The answer to this question depends on many factors outside your control. But you should expect your case to settle within several months up to a year.
California insurance regulations set times for California insurers to act on claims. These time frames provide little structure for the claim review process. As a result, you should only view them as a set of loose guidelines rather than hard deadlines.
Here is some information about the claim review and settlement process and how long you should expect to wait for a settlement in California.
What Does the Insurance Claim Process Look Like?
California uses a fault-based insurance system. This means that the insurer for the driver who caused a car accident will handle the claims for everyone injured in the accident.
Steps for Accepting or Denying a Claim
When an insurer receives a claim, it will review the claim and determine if it has all the information needed to determine its liability. If the insurer requires additional information from you, it will send you a request specifying the documents it needs.
The insurer will also investigate independently. For example, the insurer will request a copy of the accident report directly from the law enforcement agency that responded to the accident.
After the insurer has all the information needed to process the claim, it will apply tort law and insurance law principles to determine if it must pay the claim. If the insurer is liable for the claim, it will accept the claim and notify you of the impending settlement. This happens, but it is rare.
If the insurer is not liable for the claim, it will deny the claim and notify you of the reasons for the denial. This also happens infrequently.
The most common outcome is for the insurer to accept the claim but reduce the claim and only offer a fraction of its value. The burden then shifts to you and your injury lawyer to negotiate for a better claim settlement.
What are the Time Frames Under California Regulations?
California has insurance regulations that set out the time frame for completing each of the steps of the claim review process. These regulations, referred to as the Fair Claims Settlement Practices Regulations, apply to all liability insurers. Thus, the same time frame applies equally to premises liability claims, car accident liability claims, and medical malpractice liability claims.
Proof of Claim
The time frame begins when you notify the insurer of the claim. After you file a notice of your claim, the insurer has 15 days to send you proof of claim forms and request documentation of your claim.
When you receive the proof of loss forms, you will pull together your medical records, wage statements, time cards, and any other information to prove your medical expenses and lost income.
You do not need to provide a copy of the accident report or give a recorded statement. The claims adjuster will get a copy of the accident report directly from the responding law enforcement agency.
The claims adjuster could use a recorded statement to reduce or deny your claim. Most injury lawyers recommend against giving a recorded statement.
Once you complete the proof of claim forms and provide documentation to support your claim, the insurer has 40 days to investigate the claim and either accept or deny the claim. Under California insurance law, insurers must make a good faith attempt to settle claims where liability has become clear.
But the regulations provide a lot of leeway in this time frame. An insurer could comply with the regulations by asking for more information rather than deciding within 40 days. An insurer could also deny the claim in whole or in part during the 40 days to meet the time frame.
As long as the claims adjuster has a good faith basis for denying the claim, the insurer has satisfied the regulations.
If the insurer accepts the claim, it has 30 days to issue payment to the claimant. Adding up the periods in the time frame, an insurer could settle a claim in 85 days in a best-case scenario. That is, 15 days to respond to the claim notice, 40 days to investigate the claim, and 30 days to pay the claim.
What is the Real-World Time Frame?
This 85-day time frame is possible but unrealistic for a few reasons:
This time frame does not include the time you take to prepare and file the proof of claim and supporting documentation. Even if you try to respond immediately after receiving the proof of claim forms, you may need a few days or weeks to collect your medical records, wage records, and other evidence to support your claim.
Responding to Requests for More Information
The claims adjuster may request additional information. These requests sometimes represent a delaying tactic by the insurer. But in most cases, the claims adjuster has a good faith reason for asking for more information.
In either case, the time to respond does not count toward the 40-day investigation period.
As mentioned previously, you and your lawyer may need to negotiate with the claims adjuster to settle your claim. If the insurer meets all of the periods in the regulations, it can take unlimited time to negotiate the value of the claim.
In many cases, the 85 days set out in the regulations represent just the beginning of the process. The real work begins once the insurer sends the initial offer. This offer will provide a starting point for negotiating the settlement, rather than an ending point.
Contact a San Diego Personal Injury Lawyer for Help Settling the Claim
With this understanding of the claim process, you should probably expect a claim settlement to take at least 85 days or just under three months. Realistically, you could add several weeks, or even several months, for responding to requests for additional information and negotiating the claim.
During this time, you should remain patient with both your lawyer and the claims adjuster. Your lawyer will push the claims adjuster to settle the claim, but they represent the interests of a huge insurance company and will need time and documentation to settle the claim.
Our attorneys at Mission Personal Injury Lawyers, P.C. are standing by to discuss the time frame for your settlement. Contact our San Diego office or call us at (619) 777-5555 today for a free consultation. We’ll review your case and help you to fight for the settlement you deserve.