What to Do When You Receive No Response to Your Demand Letter
In most cases, the adjuster should be able to evaluate your medical records and respond to your demand letter within thirty days. By the way, that is thirty calendar days, not thirty working days. There is no magic in that figure; it is simply the consensus in the industry that claims adjusters aim to achieve.
You may have sent off what you thought was a simple and complete demand letter, but weeks have passed and not even a peep has been heard from the adjuster. What do you do now? How long should you wait, and when you do respond, what should you say? What about complaining to your state insurance commissioner?
We think there are many reasons for delay in responding to a demand letter. To start with, it is hard to imagine the workload some adjusters carry. Already overburdened, they will fall even further behind if they are required to sit in on all or some major part of any of their claims that go to trial. True, the fact the company is too cheap to adequately staff its claims department should not be your burden, but that is a battle you can carry on with your state insurance commissioner after your claim is paid. At least the adjuster's heavy workload backlog is a burden you can offer to help make better if she would just cooperate and settle your claim!
So workload is our number one guess as to why the adjuster did not get back to you. The second reason could be she has been on vacation. They normally have internal controls to tickle a response before the end of the thirty days, but vacation time could throw her schedule off.
The third most likely reason for delay is that she could be seeking an office review of your medical records from a doctor under contract with the company. It is not uncommon to send complex cases, trauma that aggravated a prior injury, or claims that involve a lot of treatment out for review by another doctor in the same discipline as your treating doctor.
Other reasons for delay are a burned-out adjuster or an adjuster who does not like you and is not in any hurry to get your claim resolved. The former is pretty common. The latter is uncommon because the vast majority of adjusters are professionals who have heard it all before and just go forward doing their job with no particular axe to grind against any individual claimant.
Another reason for the insurance industry to delay sending a response to your demand letter is to intimidate you: to let you know that this is not an even playing field, that they own all the marbles, and further, to demonstrate that if you don't like it, there is not a whole lot you can do about it. Thus, delay is a valuable tool since most against whom this tactic is employed are at a loss to do much against it. In the letters available to our members, SettlementCentral.Com will arm you with techniques that make this tool less valuable, but you still have to put up with some of the delay.
The final reason why the insurance industry will delay in responding to your demand letter is to put the pinch on you financially, and thus to induce a "quickie" settlement for less than you would have received if you were not so strapped for cash. You see, they know the extent to which injuries can disrupt a livelihood of one-or even the whole family. Thus, if you are not being reimbursed for wage loss, and you are continuing to suffer a loss of income, they will induce a lower settlement out of you by forcing you to go without money for as long as they can. When they finally get around to making you an offer, they hope you will be like a hungry dog at a meat market door: willing to give anything to get inside. That is when they can get away with settling for a smaller percentage of the true value of your claim.
What Should You Do When There is NO RESPONSE to Your Demand Letter
We think an adjuster ought to acknowledge receipt of your demand letter and if she cannot get you a response within thirty days, she needs to write to you to explain why. Is that the law? Not really. Many states have guidelines adopted by their Insurance Commissioner that govern first party claims processing, but few have applied them to third party processing. Why the difference? Commissioners base their regulations on a direct contract link between the insurance company and the insured who is making a first party claim. The PIP claimant paid for services from the company, whereas in the third party situation, it was the tortfeasor, not the injured claimant, who made the contract with the insurance company.
But even if your Insurance Commissioner does not have any regulations, the basic standard of good faith is always a requirement in claims processing. Good faith includes devoting the resources necessary to handle correspondence within a reasonable time. So, an excuse of being overworked can only legitimately buy so much time; after that, it borders on bad faith if the adjuster cannot process your demand package in forty days.
If you are having problems with the adjuster getting back to you, don't get your ego involved so that you take it personally. Anger will not work wonders in claims resolution. Reread the section above to understand that this delay is likely not directed AT YOU. It is just something you are caught up in, and a good opportunity to grow the virtue of patience. Of course it is frustrating, and you would love to throttle the adjuster or make her feel your frustrations. But, in truth, getting mad at her will do nothing to speed up the processing or to bring a bigger award.
We suggest that you take the following steps if your demand letter has brought no response or reasonable explanation for the delay:
- Call your State Insurance Commissioner and ascertain whether there is a regulation on timely response for the type of claim you are making
- Ask the representative at the Insurance Commissioner's office for suggestions regarding the situation.
- Ask that representative for statistics on complaints about the company you are dealing with, and if they do not have a good record, then consider filing the complaint sooner than you would otherwise.
- Send our First Follow-Up Letter to Adjuster re: Failure to Respond to Demand Letter, available to members of our site.
- Follow that letter within 10 days with our member's letter to the adjuster's supervisor with which you enclose a proposed letter of complaint to the state Insurance Commissioner. You can get the supervisor's name by calling the Claims Department and asking who supervises your adjuster.
- NOW you should get some response. The supervisor will not likely respond to your letter other than to mention that the adjuster has been busy (trials, and the usual excuses, etc.), but she will be responding to your demand letter very soon.
- Of course if there is no response within 10 days, you will have to file the complaint with the Insurance Commissioner, by sending her our Letter to Insurance Commissioner Failure to Respond to Demand Letter. The Insurance Commissioner will send an inquiry to the supervisor and you WILL hear back from the adjuster after that.
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