1st Supplemental request to insurance company no response in 4 weeks. What should I do next? Jay Weiss asked 5 months ago
1st Supplemental request to insurance company no response in 4 weeks. What should I do next?

I requested State Farm claims adjuster approval for carpet removal & replacement, ductwork removal & replacement, sofa replacement, along with crawl space insulation removal & replacement. It’s been over a month and I just heard back from the insurance company: “It’s still under review.”

In order to keep my remediation project going, I had to make decisions that add up to an additional $80,000. I was wondering how long is reasonable to wait for a response and what my next steps should be.

1 Answers
Ron Reitz Ron Reitz Expert answered 4 months ago

Hi Jay,
We can understand your concern, especially when you are trying to keep your repair project scheduled. There is often a multiple level approval process with larger $$ value claims and supplements or payments. It is not uncommon for the carrier to take 30-90 days for approvals, depending on the claim and situation.

California has a Fair Claims Settlement Practices Act that dictates the timeframe in which insurers have to respond. Here is a link to the regs that will be of use to you.

https://govt.westlaw.com/calregs/Document/IE642F9A05C2F11EC9C68000D3A7C4BC3?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)&bhcp=1

This is the pertinent language:
(b) Upon receiving any communication from a claimant, regarding a claim, that reasonably suggests that a response is expected, every licensee shall immediately, but in no event more than fifteen (15) calendar days after receipt of that communication, furnish the claimant with a complete response based on the facts as then known by the licensee. This subsection shall not apply to require communication with a claimant subsequent to receipt by the licensee of a notice of legal action by that claimant.

We would recommend that you follow up with your adjuster and memorialize any conversations and/or estimate submission requests. And if needed, try to reach a supervisor or engage the Department of Insurance to pursue the matter – you can find the DOI link here: https://uphelp.org/claim-guidance-publications/getting-help-from-the-ca-dept-of-insurance/

Ron