how long does the insurance co have to decide

[thestral66]

What is the name of your state (only U.S. law)? nj. i've been paid one half of face value the other half is dependent on the ins co's medical records examiner...it has been months and no word yet...what is the waiting time for a case like this? What would make them deny the other half?

[BikerBob]

My recommendation is that you contact the Claims' Department for update as to what's going on. I'm assuming they provided a Claims' Number? If the claim was denied then they are required to state the reason why. Get names and titles of everyone you speak to. If they are nonresponsive to your inquiry or you are disagreeable with their action then my advice is that you file complaint against the insurance company via the Insurance Commissioner's Office in your State (sometimes identified as the Department of Insurance). They will send you a complaint form to fill out and submit back to them or perhaps they have an online submission form that can be issued to them over the Internet. The Department of Insurance does not initially read your complaint. Rather they forward your complaint to the insurance company which is required to respond within approximately 21 days (depending on state). Upon receipt of a response, a consumer advocate at the Department of Insurance will read your complaint and the responding answer from the insurance company. If the reviewing advocate believes the insurance company has failed to address the complaint in entirety, they will either call the insurance company or return the complaint with a list of questions or concerns. The Department of Insurance will present you with the information. Depending on the circumstances, the insurance company rushes to get the situation resolved in order to remain favorable in the eyes of the Insurance Commissioner. I hope this information has been helpful. -Biker Bob