11 Reasons Insurance Claims Stay “Under Review”

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Waiting on an insurance claim can feel like watching paint dry while standing on one foot. One day you file, the next day you’re told it’s “under review,” and suddenly time stretches into a weird limbo. Your inbox refresh button is worn out, your patience is thinning, and every phone notification sparks hope. The truth is, “under review” can mean a dozen different things, some reasonable and some wildly frustrating.

Knowing what’s happening behind the curtain gives you leverage, confidence, and a clear sense of when it’s time to push the issue higher.

1. Missing Or Incomplete Documentation

This is the most common reason a claim stalls, and it’s also the easiest to fix. Adjusters rely on paperwork to confirm what happened, when it happened, and what it cost. If a form is unsigned, a receipt is blurry, or a medical bill lacks proper codes, the file can freeze instantly. Claims departments are not allowed to guess or fill in blanks on your behalf.

Many reviews drag on simply because one tiny document is sitting in the wrong inbox. Escalation makes sense if you have proof everything was submitted and weeks pass without acknowledgment.

2. Policy Coverage Questions

Sometimes the delay isn’t about your claim at all, but about your policy language. Insurance contracts are dense, specific, and full of exceptions that require careful interpretation. When a claim touches a gray area, multiple reviewers may weigh in. This back-and-forth can keep a claim under review far longer than expected. Adjusters must be confident the loss actually qualifies before paying out. You can escalate if the insurer cannot clearly explain which policy clause is causing the delay.

3. Liability Disputes

Claims involving accidents often hinge on who is legally responsible. If fault isn’t immediately clear, insurers investigate statements, police reports, and witness accounts. Each conflicting detail can extend the review process. No company wants to pay until liability is firmly established. This is especially true when multiple parties or insurers are involved. Escalation is appropriate if the liability investigation seems stalled with no new information being requested.

4. Damage Assessment Delays

Before approving payment, insurers need a clear picture of the damage. That might require inspections, expert opinions, or repair estimates. Scheduling those assessments can take time, especially after natural disasters or major incidents. Disagreements between adjusters and contractors can add even more delay. The claim remains under review until numbers line up. You can escalate if inspections have been completed but no decision follows.

5. Medical Reviews And Coding Checks

Health and injury claims go through an added layer of scrutiny. Medical records, treatment plans, and billing codes must all align perfectly. Insurers often send files to medical reviewers to confirm necessity and accuracy. Any mismatch can pause the process. These reviews are meant to control costs and prevent errors. Escalation is reasonable if medical providers confirm everything was submitted correctly and the insurer remains silent.

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6. Third-Party Coordination Issues

Many claims depend on information from outside parties. Repair shops, hospitals, other insurers, and even government agencies may need to respond. If one party drags its feet, your claim can sit untouched. Unfortunately, you may never be told that someone else is holding things up. Insurers often wait rather than chase aggressively. Escalate when delays stem from third parties and your insurer isn’t actively following up.

7. Suspected Fraud Flags

Even honest claims can trigger automated fraud alerts. Unusual timing, inconsistent details, or high dollar amounts may prompt additional review. This doesn’t mean you’re accused of wrongdoing. It simply means the insurer must verify facts more carefully. These investigations take time and are handled cautiously. Escalation can help if you’re providing full cooperation and still receiving no updates.

8. Internal Workload Backlogs

Sometimes the reason is painfully simple: volume. Claims departments can become overwhelmed after storms, accidents, or economic shifts. Adjusters juggle massive caseloads, and reviews slow down. Your claim might be valid and complete, yet still waiting its turn. Insurers rarely advertise backlog issues. Escalate if your claim has exceeded standard processing times without explanation.

9. Legal Or Regulatory Reviews

Certain claims require legal review to ensure compliance with state or federal rules. This is common with large payouts, specialized policies, or disputes involving contracts. Legal teams move carefully and methodically. Their involvement often extends the review period. While necessary, these reviews shouldn’t drag on indefinitely. Escalation is appropriate if legal review becomes an indefinite holding pattern.

10. Negotiation And Settlement Calculations

Claims don’t always end with a simple yes or no. Insurers may be calculating settlement ranges or negotiating internally. Multiple departments might weigh in on valuation. These internal discussions keep the claim marked as under review. The process can feel invisible and endless from the outside. Escalate when negotiation drags on without any counteroffers or communication.

11. When And How To Escalate

Escalation isn’t about being aggressive, it’s about being informed and persistent. Start by asking for clear timelines and written explanations. Request a supervisor review if deadlines are missed. Document every interaction and keep copies of everything. Regulatory complaints or formal appeals should be a last step, not a first reaction. When done calmly and strategically, escalation often jumpstarts stalled claims.

Turning Waiting Into Action

Insurance claims don’t have to feel like a black hole of uncertainty. Understanding why a claim stays under review gives you power and peace of mind. The more informed you are, the easier it becomes to spot unreasonable delays.

If you’ve been through a drawn-out review, your experience could help someone else navigate theirs. Drop your thoughts or stories in the comments section below and keep the conversation going.