Detailed Answer
Short overview: After you submit a first-party insurance claim in Missouri, the insurer normally acknowledges receipt, investigates coverage and causation, requests any needed proof of loss, and then either pays (in whole or part) or denies the claim. If the insurer denies or delays payment unreasonably, you have options including internal appeal, filing a complaint with the Missouri Department of Commerce & Insurance, or consulting an attorney. This is not legal advice.
Acknowledgment and initial intake
Most insurers will send an acknowledgement or claim number and assign an adjuster. This step confirms the insurer received your notice and starts the insurer’s obligations under your policy and Missouri law. Keep the claim number and the name and contact information for any adjuster or representative.
Investigation
The insurer investigates promptly. Typical steps include:
- Reviewing the policy to determine covered losses and applicable limits or exclusions.
- Assigning a claims adjuster to inspect the property, interview witnesses, or review police/fire reports.
- Requesting a proof of loss or additional documentation (receipts, photos, estimates).
Provided you cooperate and supply requested records, the insurer must conduct a reasonable, good-faith investigation before denying or reducing a claim.
Coverage decision and payment
After the investigation, the insurer will either:
- Accept the claim and issue payment for covered amounts (sometimes after depreciation or a deductible);
- Partially accept and pay certain items while denying others; or
- Deny the claim, explaining the reason (e.g., excluded cause of loss, late notice, or lack of coverage).
If the insurer approves payment, it may pay you directly, pay a third party (repair shop), or issue multiple payments (e.g., actual cash value first, then recoverable depreciation after repairs). If timely payment is required by contract or statute, document the payment method and retain receipts.
Repairs, estimates, and disputes over amount
Disputes about repair cost or scope are common. You can get independent estimates. Many policies include appraisal, arbitration, or other dispute-resolution clauses; use them if the insurer and you cannot agree. If repairs will be made, keep detailed invoices and before-and-after photos.
Denials, extensions, and requests for more information
If the insurer denies your claim or asks for more documentation, it should explain the reasons. If you disagree, respond in writing, provide additional documentation, and ask for a claim supervisor review. Preserve all communications in writing and note phone calls (date, time, person, summary).
Subrogation and third-party recovery
If a third party caused your loss, the insurer may pay you and then pursue recovery from the responsible party (subrogation). If you recover from the third party, you may need to account for amounts paid by your insurer depending on policy terms.
Regulatory protections and complaints in Missouri
Missouri regulates insurance through statutes and the Department of Commerce & Insurance. Chapter 375 of the Missouri Revised Statutes governs insurance generally; it includes unfair practices and company duties. See the text for details: RSMo Chapter 375 (Insurance). For help or to file a complaint with the state regulator, use the Missouri Department of Commerce & Insurance consumer pages: Missouri DCI – Consumers.
When to consider an attorney
Consider consulting a lawyer if:
- The insurer denies coverage and you believe the denial is incorrect;
- The insurer delays payment unreasonably or offers an amount far below estimates;
- Complex liability or third-party issues exist (e.g., serious auto or injury claims); or
- You want help with litigation, appraisal, or settlement negotiations.
Important: Policies often include deadlines (suit limitations, proof-of-loss timelines, or appraisal windows). Review your policy carefully and act promptly. If you are unsure about deadlines or next steps, consult an attorney for advice specific to your situation.
Disclaimer: This article explains common steps after filing an insurance claim in Missouri and provides general information only. It is not legal advice and does not create an attorney-client relationship. For advice tailored to your situation, contact a licensed Missouri attorney.
Helpful Hints
- Document everything: take photos, save receipts, and keep a written log of contacts with dates, names, and summaries.
- Send important communications by email or certified mail so you have proof of delivery.
- Provide requested documents quickly but only rely on written instructions from the insurer for coverage promises.
- Get at least one independent repair estimate; don’t rely solely on the insurer’s contractor.
- Keep damaged items if the insurer requests inspection unless unsafe; ask for written confirmation before disposing of evidence.
- If the insurer delays, ask for a written status update and a timeline for a decision.
- Before signing any release or settlement, make sure the payment matches what you expect and consult an attorney if the amount is substantial or the release is broad.
- If you suspect unfair treatment, file a complaint with the Missouri Department of Commerce & Insurance: insurance.mo.gov/consumers.