Mandatory Carrier Timelines by State

Overview

States set mandatory timeframes for claim acknowledgment, investigation progress, decision letters, and issuance of undisputed funds. Tracking these dates is critical to stop delay and preserve leverage.

Key Rules & Requirements

• Acknowledgment: Typically 7–15 days after notice of loss.
• Information requests: Must be reasonable and related to the claim; some states require requests to be consolidated to avoid piecemeal delays.
• Decision letters: Often 30–45 days after receiving necessary proofs, or the carrier must explain why more time is needed.
• Undisputed payments: Payment must follow promptly (commonly within 5–20 days) once liability and amount are established.
• Extensions: Additional time must be justified in writing with a specific reason, not generic delays.
• Catastrophe adjustments: Some states extend deadlines during CAT events but still require reasonable progress.

Step-by-Step Guidance

1. Log the notice date to start the acknowledgment clock.
2. After each request, ask the adjuster to confirm remaining items needed to decide the claim.
3. If no decision by the statutory date, send a follow-up citing the state timeline and ask for a firm decision date.
4. When liability is accepted, demand undisputed payment under the applicable statutory timeframe.
5. Document any extensions the carrier claims; require the reason in writing tied to the regulation.
6. Escalate to supervisors or the state department if delays persist past statutory windows.

Required Documentation

• Timeline of events: notice, acknowledgment, inspections, requests, submissions.
• Copies of all written extension notices or lack thereof.
• Decision letters with policy citations.
• Proof of loss and supporting evidence showing when the carrier had what it needed.
• Payment logs showing dates and amounts issued.

Common Insurer Tactics

• Serial requests for minor items to claim the investigation is incomplete.
• Issuing “status letters” that restate the clock instead of deciding the claim.
• Delaying undisputed payments until all disputes are resolved.
• Citing catastrophe volume without demonstrating reasonable efforts.

Red Flags to Watch For

• No written acknowledgment within the statutory window.
• Failure to give a decision date or reason for delay after all proofs are submitted.
• Undisputed amounts identified but not released promptly.
• Extensions that lack a specific factual basis.

Best Practices for Policyholders

• Ask for timelines in writing and restate them in follow-up emails.
• Provide requested items promptly and confirm receipt.
• Separate undisputed amounts from disputed scope to force partial payment.
• Use state citations in correspondence to show you know the rules.
• Escalate to the regulator when delays breach statutory limits.

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