Insurance Claim Red Flags

Red flags are specific practices or statements by insurance carriers that indicate the claim may not be handled fairly or legally. Red flags don't automatically prove bad faith, but they warrant closer attention and documentation.

• No acknowledgment within 15 days: Carrier has not acknowledged your claim within the legal timeframe.
• No decision after 45 days: Carrier has not made a coverage decision within the legal maximum in your state.
• Vague documentation requests: Carrier requests nebulous documentation without specific details of what is needed.
• Repeated requests for same documentation: Carrier asks for documents you already submitted, suggesting disorganization or intentional delay.
• No written explanation for denial: Denial letter does not cite specific policy language or reason.

• Adjuster does not conduct full inspection: Adjuster views damage briefly or only from exterior without entering home.
• Estimate does not match scope of damage: Your damage clearly extends to items not listed in the estimate.
• Adjuster refuses to discuss specific denials: When asked why an item was excluded, adjuster provides vague responses.
• Adjuster pressures you to accept settlement: Adjuster suggests if you don't accept quickly, payment may be reduced.
• Depreciation applied without explanation: Depreciation appears in estimate but is not itemized or justified.

1. Document everything. Save all communications, correspondence, and dates of interactions.
2. Request written explanations. If the adjuster makes statements by phone, request written confirmation via email.
3. Send written responses. Always respond to carrier requests in writing with dates and specific documentation cited.
4. Seek professional advice. Consult a public adjuster or attorney if multiple red flags are present.
5. File a complaint. If red flags suggest bad faith, file a complaint with your state Department of Insurance.