How Long Does an Insurer Have to Deny an Injury Claim in Indiana?

After suffering an injury, it can be difficult to wait for the compensation you need to help your recovery. Most people do not know how long an insurer will take to approve or deny their claim.

Fortunately, insurance companies cannot draw out the process indefinitely. Rules are in place to ensure that insurers act fairly and do not take an undue amount of time processing claims, but there is no set time limit. Because of this, some insurance companies take advantage of the ambiguity to pressure people into accepting low settlements or abandoning their claims altogether. Our team can help if you have been waiting for a response from your insurer. Even if your claim is denied, we can explore options with you to get the compensation you deserve, including organizing and filing an appeal on your behalf.

For a free review of your case with our Indiana personal injury lawyers, call Wruck Paupore at (219) 322-1166.

How Much Time Do Insurers Get to Deny an Injury Claim in Indiana?

While Indiana law does not prescribe specific deadlines for insurers' acceptance or denial of injury claims, the guiding principle remains that such decisions should be made within a “reasonable time.” For those navigating this process, working with our Indianapolis personal injury lawyers is the best way to resolve your case without wasting time. Though somewhat subjective, the standards involved uphold the expectation of fair dealings between insurers and claimants.

I.C. § 27-4-1-4.5, while not providing explicit timelines, sets standards for what constitutes fair and reasonable practices by insurers. These standards are intended to prevent unfair delays in handling claims but do not specify exact time frames for claim denial or acceptance.

Examples of Unfair Practices that Can Result in a Denial of Your Injury Claim in Indiana

The law mentioned above gives several examples that illustrate unfair practices in delaying or denying insurance claims. These include, but are not limited to, the following scenarios:

Misrepresentation of Policy Provisions

Insurance companies must provide accurate and truthful information about the terms and provisions of their policies. This means that insurers are not allowed to provide false or misleading information about the coverage at issue.

They are also prohibited from omitting any material facts that could potentially affect the policyholder’s decision to purchase the policy or make a claim. In other words, insurance companies are legally obligated to disclose all relevant details about the coverage, including any limitations or exclusions, so that policyholders can make informed decisions about their insurance needs.

Failure Act Promptly

Insurance companies are responsible for promptly acknowledging and responding to any communications related to claims filed by policyholders. This includes acknowledging receipt of the claim, providing updates on the status of the claim, addressing any questions or concerns regarding the claim, and promptly informing the claimant of its final decision.

Failure to Adopt and Implement Reasonable Standards

Insurance companies are also required to establish and adhere to reasonable standards for promptly investigating claims filed by their policyholders. This means that they must have a set of guidelines and procedures in place to ensure that the claims investigation process is conducted in a fair, efficient, and timely manner.

Refusal to Pay Claims without Conducting a Reasonable Investigation

Insurers must also conduct a thorough investigation before refusing to pay out claims. This investigation must be based on all available information, including any evidence or documentation provided by the policyholder.

This investigation aims to ensure that the insurance company has all the relevant facts and information needed to make an informed decision about whether to pay out the claim. Failure to conduct a proper investigation before denying a claim could be grounds for legal action against your insurance company.

Failure to Affirm or Deny Coverage within a Reasonable Time

Once a policyholder submits proof of loss statements to their insurance provider, the investigation should be completed within a reasonable time frame. Once the investigation is complete, the insurer is required to grant or deny coverage of the claim, along with a detailed explanation of their decision. Without a full accounting of the reasons for your denial, the insurance company is not within its rights to deny your compensation.

Not Attempting in Good Faith to Settlement the Claim

When liability has been established and is reasonably clear, insurers are responsible for making a sincere and honest effort to settle the matter promptly and fairly. Insurers are required to act in good faith, meaning that they must act honestly and with integrity and ensure that the settlement process is carried out in a manner that is consistent with the principles of fairness and equity.

This includes ensuring that you are not unduly pressured into accepting an unfair settlement and are given the opportunity to present your case and provide evidence to support your claim.

What Should I Do if My Indiana Injury Claim is Denied?

After receiving a denial, the first step is to review the insurer’s letter carefully. Insurers are required to provide a clear and detailed explanation for their decision. This explanation often includes references to specific policy provisions or aspects of the claim that led to the denial.

Some common reasons for claim denials include the claim falling outside the policy’s scope, delay in reporting the injury or filing the claim, disputed liability, and insufficient evidence supporting the claim’s validity or the extent of the injuries. Identifying the reason for denial helps you tailor your response and determine whether there is a basis to contest the denial.

Most insurance policies have a procedure for appealing a denial, which can give you another chance to receive the coverage you need. To initiate the appeal process, you must typically submit a written appeal to your insurer. This appeal should include any additional documentation or information that supports your claim, such as medical records, receipts, or witness statements.

When drafting your appeal, it is important to address the specific reasons for the denial that the insurer stated. This means examining the language of the denial letter closely and identifying any factual errors, omissions, or misunderstandings that might have led to the denial. Once you have identified these issues, you should present evidence to contradict them. This evidence could include medical opinions, test results, or expert reports.

In addition to providing evidence, your appeal should also be clear, concise, and persuasive. You should explain why you believe the insurer’s decision was wrong and why you are entitled to coverage under the terms of your policy. That is where our team can be highly beneficial to your case.

Our Indiana Personal Injury Attorneys Can Help if Your Claim was Unfairly Denied

Contact Wruck Paupore by calling (219) 322-1166 for a free case assessment with our Evansville, IN personal injury attorneys.