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Delayed insurance claim · St. Louis

Delayed insurance claim: the Missouri time rules insurers must follow

Missouri rules give insurers time limits on property claims. An insurer must acknowledge your claim within 10 working days and decide within 15 working days after it has all the forms it needs. If it needs more time, it must tell you why, and send a new letter every 45 days.

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The time limits in Missouri’s claim rules

Missouri’s Department of Commerce and Insurance has written rules for how insurers handle claims. These are the main clocks for a claim on your own policy:

MISSOURI CLAIM-HANDLING CLOCKS

  • 10 working days to acknowledge your claim. The insurer can pay, write, or call. Telling the insurer’s agent counts as telling the insurer (20 CSR 100-1.030).
  • 10 working days to reply to any message that reasonably calls for a response (20 CSR 100-1.030).
  • 30 days to finish its investigation, unless it cannot reasonably be done in that time (20 CSR 100-1.050).
  • 15 working days to accept or deny, counted from when you have sent all the forms needed to show the nature and extent of the claim (20 CSR 100-1.050).
  • Every 45 days, if the investigation is still open, a letter explaining why more time is needed (20 CSR 100-1.050).

15 working days

The time an insurer has to accept or deny a first-party claim after you send all the forms needed to show the nature and extent of the claim. Source: 20 CSR 100-1.050.

Why these rules help, and their limit

The rules tell you what to expect. They also give you words to use. You can write, “Please tell me why more time is needed, as Missouri’s claim rules require.”

But these rules come from Missouri’s Unfair Claims Settlement Practices Act. That law says it does not create a private right to sue (RSMo 375.1000). The state enforces it. The director can issue orders, act on an insurer’s license, or bring a civil action (RSMo 375.1010).

So a missed deadline does not, by itself, give you a lawsuit. Your lawsuit, if you need one, is on the policy.

Common causes of delay, and what fixes them

  • Missing documents. The 15-day clock waits for the forms. Ask in writing for a full list of what the insurer still needs.
  • A new adjuster. Files change hands. Send the new adjuster a short summary with copies.
  • Waiting on an engineer or other report. Ask when it is due, and ask for a copy.
  • Big storms. After a large storm, adjusters carry many files. Delays happen. The 45-day letters still apply.
  • A dispute over the amount. See underpaid insurance claims and the appraisal clause.

Protect your home while you wait

Most policies require you to take reasonable steps to prevent more damage. Tarp the roof. Shut off the water. Dry out wet areas. Keep the receipts, because many policies pay reasonable costs for these steps.

If you cannot live in your home, check your policy for “additional living expense” or “loss of use” coverage. It can pay extra costs, like a hotel, above your normal living costs. Keep every receipt.

What to do when your claim stalls

  1. Keep a log of every call and message: date, name and what was said.
  2. Put requests in writing. Email is fine. Keep copies.
  3. Ask for a written list of anything the insurer still needs, and send it.
  4. Ask for a written reason for the delay if you have not had one in 45 days.
  5. Consider a complaint to the Department of Commerce and Insurance. It takes complaints online, by mail, by fax, or at 800-726-7390.
  6. If the insurer still does not pay, a written demand starts the 30-day period under Missouri’s vexatious refusal law.

One more rule helps people handling claims alone. If you have no lawyer, an insurer must warn you in writing 30 days before a policy or legal time limit may run out on your claim (20 CSR 100-1.050).

Harjot Singh Padda, JD can review your log and letters and explain your options.

Common questions

How long does an insurance company have to pay a claim in Missouri?

It must accept or deny within 15 working days after it has all needed forms, unless it tells you why it needs more time. See the property insurance claims overview.

Can I sue because the insurer missed a deadline?

Not for the missed deadline alone. The claim rules are enforced by the state. Your suit is on the policy. See breach of contract claims.

Will a complaint to the state get my claim paid?

It can prompt a response. The Department cannot decide your claim’s value. See denied insurance claims.

Does delay count as refusing to pay?

After a written demand and 30 days, continued nonpayment can support the penalty claim. See the vexatious refusal guide.

My business is closed while the claim drags on. What covers that?

Business income coverage may. See business interruption claims.

Related reading

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