When you submit a valid insurance claim, you expect the insurance company to investigate the claim and pay the benefits owed within a reasonable period of time. Unfortunately, some policyholders and beneficiaries find themselves waiting weeks or months while the insurance company repeatedly asks for documents, claims the investigation is ongoing, or simply fails to make a decision.
If an insurance company is delaying payment of your claim, you do not necessarily have to wait indefinitely.
Florida law and the terms of the insurance policy may impose obligations on an insurer concerning the investigation, handling, and payment of claims. Depending on the type of insurance involved and the circumstances surrounding the delay, legal action may be available to force the insurer to address the claim and potentially recover additional damages or other relief.
Why Do Insurance Companies Delay Claims?
Not every delay means that an insurance company is acting improperly. Insurance companies have the right to investigate claims and determine whether coverage exists.
However, there is an important difference between a legitimate investigation and an unreasonable delay.
Common reasons an insurance company may give for delaying payment include:
- The insurer is waiting for additional documentation.
- Medical records have not yet been received.
- The insurer is investigating statements made in the insurance application.
- There is a dispute regarding coverage.
- The insurer is reviewing whether an exclusion applies.
- Multiple people are claiming entitlement to the insurance proceeds.
- The insurer is investigating the circumstances surrounding the loss or death.
- The claim has been referred to a special investigations unit.
- The insurer claims information provided with the claim is incomplete.
- The insurance company is waiting for information from a third party.
Some of these reasons may justify additional investigation. Others may become problematic if they are used repeatedly without meaningful progress toward resolving the claim.
How Long Can an Insurance Company Delay Payment in Florida?
There is no single deadline that applies identically to every type of insurance claim.
The applicable time requirements can depend on the type of insurance policy, the language of the policy, the circumstances of the claim, and the Florida statutes governing that particular insurance coverage.
For example, Florida law contains specific provisions addressing the payment of life insurance proceeds. Other types of insurance claims may be governed by different statutory requirements and policy provisions.
The critical question is often not simply “How long has the claim been pending?” but also:
“What has the insurance company actually been doing during that time?”
A complicated claim may legitimately require investigation. But an insurer should not be able to avoid its obligations merely by repeatedly stating that a claim remains “under review.”
Warning Signs That an Insurance Company May Be Unreasonably Delaying Your Claim
Certain patterns may indicate that it is time to take a closer look at how your claim is being handled.
Potential warning signs include:
Repeated Requests for the Same Documents
You provide the requested records, only to receive another letter asking for documents you already submitted.
Long Periods Without Communication
Weeks pass without a meaningful update regarding the status of the investigation.
Vague Statements That the Claim Is “Under Review”
The insurer repeatedly says that the investigation is continuing but does not explain what remains outstanding.
Constantly Changing Reasons for the Delay
One month the insurer says it needs medical records. The next month it needs employment records. Later, it identifies an entirely different issue.
Requests for Information That Appears Unrelated to the Claim
Broad requests for records may sometimes be legitimate, but excessively broad demands can raise questions about whether the insurer is conducting a reasonable investigation.
No Clear Explanation of What Is Preventing Payment
If the insurance company cannot identify what information it still needs or why it cannot make a coverage decision, further investigation may be warranted.
What If a Life Insurance Company Is Delaying Payment?
Delays can be particularly difficult in life insurance cases because beneficiaries may be relying on the death benefit to replace lost income, pay a mortgage, cover funeral expenses, or meet other financial obligations following the death of a loved one.
Life insurance claims may be delayed for several reasons.
Contestability Investigations
If the insured dies during the policy's contestability period, the insurance company may conduct a more extensive investigation into the original application.
The insurer may review medical records, prescription histories, financial information, or other evidence to determine whether the application contained a material misrepresentation.
A contestability investigation does not automatically mean the claim will be denied. However, it can substantially increase the amount of time required to process the claim.
Beneficiary Disputes
Payment may also be delayed when two or more people claim entitlement to the death benefit.
For example, disputes may arise involving:
- Former spouses;
- Current spouses;
- Children;
- Trusts;
- Estates;
- Recently changed beneficiaries; or
- Allegations of fraud, forgery, incapacity, or undue influence.
In some cases, the life insurance company may file an interpleader action, asking a court to determine who should receive the policy proceeds.
Questions About the Cause of Death
The insurance company may investigate whether a policy exclusion applies based on the circumstances of the insured's death.
The existence of an investigation, however, does not necessarily give the insurer unlimited time to hold the policy proceeds.
Can an Insurance Company Keep Asking for More Information?
Insurance companies generally have the right to request information reasonably necessary to evaluate a claim.
That does not mean every request is necessarily appropriate.
When evaluating repeated requests for information, important questions may include:
- Is the requested information relevant to coverage?
- Has the information already been provided?
- Why does the insurer say it needs the information?
- Is the insurer requesting records covering an unusually broad period?
- Has the company explained what issue it is investigating?
- Does each response simply result in another request?
- Is the insurer actually moving toward a decision?
An experienced insurance claims attorney can evaluate the correspondence and determine whether the requests appear reasonably related to the claim.
What Should You Do If Your Insurance Claim Is Being Delayed?
If your claim has been pending for an extended period, there are several steps you can take to protect yourself.
1. Keep Everything in Writing
Maintain copies of letters, emails, claim forms, document requests, and other communications with the insurance company.
Written communications can establish exactly what the insurer requested and when you responded.
2. Keep Proof That Documents Were Submitted
Do not assume the insurance company will maintain a perfect record of everything you provide.
Keep copies of submitted documents along with proof of delivery whenever possible.
3. Create a Claim Timeline
Write down important dates, including:
- The date the claim was submitted;
- The date the insurer acknowledged the claim;
- Each request for additional information;
- The date you responded;
- Telephone conversations with adjusters or representatives; and
- Any deadlines identified by the insurance company.
A detailed timeline can help reveal patterns of delay.
4. Ask What Specifically Is Preventing Payment
Instead of accepting a general statement that the claim is still being reviewed, consider requesting a written explanation identifying what information remains outstanding and what issues are preventing the company from making a decision.
5. Be Careful Before Giving Recorded Statements or Signing Authorizations
Depending on the type of claim, an insurer may request recorded statements, examinations, medical authorizations, or other information.
These requests may have legal consequences. If you are uncertain about what you are being asked to provide, consider consulting an attorney before responding.
6. Consider Speaking With an Insurance Claims Lawyer
If the insurer continues delaying payment despite having the information necessary to evaluate the claim, an attorney can review the policy, correspondence, claim history, and applicable Florida law to determine what options may be available.
Can You Sue an Insurance Company for Delaying Payment?
Potentially.
Whether a lawsuit is appropriate depends on the insurance policy, the reason for the delay, the applicable law, and whether the insurer has breached its contractual or statutory obligations.
An insurance claim dispute may involve issues such as:
- Breach of the insurance contract;
- Wrongful denial of benefits;
- Failure to timely pay benefits;
- Disputes regarding policy exclusions;
- Material misrepresentation allegations;
- Beneficiary disputes;
- Declaratory relief; or
- Potential bad-faith issues where legally applicable.
Florida insurance law is highly dependent on the type of policy and the specific circumstances. A delay alone does not automatically establish bad faith or entitle a claimant to additional damages.
Is a Delayed Insurance Claim the Same as a Denied Claim?
No.
A denied claim occurs when the insurer formally determines that it will not pay some or all of the claimed benefits.
A delayed claim remains unresolved.
In some situations, however, prolonged delay can create financial consequences almost as serious as an outright denial.
A claimant should therefore pay attention not only to whether the insurer has formally denied the claim, but also to whether the company appears to be conducting a genuine investigation and moving toward a coverage determination.
Does Hiring a Lawyer Make the Insurance Company Pay Faster?
No attorney can guarantee that hiring counsel will immediately result in payment.
Legal representation can, however, change how a delayed claim is addressed.
An attorney may:
- Review the insurance policy and coverage provisions;
- Determine what information the insurer has requested;
- Identify documents that have already been provided;
- Communicate directly with the insurance company;
- Request an explanation for outstanding issues;
- Evaluate applicable payment requirements and deadlines;
- Challenge improper coverage positions;
- Determine whether litigation is appropriate; and
- File suit when necessary to enforce the insured's or beneficiary's rights.
The objective is not simply to demand faster payment. It is to determine why the insurance company has not paid and what can legally be done about it.
How Our Florida Insurance Claims Law Firm Can Help
At J.P. Gonzalez-Sirgo, P.A., we represent Florida consumers and beneficiaries in significant insurance claim disputes, including high-value life insurance claims.
When an insurance company delays payment, we examine the entire history of the claim rather than simply accepting the insurer's explanation.
That may include reviewing:
- The insurance policy;
- The original claim submission;
- Correspondence from the insurance company;
- Requests for documents or authorizations;
- Medical or underwriting records when relevant;
- Beneficiary designations;
- Coverage defenses;
- Claim investigation activity; and
- The insurer's stated reasons for withholding payment.
Our goal is to identify the real issue preventing payment and develop a strategy designed to move the claim toward resolution.
Frequently Asked Questions About Delayed Insurance Payments
Why is my insurance company taking so long to pay my claim?
There are many possible reasons. The insurer may be investigating coverage, waiting for documents, examining an exclusion, reviewing an insurance application, or dealing with competing claims. The key question is whether the delay is justified under the circumstances.
How do I know if the delay is unreasonable?
Consider how long the claim has been pending, what information the insurer says it still needs, whether you have already provided that information, and whether the company can give a meaningful explanation for why it has not made a decision.
Can an insurance company delay a claim indefinitely?
An insurer does not automatically receive unlimited time merely because it says a claim remains under investigation. The applicable policy terms and Florida law must be examined to determine the insurer's obligations.
Should I keep calling the insurance company?
Following up can be useful, but important communications should generally be documented. Maintaining a written record of the claim can become important if a dispute develops.
Should I hire a lawyer before my claim is denied?
You do not necessarily have to wait for a formal denial. If a substantial claim has been delayed and the insurance company cannot provide a clear explanation, an attorney can evaluate the situation before a denial occurs.
Can a lawyer help with a delayed life insurance claim?
Yes. A lawyer can review the policy, claim file, beneficiary issues, contestability questions, and the insurer's document requests to determine what is causing the delay and what legal options may be available.
Speak With a Florida Insurance Claims Attorney
An insurance company's statement that your claim is “still under review” does not answer the most important question:
Why hasn't the claim been paid?
If you have provided the requested information and the insurance company continues delaying payment without a clear explanation, it may be time to have the claim independently reviewed.
J.P. Gonzalez-Sirgo, P.A. represents consumers and beneficiaries in Florida insurance disputes, including high-value life insurance claims involving delayed payments, denied claims, contestability investigations, beneficiary disputes, and other coverage issues.
Contact our office for a free, confidential consultation to discuss your claim and determine what options may be available.
Have you or someone you know been denied a life insurance claim? Contact Florida Life Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Miami Attorney Gonzalez-Sirgo directly at jp@yourattorneys.com or by text at (305) 929-8935.
This article is for informational purposes only and does not constitute legal advice.
