How Long Does an Insurance Company Have to Respond to My Claim in Pennsylvania?

Pennsylvania has real timelines

They are found in the Unfair Claims Settlement Practices regulations at 31 Pa. Code Chapter 146, which set minimum standards for how insurers handle claims. The relevant ones are short and worth knowing:

• Acknowledgment: an insurer must acknowledge receipt of notice of a claim within ten working days.

• Decision on a first-party claim: within fifteen working days after receiving properly executed proofs of loss, the insurer must advise the first-party claimant whether the claim is accepted or denied.

• If more time is needed: the insurer must say so within that same fifteen working days and give its reasons — then update the claimant thirty days after that initial notification, and every forty-five days thereafter, explaining why more time is needed and when a decision can be expected.

• Denials must be in writing, and an insurer may not deny based on a policy provision, condition or exclusion without referencing it in the denial.

An important limitation, stated plainly

These regulations describe minimum standards of conduct. Pennsylvania courts have held that there is no private cause of action for an individual under the Unfair Insurance Practices Act or these regulations — meaning you generally cannot sue an insurer simply for missing one of these deadlines.

What the deadlines are good for is different, and still valuable: they define what reasonable claims handling looks like, they give you something concrete to cite in a letter, and a pattern of ignoring them is the kind of thing the Insurance Department is interested in.

Third-party claims work differently

If you are claiming against the other driver’s insurer, you are a third-party claimant. There is no policy contract between you and that company and no fixed statutory clock on settling your bodily injury claim.

The real deadline in that situation is yours, not theirs: Pennsylvania’s two-year statute of limitations for most personal injury claims. An insurer that is slow is not obligated to extend it, and a claim that is still “under review” when the two years expire is generally gone.

One related provision is worth knowing. Under the regulations, an insurer may not keep negotiating directly with an unrepresented claimant as a limitations deadline approaches without giving written notice that the time limit may be expiring — thirty days ahead for first-party claimants, sixty days for third-party claimants.

What to do when nothing is happening

• Put it in writing. Email, or letter with the claim number in the subject line. A documented request creates a record a phone call does not.

• Ask three specific questions: what is outstanding, who is responsible for the next step, and when a decision is expected.

• Ask for the supervisor if two written requests go unanswered. Claims files change hands, and sometimes nobody is holding yours.

• File a complaint with the Pennsylvania Insurance Department if delay continues. It is free, it is handled by the Bureau of Consumer Services, and it generates a file the insurer has to answer.

• Watch your own calendar. Do not let an insurer’s pace consume your two years.

When delay becomes something more

Pennsylvania does recognize a bad faith claim against an insurer under 42 Pa.C.S. § 8371, but it is a specific claim with a demanding standard, and it applies to your own insurer rather than to the other driver’s.

Ordinary slowness is not bad faith. A sustained, unexplained refusal to investigate or pay a claim you are owed can be a different matter, and that is worth having someone look at.

Talk it through with someone local. If you have questions about your own situation, the attorneys at Joyce, Carmody & Moran can review what happened and explain your options — no cost for the first conversation, and no obligation. We are based in Pittston and handle injury matters throughout Luzerne County.