What Stalling Tactics Do Insurance Adjusters Use?

After an accident, it is vital to understand your insurance company and the role of your adjuster in the process. Marketing slogans aside, insurance is a business, and as such, an insurance company’s highest priority is to make money and minimize costs. An insurance company’s most significant cost is the payout of legitimate claims from their policyholders.

If you have been in an accident and the other driver is clearly at fault, that driver’s insurance company is on the hook to pay for the damages that result. At Smith, Feddeler & Smith, P.A., we have served clients in all types of personal injury claims throughout central Florida for 40 years. In addition to this long history focusing on helping injured clients, we remain up to date, knowing that today’s claims and insurance disputes are often very different than in decades past. Still, our lawyers know how to negotiate with the insurance companies and insurance adjusters to ensure you get the full award to which you are entitled.

The Insurance Adjuster’s Role

Insurance adjusters investigate insurance claims by interviewing the claimant and witnesses, inspecting property damage, and reviewing police reports and medical records to determine the extent of the insurer’s liability. They are supposed to negotiate settlements with claimants to ensure fair compensation based on the policy terms and the evidence gathered.

However, they work for a company that is more focused than ever on turning a profit. This means they are less interested in paying damages or settlements to victims. To this end, they make it harder and harder for insureds to get the financial support people rightfully expect after paying their premiums. Florida has changed some laws and regulations to strengthen customers’ rights, but many other law changes favor the carriers. Recent changes include:

1. Shortened deadlines: The time for insurers to pay or deny a claim has been reduced from 90 to 60 days. Additionally, insurers now have only seven days to review and acknowledge a claim, begin an investigation and conduct a physical inspection.
2. One-year claim filing deadline: The deadline to notify an insurer about a potential new property insurance claim is now one year from the date of loss, down from two years.
3. Elimination of one-way attorney’s fees: New laws have removed the provision that allowed policyholders to recover attorney’s fees if they won any amount in a lawsuit against an insurer.
4. Assignment of benefits (AOB) restrictions: The laws have effectively eliminated the ability to assign post-loss benefits under property insurance policies, which means policyholders can no longer transfer their claim rights to contractors or other third parties.
5. Stricter documentation and communication requirements: Insurers now face stricter deadlines and requirements for processing claims, including mandatory electronic means of claims processing and more stringent documentation requirements.

These changes aim to streamline the claims process, reduce litigation and ensure quicker resolutions for policyholders. See the section below for more information on the state’s regulations. Each claim is different, so you can also contact Smith, Feddeler & Smith, P.A., to see how these changes apply to your case. Call 863-687-7258 or contact us here to schedule a free initial consultation.

Stalling Tactics And Warning Signs

The more things change, the more they stay the same. Adjusters have an array of new tactics to go along with the tried and true ones we’ve always seen them employ to delay paying a claim. Below are some of the most common tactics and warning signs you should watch for after an accident.

Traditional stall-and-delay tactics include:

• Denied claim due to lack of cooperation from the insured: An insurance company will often blame the insured for not providing adequate information to approve the claim. Although the insurance company needs information from its policyholder before approving a claim, in many cases, the insurance company already has enough information to approve your claim. The insurance company used a purported lack of information as a stalling tactic to delay paying out.
• Incremental information requests: Adjusters will sometimes ask for one piece of information from you now, then another in a few weeks, etc. This approach is almost always a stalling tactic. Adjusters usually know what information they need right at the beginning of the claim process.
• Changing representatives: This is a similar stalling technique to the incremental information requests. It is understandable that a company could change your representative, but if you have had to work with several different representatives from the insurance company after an accident, this is likely a stalling tactic.
• Trying to use your insurance: If the other driver is responsible for the accident, that driver’s insurance company should be paying. If that insurance company representative suggests that your insurance policy should cover the compensation, it is a tactic to avoid paying out on a valid claim.

These are some modern claims delay tactics:

• Automated systems for document requests: Insurers may use automated systems to repeatedly request additional documentation, even if it has already been provided. This ploy can create delays as claimants scramble to gather and resubmit paperwork.
• AI-powered claim reviews: Some companies use AI to review claims and identify potential inconsistencies or reasons to deny or delay them. While this can streamline legitimate claims, it can also find minor discrepancies to justify delays.
• Digital communication delays: Insurers might use digital communication tools to manage claims but delay responses. For example, they might take longer to respond to emails or messages through their online portals, slowing down the process.

These tactics can be frustrating and stressful. If you suspect your insurer is stalling, consulting with the injury attorneys at Smith, Feddeler & Smith, P.A., can help ensure the insurance company handles your claim fairly and follows all applicable regulations. If the case needs to go to court, our attorneys will leverage their extensive litigation experience.

Insurance Involves A Detailed Legal Framework

A combination of federal and state laws governs insurance claims in the U.S. Here are some key aspects:

State Regulations

Like other states, Florida has insurance regulations overseen by the MyFloridaCFO’s Insurance Agent and Agency Services. These regulations cover everything from the licensing of insurers to the handling of claims. Here is a timeline that insurers in Florida must follow when handling claims:

1. Acknowledgment: Insurers must acknowledge receipt of a claim within 14 days of receiving it.
2. Investigation: Insurers must begin investigating the claim within 14 days of receiving proof of loss statements. If the investigation involves a physical inspection, the adjuster must provide the policyholder with their name and state adjuster license number.
3. Resolution: Insurers must settle claims within a “reasonable time.” While Florida law does not specify an exact number of days for settlement, insurers are generally expected to resolve claims promptly once the investigation is complete.
4. Payment: Insurers have 20 days to pay the claim once they settle.

Federal Laws

While states primarily regulate insurance, federal laws also play a role. The McCarran-Ferguson Act of 1945 allows states to regulate insurance without interference from federal regulation, except in cases where federal law specifically provides otherwise. Consumer protection laws fall into this category. These laws ensure that insurance companies act in good faith and deal fairly with policyholders. They prohibit unfair practices such as unreasonable delays in claim processing and deceptive marketing practices.

Recent Changes In Laws And Regulations

There have been several recent legislative changes affecting how insurance claims are processed:

• Florida’s legal reforms: In 2023, Florida passed sweeping legal reforms to improve insurer claims handling practices. These reforms include stricter penalties for insurers that engage in a pattern of violations and enhanced enforcement measures.
• Supreme Court rulings: In 2024, several Supreme Court of the United States rulings have impacted the regulatory environment for insurance. For instance, the end of Chevron deference means that federal judges, rather than regulators, have the final say on ambiguous law provisions. This could lead to more litigation and changes in how courts interpret laws and regulations.

These updates reflect ongoing efforts to balance consumer protection with the efficiency and fairness of the insurance claims process. Contact Smith, Feddeler & Smith, P.A., for the most up-to-date information on insurance regulations and injury claims. Call 863-687-7258 or use this website to schedule a free case consultation.

Florida Consumers Have Rights

Here are some critical rights outlined in Florida statutes and the Homeowner Claims Bill of Rights:

1. Timely acknowledgment: Your insurance company must acknowledge your claim within seven days of receiving it.
2. Prompt investigation: Insurers must conduct a timely, thorough and unbiased investigation of your claim.
3. Communication: You have the right to receive a copy of any detailed estimate of the damage within seven days of the company’s adjuster generating it.
4. Claim decision: Within 30 days of submitting a complete Proof of Loss Statement, your insurer must inform you whether your claim is fully covered, partially covered, denied or still under investigation.
5. Fair treatment: Insurers must treat you fairly and reasonably and comply fully with the terms of your policy and applicable laws.
6. Interest on late payments: If your insurer fails to pay an undisputed claim amount within 90 days, they must pay interest on the overdue amount.
7. Right to mediation: If you dispute your insurer’s finding, you may be eligible for mediation or neutral evaluation through the Florida Department of Financial Services.

Other Legislative Updates

Recent legislative changes have further refined the insurance claims process in Florida:

• Tort Reform Act (2023): This act introduced significant changes, including repealing one-way attorney’s fees in coverage litigation and stricter guidelines for bad faith claims.
• Emergency rule on adjusters’ reports (2024): Following allegations of insurers altering adjusters’ reports, Florida’s CFO issued an emergency rule prohibiting such actions without proper documentation.
• Shortened claim deadlines: The time for insurers to pay or deny a claim went from 90 to 60 days, and the deadline to notify an insurer about a potential new property insurance claim is now one year from the date of loss.

Not sure how these changes effect your claim? Contact Smith, Feddeler & Smith, P.A., for a free consultation to discuss your case. Our firm is a place where the customer comes first.

7 Immediate Actions To Take If Your Insurance Company Is Stalling

Here is a step-by-step guide of immediate actions to take if the carrier or the adjuster is giving you the runaround:

1. Document everything: Keep detailed records of all communications with your insurer, including dates, times and the names of representatives you speak with. Save copies of all correspondence, emails and letters. Also, take photos and videos of the damage or loss and keep receipts and repair estimates.
2. Follow up regularly: Contact your insurance company regularly to check on the status of your claim. Be persistent and polite, and log each follow-up call or email.
3. Provide requested information promptly: Ensure you provide any additional documentation or information requested by your insurer as quickly as possible to avoid further delays.
4. Request a written explanation: If the carrier delays your claim, ask for a written explanation detailing the reasons for the delay and what additional information is needed.
5. File a complaint: If you believe your insurer is stalling without valid reasons, file a complaint with the Florida Department of Financial Services. They can investigate and help resolve the issue.
6. Consider hiring a public adjuster: Hiring a public adjuster can help ensure your claim is handled fairly. They negotiate with the insurance company on your behalf.
7. Seek legal advice: If the stalling continues, consult an attorney specializing in insurance disputes. They can provide legal advice and represent you in negotiations or court if necessary.

Don’t Try To Do This On Your Own

Not only do carriers have adjusters and endless layers of bureaucracy, but they also have lawyers looking to use the laws to their advantage. Claimants often get better results when they hire an attorney with experience in insurance claims. The benefits include:

• Experience: Lawyers focusing on insurance claims understand the legal framework and can navigate complex regulations.
• Advocacy: They can advocate on your behalf, ensuring your rights are protected and you receive a fair settlement.
• Negotiation: Experienced attorneys can negotiate effectively with insurance companies, often leading to quicker and more favorable outcomes.

Our lawyers at Smith, Feddeler & Smith, P.A., provide top-tier legal experience, advocacy and negotiation skills to their clients. Learn how we get results by calling 863-687-7258 or using our website contact page.

5 Tips For Finding The Right Attorney

The best results often come from doing your homework, which includes:

1. Research and referrals: Ask for recommendations from friends, family, or colleagues who have had similar experiences. Look for attorneys with positive reviews and a strong track record in insurance disputes.
2. Check credentials: Ensure the lawyer is licensed to practice in Florida and has experience with insurance claims. It is also good to verify their standing with the Florida Bar Association.
3. Consultations: Many attorneys offer free initial consultations. Use this opportunity to discuss your case and assess their expertise and approach. The discussion should include their experience with cases similar to yours and their success rate.
4. Fee structure: Understand the fee structure before hiring an attorney. Some work on contingency, meaning they only get paid if you win your case.
5. Communication: Choose a lawyer who communicates clearly and regularly updates you on the progress of your case.

Contact Smith, Feddeler & Smith, P.A., for a free consultation. Learn how we could handle your claim.

Technological Advances In Insurance Claims

The insurance industry has seen significant technological advancements in recent years, transforming how claims are processed and managed. These innovations aim to improve efficiency, accuracy, and customer satisfaction.

• Artificial Intelligence (AI): For better or worse (see above about using it for giving folks the runaround), AI is revolutionizing the detection of stalling tactics and fraud in insurance claims. Machine learning algorithms can analyze vast amounts of data to identify patterns and anomalies that may indicate fraudulent activity or unnecessary delays.
• Blockchain technology: Blockchain offers a secure and transparent way to manage insurance claims. By creating an immutable ledger of all transactions and interactions, blockchain can help prevent tampering with claim records and ensure all parties have access to the same information. This transparency reduces the likelihood of stalling tactics, as any attempt to alter or delay the process is easily traceable. Additionally, smart contracts on blockchain can automate claim approvals and payments, further reducing the potential for delays.
• Automated claims processing: Technology has significantly expedited the claims process through automation. AI-powered chatbots and virtual assistants can handle initial claim intake, answer policyholder questions, and guide them through a submission. Theoretically, this reduces the time it takes to file a claim and ensures that all necessary information is collected upfront. Automated systems can also prioritize claims based on severity and complexity, ensuring that the company addresses urgent cases promptly.
• Digital platforms and mobile apps: Insurers increasingly use digital platforms and mobile apps to streamline the claims process. Policyholders can now file claims, upload documentation, and track the status of their claims in real-time through interfaces. These platforms often integrate with other systems, such as repair shops and medical providers, to facilitate faster approvals and payments. By providing a seamless and transparent experience, these technologies should enhance customer satisfaction and reduce the overall time to resolution.
• Data analytics: Advanced data analytics plays a crucial role in expediting claims. By analyzing historical data and current trends, insurers can predict claim volumes, identify bottlenecks, and optimize their processes accordingly. Predictive analytics can also help assess the risk and potential cost of claims, allowing insurers to allocate resources more effectively and speed up decision-making.

These technological advancements are reshaping the insurance landscape, ideally making the claims process more efficient, transparent and customer-centric. Conversely, they can be used to do the opposite, which can be incredibly frustrating. Is it time for answers? Call Smith, Feddeler & Smith, P.A., at 863-687-7258 or use our contact page to schedule a free consultation.

Real-Life Examples: Challenging Stalling Tactics

This firm did not work on the cases described below, but they do provide a few examples of what carriers try to do.

Case 1: Homeowner vs. Insurance company in Florida

A homeowner in Florida experienced significant delays in processing a claim for hurricane damage. The insurance company repeatedly requested additional documentation, claiming there were incomplete initial submissions. After months of stalling, the homeowner hired a public adjuster who meticulously documented all interactions and provided the necessary evidence. Despite this, the insurer continued to delay. The homeowner then filed a complaint with the Florida Department of Financial Services, which prompted an investigation. The state found that the insurer violated state regulations and ordered the carrier to expedite the claim and pay penalties.

Case 2: Business Owner vs. Insurer in Texas

A business owner in Texas faced delays in a claim for fire damage. The insurer disputed the cause of the fire, suggesting it was due to negligence. The business owner hired an attorney who specialized in insurance disputes. The attorney gathered expert testimony and evidence to refute the insurer’s claims. After the claimant presented a strong case, the insurer agreed to settle the claim to avoid litigation. The business owner received the total amount owed, plus interest for the delay.

Case 3: Auto accident claim in California

In this case, an individual involved in an auto accident faced stalling tactics from their insurer, who delayed the claim by repeatedly requesting medical records and questioning the severity of injuries. The claimant sought legal representation, and the attorney sued for bad faith insurance practices. The court ruled in favor of the claimant, awarding the claim amount and additional damages for the undue stress and financial hardship caused by the delays.

Successful Resolutions: Legal Intervention

Resolution 1: Public adjuster and legal team collaboration

The insurer initially offered a low settlement in a case involving significant water damage to a home. The homeowner hired a public adjuster who documented the full extent of the damage and negotiated with the insurer. When the insurer continued to stall, the homeowner’s attorney intervened, filing a lawsuit for breach of contract. The legal pressure led to a swift settlement, with the insurer agreeing to pay the total claim amount plus legal fees.

Resolution 2: Mediation and arbitration

A policyholder in Florida faced delays in a claim for roof damage. The insurer disputed the extent of the damage and the cost of repairs. The policyholder’s attorney suggested mediation, which is a less adversarial process than litigation. Both parties presented their evidence during mediation, and a neutral mediator facilitated a settlement. The insurer agreed to a fair payout, avoiding the need for a lengthy court battle.

Resolution 3: Court ruling in favor of the claimant

A severe storm damaged a claimant’s home. The insurer delayed the claim by questioning the cause and extent of the damage. The claimant’s attorney filed a lawsuit. During the trial, it came to light that the insurer had a pattern of delaying similar claims. The court ruled in favor of the claimant, ordering the insurer to pay the total claim amount, punitive damages, and attorney’s fees.

These examples highlight the importance of legal intervention in ensuring fair and timely resolution of insurance claims. If you face similar issues, consulting with a legal professional can significantly improve your chances of a successful outcome.

Call For A Free Consultation

Insurance companies use the tactics above to confuse and frustrate individuals filing a claim. Often, people without legal representation will get frustrated and give up, which is what the company wants. At Smith, Feddeler & Smith, P.A., we are here to ensure that doesn’t happen.

After an accident, talk with one of our lawyers right away. We can help you walk through the legal process and protect you from the insurance company’s tricks and tactics. Call us at 863-687-7258 or email us today.