How Long Does an Insurance Company Have to Investigate an Auto Claim in Florida?

After receiving proof-of-loss statements, Florida insurers typically have 30 days to investigate car accident claims. No one wants a long insurance claims process, but situations like a complicated property damage case or policyholder fraud can delay the claims process.

Understanding Florida laws and insurance policy guidelines is essential to navigating the auto insurance claims process. Here’s what you need to know about car insurance claims in Florida, including your insurer’s obligations and what to do if your insurer denies or delays your claim.

Time limits for auto insurance investigations in Florida

Florida laws establish four different time frames that account for each step of the claims process if you’re filing a car insurance claim with your insurance company. If you’re filing a claim against another driver’s insurance, the time frames may differ since you don’t have an insurance contract with the other driver’s company.1

Take a look at what each time frame entails below.

Initial acknowledgement period

When you file a claim with your insurance company, it must review and acknowledge receipt of your car accident claim within seven business days. The acknowledgment ensures the insurer actively manages your insurance claim as outlined in your insurance policy.

Investigation period

Once your insurance company receives proof-of-loss statements, it has seven business days to begin its claims investigation. The insurance adjuster will then have 30 days to assess and investigate the damages. This step involves gathering information about the car accident, determining fault, and verifying the insurance policy to ensure the claim’s validity.

Decision deadline

After an investigation, your insurer must send you its decision regarding the claim payout within seven days of the insurance adjuster’s estimate.

Payment deadline

Insurers must either pay or deny the claim within 60 days of receiving your claim notice. Florida law doesn’t hold insurance companies to this deadline due to factors outside the insurer’s control.

Factors that affect claim processing times

In some cases, insurers can extend deadlines for the claims process. The Florida Office of Insurance Regulation (OIR) must approve the extension.2 Some complicating factors that can result in an extension include:

• Claim complexity: If a claim is particularly complicated, an insurance company may request an extension. One example of this would be if the claim involves multiple vehicles colliding with severe injuries and property damage. The OIR would likely grant the insurer an extension so it can conduct a thorough investigation.

• Evidence and documentation availability: If third parties cause delays that prevent the insurance company from accessing necessary information and documentation, the insurer can request an extension.

• Your cooperation as a policyholder: To avoid delays and speed up the process, be sure to cooperate with your insurer. If you don’t provide timely information, this can slow down the investigation and potentially delay your claim.

When insurers can request an extension

Insurers can request an extension if factors beyond the insurer’s control cause delay, according to Florida law. In most cases, insurance companies can’t extend the period for payment or denial of a claim for longer than 30 days.

Factors beyond an insurer’s control include:

• A state of emergency

• A breach of security

• An information technology issue

• Policyholder fraud or intentional misrepresentation

Insurers must request an extension with the OIR through the Regulatory Electronic Filing System (REFS). To get an extension approved, insurers must provide proof of which factors beyond their control affect timelines. Insurance companies must also notify you about the request for an extension and keep you updated on the progress of the claim investigation.3

Your rights during delays

If you feel that your insurance company is delaying the claims process without adequate justification, you have the right to:

• Timely claims processing: Your insurer must comply with state laws regarding deadlines unless the state approves the insurance company for a deadline extension.

• Get a written explanation for any delays: You can submit a request to your insurer asking it to explain any delays to you in writing and keep you updated on any developments.

• Collect interest on late payments: If your insurance company fails to pay your claim by the payment deadline, you’re entitled to interest on your claim at 12% per year.

• File a complaint: If you believe the delay is unreasonable, you can file a complaint with the OIR to investigate your insurance company.

• Initiate legal action for bad-faith delays: If your insurer delays your claim without adequate justification or in bad faith, you have the right to pursue legal action against it under Florida’s Unfair Insurance Trade Practices Act.4

What to do if your insurance company misses deadlines

If your insurance company misses claims-processing deadlines, you have a few methods of action.

What to do if an insurance company denies your claim in Florida

Insurance companies may deny claims for various reasons. If your insurer denies your car insurance claim, you can do a few things.

First, review your claim denial letter and call your insurance company for clarification on why it denied the claim. If you feel that the denial is unfair, you can file an appeal with your insurance company by providing evidence of why you feel the company should cover the claim.

If your insurer continues to deny your claim, you can file a complaint with the Florida Department of Financial Services. It can provide you with free mediation for a denied claim or a low settlement offer in some cases. You can reach this department online or by phone at 1 (877) 693-5236.

Tips to make the claims process go as smoothly as possible

To ensure your claims process goes smoothly, be as cooperative with your insurance company as possible. This prevents your insurer from claiming you refused to assist or cooperate with its investigation.

Here a few other things you can do to make sure the claims process goes smoothly:

• Provide complete, accurate, and detailed information. Submit all the necessary details about your claim. Include the location, date, time, parties involved, and a clear description of what happened.

• Keep detailed records of your communication with your insurer. Document every conversation you have with your insurance company. Keep track of dates, who you spoke with, and what the topic of discussion was.

• Follow up regularly with your insurance company. Stay in touch with your insurance company to ensure the claims process continues.

• Respond to requests from your insurer promptly. If your insurance company requests information — such as additional documents or actions — do your part to keep the claims process moving.

• Understand your coverage. Knowing what your insurance policy covers can help you avoid any confusion and disputes in the claims process.

Claims investigation in Florida FAQs