptance of your claim;
- Denying your claim without a good reason, or refusing to give you a reason at all; or
- Accusing you of fraud without justification.
Many other forms of insurance company misconduct can justify a bad faith insurance claim. Keep in mind that insurance bad faith lawsuits are notoriously difficult to win, especially if you don’t have a lawyer.
Insurance Companies Are For-Profit Businesses
Never forget that the sole purpose of the existence of an insurance company is to maximize their own profits, not compensate you for your injuries. The more money they pay claimants like you, the less profit they make. The insurance adjuster is your adversary, and they will do their best to get away with denying your claim outright or reducing its value as much as possible.
Seek the Assistance of an Experienced Fort Worth Personal Injury Lawyer
Just about any qualified Fort Worth personal injury lawyer will enjoy years of experience negotiating with insurance companies. This experience will give you a great advantage in dealing with the insurance company. You also need to make sure your lawyer has a strong track record of winning against insurance companies at trial so that the insurance company will see that it is in their best interests to settle with you.
Contact Our Personal Injury Law Firm in Fort Worth, TX
If you’ve been injured in an accident in Fort Worth and need legal help, contact our Fort Worth personal injury lawyers at Stephens Law Personal Injury | Wrongful Death | Truck Accidents to schedule a free consultation.
Stephens Law Personal Injury | Wrongful Death | Truck Accidents
1300 S University Dr # 300
Fort Worth, TX 76107