Understanding the Insurance Claim Process in Tennessee

This guide explains what to expect once you file an insurance claim in Tennessee and how state rules affect the process. It assumes no prior legal knowledge and focuses on practical steps, typical insurer actions, and remedies if you encounter delays or unfair treatment.

Detailed Answer

Initial Acknowledgment and Assignment

After you submit a claim, the insurer typically acknowledges receipt, opens a claim file, and assigns an adjuster. The insurer may contact you to confirm basic facts, request documents (photos, receipts, police reports), and arrange an inspection. Keep copies of everything you send.

Investigation

The adjuster investigates coverage and liability. Investigation tasks can include inspecting property or vehicle damage, interviewing witnesses, obtaining repair estimates, and reviewing medical records (for injury claims). The carrier may request a recorded or written statement; you can usually decline a recorded statement until you understand your rights, and you may want to consult an attorney if the claim involves significant injury or complex liability.

Coverage Decision

The insurer analyzes your policy terms to determine whether the loss is covered. If coverage applies, the company will evaluate the amount it owes under the policy (subject to deductibles, limits, depreciation, and policy conditions). If coverage does not apply, the insurer should explain the reasons in writing.

Settlement Offer or Denial

After investigation, the insurer will either offer a settlement, make a payment, or deny the claim. A denial should include the reasons and point to the policy language or factual basis supporting that decision. If the insurer offers a settlement, review it carefully — the payment may be for actual cash value, replacement cost, or a negotiated amount depending on your policy.

Payment, Releases, and Repairs

If you accept a settlement, the insurer will issue payment. For property claims, insurers may pay the claimant directly, the mortgagee/lienholder in some cases, or issue separate payments for loss and for repairs. Be cautious about signing blanket releases before you are fully compensated; read any release carefully and, for large losses, consider an attorney review.

Disputes, Appraisal, and Legal Remedies

If you disagree with the insurer’s coverage decision or offer, there are several options: ask for a re-evaluation, request an appraisal (if your policy includes an appraisal clause), use mediation or alternative dispute resolution, file a complaint with Tennessee’s insurance regulator, or pursue a lawsuit. The Tennessee Department of Commerce & Insurance handles consumer complaints and can be contacted for assistance: Tennessee Department of Commerce & Insurance — File a Complaint.

What Tennessee Law Requires — Good-Faith Handling

Insurance companies in Tennessee must follow state insurance law and claims handling standards found in Title 56 of the Tennessee Code, which governs unfair claims practices and insurer conduct. These provisions require insurers to investigate and resolve claims in good faith and not engage in unfair settlement practices. For more on the statutory framework for insurance regulation in Tennessee, see Title 56 of the Tennessee Code: Tenn. Code Ann. Title 56 — Insurance.

When to Consider an Attorney

Contact a lawyer if:

• You have a large or complex loss (major property damage or serious injury).
• The insurer denies coverage and the denial appears inconsistent with your policy.
• The insurer delays unreasonably or fails to respond to repeated requests for information.
• Settlement offers are far below reasonable repair or medical costs.

An attorney can review your policy, advise on coverage, communicate with the insurer, and explain options like appraisal, arbitration, or litigation.

Helpful Hints

• Document everything: date and time of loss, photos, police reports, medical records, repair estimates, and all communications with the insurer.
• Submit claims in writing when possible and keep copies of all submissions.
• Respond promptly to reasonable information requests, but do not sign releases or accept settlement checks until you understand the full extent of your loss.
• Get multiple repair or replacement estimates and keep receipts for temporary repairs and living expenses if your policy covers them.
• Be careful with recorded statements. If you feel unsure, ask for time to consult an attorney before providing a recorded statement for injury or liability claims.
• If you receive a denial, ask for the denial in writing and ask the insurer to point to the exact policy language and facts supporting the denial.
• Use your policy’s appraisal or dispute resolution clauses if appropriate; these can be faster than litigation for valuation disputes.
• If the insurer’s conduct looks unfair or you suspect bad faith, you can file a complaint with the Tennessee Department of Commerce & Insurance: File a complaint with TDCI.
• Meet statutory deadlines. If you may need to sue, consult an attorney quickly to preserve rights; statutes of limitation apply to insurance-related lawsuits.
• Keep communications professional and concise. Put important requests and disputes in writing and request written responses.

Disclaimer: This information explains general Tennessee insurance claim procedures and regulatory resources. It is educational only and is not legal advice. For advice about your specific situation, consult a licensed Tennessee attorney or contact the Tennessee Department of Commerce & Insurance.