Disclaimer: This content is for informational purposes only and is not legal advice. Consult a qualified attorney for guidance on your specific situation.
Detailed Answer
After you submit additional medical evidence to an insurance company in South Carolina, you want to make sure the insurer considers your documentation promptly and thoroughly. Under South Carolina law, insurers must handle claims fairly and within a reasonable time. Two key provisions include:
- SC Code Ann. §38-77-130 – Defines unfair claim settlement practices, including failure to acknowledge and act promptly on communications about claims.
- SC Code Ann. §38-77-150 – Requires insurers to acknowledge receipt of a claim or related correspondence within 15 days and to promptly decide on its own behalf.
Here’s how to follow up effectively:
- Document Your Submission: Note the date you sent the medical records, the adjuster’s name, and the claim number. Keep copies of all emails, letters, and attachments.
- Send a Certified Follow-Up Letter: Within one week of your submission, send a short letter by certified mail. Reference your claim number, the date of your previous submission, and request confirmation of receipt and an estimated timeline for review.
- Make a Polite Phone Call: If you haven’t received an acknowledgment within 15 business days, call the adjuster. Identify yourself, mention the certified letter, and request a status update. Take notes: time of call, who you spoke with, and the response.
- Escalate If Needed: If the adjuster does not respond or if the insurer misses the statutory timeline, ask to speak with the claim supervisor or manager. Reference the insurer’s obligations under SC Code Ann. §§38-77-130 and 38-77-150.
- File a Complaint: Should the insurer continue to ignore your evidence or deadlines, you may file a complaint with the South Carolina Department of Insurance online at doi.sc.gov/Consumers/Complaints. Provide copies of your submission, follow-up letters, and call notes.
- Consider Legal Advice: If the insurer unfairly denies or delays your claim, consult a personal injury attorney. An attorney can send a formal demand or pursue other remedies under South Carolina law.
Helpful Hints
- Maintain a detailed claim journal: record dates, names, and outcomes of calls or letters.
- Email copies of documents when possible to create automatic timestamps.
- Keep all medical bills and records organized by date and provider.
- Use clear, concise language in written communications.
- Be polite but firm, referencing state statute requirements when necessary.
- Save proof of delivery for every certified letter.