You filed your claim, you submitted your documentation, and now the insurance company has told you that your claim is under review. The phrase is designed to sound procedural and temporary, like something that happens to every claim as a matter of course before a check gets cut. Sometimes that is exactly what it is. More often, particularly when the review extends beyond a few weeks or when the phrase arrives in response to a specific request for an update, it means something more deliberate is happening, and understanding what that is determines how you respond to it.
The first thing to understand is that under review is not a legal status with a precise definition. It is a phrase that insurance companies use to describe a range of internal processes, some routine and some adversarial, without distinguishing between them in the language they use with claimants. A claim can be under review because a supervisor needs to sign off on an offer above a certain dollar threshold. It can be under review because the insurer’s medical consultant is evaluating your records. It can be under review because an investigator has been assigned to your claim. It can be under review because the insurer has identified a potential coverage issue that needs to be resolved before they determine whether they owe you anything at all. These are dramatically different situations, and the insurer is not required to tell you which one applies.
The most benign version of the under review status is supervisory approval. Most insurance companies have tiered authorization levels that require adjusters to obtain approval before settling claims above a certain value. An adjuster who has determined that your claim warrants an offer at the upper end of their authority needs a supervisor to sign off, and the claim sits in review while that approval is obtained. This process typically takes days rather than weeks, and if this is what is happening, the review period should resolve with a concrete communication fairly quickly. If weeks pass without any specific update or request for additional information, something other than routine supervisory review is likely underway.
Independent medical examinations are one of the more significant things that can happen during a review period, and they are worth understanding in detail because they affect your claim in ways that are not obvious. When an insurer says your claim is under review and subsequently requests that you submit to an independent medical examination, sometimes called an IME, the word independent is doing a great deal of work it has not earned. These examinations are conducted by physicians who are retained and paid by the insurance company, who perform a high volume of these examinations, and whose opinions skew with remarkable consistency toward conclusions that reduce or eliminate the insurer’s liability. Studies examining IME outcomes in personal injury and workers compensation contexts have consistently found that IME physicians hired by insurers disagree with treating physicians at rates that are difficult to explain by reference to medical disagreement alone. The examination itself is typically brief, sometimes lasting fifteen to thirty minutes for injuries that your treating physician has been evaluating over months of regular appointments, and the resulting report frequently minimizes the severity of your injuries, attributes your symptoms to pre-existing conditions, or concludes that your treatment has been excessive or unnecessary.
If your claim is under review and the insurer is arranging an IME, you should know your rights before you appear for that examination. In most states you have the right to have an attorney present or to have the examination recorded. You are generally required to attend if the examination is requested under the terms of your own policy, but the scope of the examination, meaning which physicians examine you and what they are permitted to examine, can sometimes be contested. Your treating physician should be informed that an IME has been requested, both because they may want to document your current condition thoroughly in advance and because their opinion of the IME report will matter if the two accounts diverge significantly, which they often do. The IME report is not the final word on your medical condition. It is one piece of evidence, produced by a process that has built-in incentives toward conclusions favorable to the insurer, and it can be challenged with your treating physician’s records, with deposition testimony from the IME physician about their examination practices, and in some cases with expert testimony that rebuts the IME’s conclusions directly.
Surveillance is another thing that can happen during an extended review period that claimants rarely anticipate and often discover only when it becomes relevant to their case. Insurance companies investigating significant injury claims routinely hire investigators to conduct video surveillance of the claimant, typically during the period when the claim is described as under review. The goal is to capture footage of the claimant engaging in physical activity that appears inconsistent with the injuries they have described, footage that the insurer can use to challenge the severity of the claimed disability or to argue that the claimant was not truthful about their limitations. Surveillance is legal, and the footage captured in public spaces or visible from public spaces is admissible. The most effective response to the possibility of surveillance is the simplest one: be consistent. Do not describe limitations to the insurer that you do not actually have. Do not describe activities to your physicians that you are not actually doing. Consistency between what you say, what your records reflect, and what your daily life actually looks like makes surveillance footage useless even if it exists, because footage of someone doing something they accurately described themselves doing is not evidence of anything.
Coverage disputes are the most serious reason a claim ends up in extended review, and they are the reason that under review, when it persists for weeks without resolution, warrants the most careful attention. A coverage dispute is not a dispute about how much your injuries are worth. It is a dispute about whether the policy covers the claim at all. Insurers reviewing claims for potential coverage issues are looking for grounds to deny the claim entirely, including policy exclusions that might apply to the circumstances of the accident, questions about whether the policyholder complied with the policy’s notice and cooperation requirements, questions about whether the vehicle or driver involved was covered under the policy, and in commercial policy contexts, questions about whether the accident arose from an excluded category of activity. A claim under review for coverage reasons may eventually produce not a settlement offer but a reservation of rights letter, which is the insurer’s formal notice that they are continuing to investigate while reserving the right to deny coverage, or a coverage denial letter, which is the insurer’s conclusion that the policy does not apply to the claim.
A reservation of rights letter is a document that demands immediate attention and that many claimants do not fully understand when they receive it. It is not a settlement offer. It is not a denial. It is the insurer’s formal statement that they are handling the claim under a reservation of their right to later deny coverage, typically because they have identified one or more potential grounds for denial that they have not yet fully investigated. Receiving a reservation of rights letter means the insurer has identified a coverage problem with your claim, that they are continuing to investigate it, and that the outcome of that investigation could be a denial. It also means, in most circumstances, that you have the right to retain independent counsel at the insurer’s expense to represent your interests in the coverage dispute, a right that insurers are not always forthcoming about explaining when they send the letter. If you have received a reservation of rights letter, consult an attorney immediately, not eventually. The coverage question being investigated will resolve one way or another on its own timeline, and your interests are not being represented in that process unless you take steps to ensure they are.
The time standards that govern how long an insurer can leave a claim in review are established by state law and vary significantly across jurisdictions. Missouri’s prompt payment laws require insurers to acknowledge a claim within ten working days of receiving it, to accept or deny the claim within fifteen working days of receiving proof of loss, and to pay accepted claims promptly. Violations of these requirements can expose the insurer to penalties, interest, and in some circumstances bad faith liability. Bad faith is the legal theory that an insurer unreasonably and knowingly denied or delayed a legitimate claim, and it carries the potential for damages beyond the value of the underlying claim, including in some jurisdictions punitive damages. A review period that extends far beyond what the investigation of the claim actually requires, that is not accompanied by any substantive communication about what the review entails, or that appears designed to pressure the claimant into abandoning the claim or accepting a reduced offer may cross the line into bad faith conduct. Whether it does in a specific case is a legal determination that requires examining the full claims file, the insurer’s internal communications, and the documented basis for the delay.
The practical response to a claim under review depends on what you know or can find out about why it is under review. If the review has extended beyond a few weeks without any concrete communication, write to the insurer and ask specifically what the status of the investigation is, what additional information or documentation they need, and what their expected timeline is for resolving the review. Do this in writing so that the request is documented. The response, or the absence of one, tells you something useful. An insurer that cannot articulate what they are still reviewing or why it is taking as long as it has is either conducting a sham review to delay payment or investigating your claim for coverage grounds they are not disclosing, and either scenario is one that benefits from legal attention.
If you are represented by an attorney, the under review status is something your attorney should be actively managing rather than waiting on. Attorneys who handle personal injury cases routinely follow up with insurers on claim status, apply statutory prompt payment frameworks where delays appear unreasonable, and in appropriate cases use the threat of bad faith litigation as leverage to move a stalled claim toward resolution. The insurer’s willingness to leave a claim in indefinite review tends to correlate directly with their assessment of whether the claimant has the resources and representation to do anything about it. A represented claimant with an attorney who understands bad faith law in the applicable jurisdiction is a much less comfortable person to stall than an unrepresented claimant who does not know what their rights are or how long a review is supposed to take.
Under review means something is happening to your claim inside a company you cannot see into, by people whose interests do not align with yours, on a timeline they control. What is actually happening to your claim in that period is one of the most important things to find out, and the best way to find out is to ask directly and in writing, to track the timeline against the state’s prompt payment requirements, and to involve an attorney if the review is taking longer than the investigation of your claim legitimately warrants. The phrase is designed to buy time. How much time you give it is a decision you can make rather than one that gets made for you.
This article is for general informational purposes and does not constitute legal advice. If your claim has been under review for an extended period, or if you have received a reservation of rights letter, consult a licensed attorney in your jurisdiction as soon as possible.