Understanding how long an insurance adjuster has to review medical records is crucial for attorneys and their support staff when handling personal injury claims. The review timeline directly impacts the claims process, settlement negotiations, and overall case strategy.
While no universal deadline applies to all cases, several factors influence how long insurers take to evaluate medical documentation.
In this guide, we’ll break down:
The time an insurance adjuster takes to review medical records varies based on state regulations, the complexity of the case, and the insurer’s internal processes.
In standard cases, reviews generally take 30 to 60 days from submission. However, more complex cases involving severe injuries or high-value claims may extend to 60 to 90 days or longer.
Some states impose specific deadlines requiring insurers to acknowledge, investigate, and decide within 30 to 45 days. However, delays can occur, sometimes due to bad faith tactics where insurers intentionally slow down the review process to pressure claimants into accepting lower settlements.
Understanding these timeframes helps personal injury attorneys manage client expectations and take proactive steps to push for timely responses.
Several elements influence how long an insurance adjuster has to review medical records. These factors can significantly impact the speed of claim processing.
Cases involving multiple injuries, surgeries, or ongoing treatment generally require more time for review. Adjusters must determine whether the treatments were medically necessary and directly related to the accident, which can prolong the process.
The more extensive the medical history, the longer it takes for an adjuster to complete the review. If a case involves hundreds of pages of medical documentation from multiple healthcare providers, additional time will be needed for thorough evaluation.
The overall workload of an insurance company can also impact the review timeline. Medical record reviews may take longer than expected if an insurer is dealing with a high volume of claims or experiencing staffing shortages.
Avoiding missing documents is critical to expediting claims. This often happens when medical records do not clearly establish causation between the accident and injuries, treatments appear excessive or unrelated, or the claimant has pre-existing conditions that require further evaluation.
State laws dictate how long an insurance adjuster has to review medical records. While deadlines vary, typical time limits include:
Personal injury attorneys should always reference the specific state regulations applicable to their cases to ensure insurers comply with required timelines.
Delays in medical record reviews can slow settlements and legal proceedings. Attorneys and their teams can take several proactive measures to speed up the process.
To prevent unnecessary requests for additional information, ensure that all medical records submitted include the following.
Addressing medical treatment gaps is essential for preserving case value and understanding potential negotiation points with adjusters. Organizing medical records in chronological order, or a MedChron, allows adjusters to review them more efficiently. Legal tech tools like EvenUp’s MedChron create interactive timelines that streamline evaluations, reducing the time required for an adjuster to process the records.
A well-documented demand letter highlighting key medical evidence can accelerate the review process and strengthen settlement negotiations. Learn how to craft a winning demand package and present a clear, evidence-backed case that encourages faster resolution.
Attorneys may request an accelerated review in cases of financial hardship. Insurers sometimes comply to avoid potential bad faith claims, particularly when significant delays could lead to legal repercussions.
Understanding how long an insurance adjuster has to review medical records allows personal injury attorneys and their teams to anticipate delays, apply pressure when needed, and ensure fair claim evaluations.
Key Takeaways:
By leveraging strong case management strategies and using advanced legal tech tools like EvenUp’s Claims Intelligence Platform™, personal injury attorneys can streamline medical record reviews and maximize settlement outcomes for their clients—leading to improved profit margins for law firms like yours.
Schedule a call and learn more today!
.png)
