When you file a claim with your health insurance policy, three things can happen. Insurers may pay claims, reject claims, or simply be in the process of settling claims. As such, when the insurer reports its claim record, it should ideally separate the claims into three categories: paid claims, rejected claims, and outstanding claims. Many Floridians aren’t aware that there is a fourth bucket, one for closed insurance claims. Why? It’s one of those things that most people only learn about the hard way – when it happens to them or a loved one.
If you are a Pinellas Park resident that’s notified your insurance claim has been closed, is that it? Are there steps you can take to reopen your closed insurance claim? The good news is that closed insurance claims don’t always have to be final in Florida – especially if you’re willing to seek legal help in disputing your insurance provider’s actions. In order to better understand this type of insurance dispute, it helps to clarify what “closed” actually means first.
Please Note: Our law firm specializes in helping clients with insurance dispute cases in the states of Florida & Georgia. If you’re visiting our site from a different state, we hope you find this information helpful, but unfortunately, we won’t be able to take on your case.
What Does a Closed Insurance Claim Really Mean?
A Pinellas claim becomes inactive when an insurance company closes a case. When an insurance adjuster closes a case, the process stops. This means the insurance adjuster won’t be taking any further action. The case will no longer be investigated, and no further payout will be sent. The insurance company may have closed the claim, but this does not mean that it has denied it. In other words, the insurer does not feel it is worth continuing to work on. But they haven’t exactly refused to pay you yet. The claim will be archived if you don’t dispute this decision, and any compensation due to you will not be paid. Uncontested claims are closed by insurance companies. It is possible to reopen an insurance claim in Florida if you have incurred additional expenses since the incident or if you are unhappy with the amount.
Can Your Provider Close Your Insurance Claim Without Your Consent in Florida?
Insurance companies can close claims in Florida for any reason they choose. When an adjuster says that he or she has closed your claim, it is usually just a way of saying that the claim has been made inactive. Generally, an insurance company closes a claim because they haven’t heard from the person who filed the claim for some time. It’s important to understand that a closed claim is different from an insurance company denying liability or coverage. Whenever you receive a denial from an insurance company, they are telling you that they will not compensate you.
Most Common Reason Insurance Providers Close Claims in Florida
The most common reason that an insurance claim in Florida has been closed is that there has not been any communication from you for a significant period of time. Keeping track of your claim is important so your insurance adjuster does not think or pretend you have stopped caring about it. If you do not provide the information they request within the timeframe they request, your claim may be closed. A claim is closed rather than denied if an insurer believes that you are not investigating the matter anymore, or if they feel they have done enough to resolve it which may differ from your reality.
Insurance companies can also close a claim for other reasons with no further consultation, such as totaling a vehicle. Insurers are not legally required to inform you when a claim is closed, but reputable insurers will keep you informed. After settlement, your case might also be closed, but if you incur additional expenses after the settlement date, you might want to reopen the claim. Additionally, you might disagree with the settlement.
Factors Impacting Insurance Claim Settlement Timeframes in Florida
Depending on the details of the accident, it can take as long as a few months to settle an insurance claim. The timing will be determined by the circumstances of the accident and factors such as state laws, the severity of the injury and damage to the property, whether lawyers are involved, and how quickly the claim was filed. Additionally, you may receive separate payouts for each type of coverage applicable to your claim at different times. The settlement check from your bodily injury liability claim may arrive before the payment from your rental car reimbursement coverage.
Settlement Timelines for General Insurance Claims
Most insurance companies have about 30 days to investigate your auto insurance claim, though the number of days varies from state to state. It can take longer to process and settle claims, especially if the accident was serious or there was a coverage investigation required by law. The investigation process can have the most significant impact on the time it takes for your settlement check to arrive. It can take longer to investigate a serious car accident involving multiple injuries and a question about who was at fault versus a minor fender-bender in which the at-fault party is apparent.
One of their tactics is called the “fake deadline”.
Here’s how it works:
- A settlement offer is made;
- Discussions may ensue, maybe even a counter proposal from the injured party;
- A second offer may have been made;
- If the injured person hesitates, a letter or phone call is made stating that the offer is only valid for ‘X’ days, and if not accepted, the case will be closed.
Clearly, the injured person loses any claim they may have, and will not be able to recover any compensation for their injuries. However, what is actually happening here?
Yes, the adjuster may close the file at any time and withdraw any settlement offers (this does not occur very often). However, you have a limited time limit to pursue your claim, not the adjuster.
Will Your Insurance Claim Be Closed If You Don’t Accept Your Provider’s First Settlement Offer?
The answer is yes, your claim can be closed if you decline to accept the first settlement offer. There are rules and regulations that insurance companies follow that apply to adjusters. The adjuster has to keep track of every move he or she makes on a case. Everything they do is being watched. In order to achieve the insurance company’s goal, these adjusters use methods of claim negotiation. What is the goal? An insurance company’s goal is to resolve the claim as quickly and cheaply as possible. Getting you to settle your injury claim for only a small amount of money as soon as possible after the collision or injury is how the initial adjuster saves the insurance company money. And they often get rewarded for their efforts. It’s usually the adjuster you deal with first who isn’t all that experienced, but who trains to get you a quick and low settlement.
What Can Floridians Do If Their Insurance Claim is Closed?
Florida is one state where you can reopen a closed insurance claim after it has been settled. The statute of limitations, however, is currently five years. You cannot reopen your claim after this period as it will be officially closed and cannot be reopened. There is the option of reopening claims, but you should know that you will possibly need the help of a Florida insurance dispute lawyer. The insurance appraisal process can take some time if your provider isn’t persuaded initially to reopen the claim. Furthermore, your insurance company will scrutinize all the details. Additionally, their adjuster may be tempted to lower the amount if you have already received a payout.
Steps Floridians Can Take to Encourage Them to Reopen Your Closed Insurance Claim
To begin, Floridians should notify people that they are still working on the claim through multiple channels. There should be at least one written channel (email or physical mail) so you can prove that you requested the claim to be reopened. Calling the insurer twice ensures that the message was received. In case mail or email goes missing, make sure to follow up and ask if it was received, and resend if necessary. Frequently, this will be enough to have the claim reopened. Send over any additional supporting documentation, such as medical records, relevant to the claim. Almost certainly, you’ll need to submit new evidence in order to reopen the case and seek more substantial damages if it were settled. In some cases, medical fees may be a result of treatment received post-settlement or repair bills resulting from accident damage that was not discovered until later. Your case can and should be reopened if it was closed due to nonpayment. As mentioned earlier insurers do this to avoid flatly rejecting a claim, which usually leads to a quicker response.
Should You Talk to an Experienced Insurance Dispute Attorney About Your Closed Claim?
Some insurance providers in Florida may refuse to reopen your claim. If this happens, you should consider talking to an insurance dispute lawyer that can handle cases in the Sunshine State. Insurance companies often hope that a claimant will go away after receiving a closed case, and indeed it can appear that a closed case is a final decision. In most cases, you can get the case reopened by contacting the court, and sometimes just a simple request is enough. If not, Herman & Wells located in Pinellas Park can help. We can help you reopen your insurance claim so you can receive the compensation you deserve from your insurance provider. Feel free to contact us for a free legal consultation.
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