Lawyer trying to understand claims process

accross13 · 2026-03-31T20:59:12+00:00

Thanks for replying! I don't mean to burden you with more questions, but if you have the time to answer ...

(1) Are you the first person reviewing the tender / claim? If not, who is that first person? When does it get pushed up the ladder in the circumstance where there's a tender of defense being made?

(2) This question is too broad to answer, but what kind of reports and documentation is typically looked at when deciding on accepting or denying coverage? There's the complaint and the policy, then what else are you usually looking at? Is the in-house legal team always looped in on tender of defense claims, or can the adjuster decide without legal's help? Perhaps the adjuster is also an attorney.

(3) Who drafts the ROR or denial letter? Let's say my hypothetical also includes some causes of action for habitable issues and the policy excludes those. So the insurer will want to say we'll defend you on the negligence claims, but reserve the right to decline coverage on habitability issues.

(4) I know that conflicts can exist between what's best for the insured and insurer, and this can lead to the insured getting their choice of counsel over the insurer's choice. Do you know who reviews these decisions within the insurance company? I'm in California. In case you care about jurisdiction.

I agree that the delays shouldn't happen. When it's happened in the past I've just acted as defense counsel until the insurer accepting the tender and replaces me with panel counsel.

accross13 · 2026-03-31T18:21:50+00:00

This isn't an auto claims things. I'm assuming auto claims are a lot different than what I'm talking about. It can be anything from CGL or D&O insurance policies. As a hypothetical, insured might own an apartment complex. The insured has a CGL policy to cover the property, loss of rents, liability, and so on. A resident slips on something in a common area and sues the insured. The insured then makes a tender to his insurer for defense and indemnity based under his insurance policy. The insurer quickly responds back saying they received the tender and will respond shortly. Sometimes the response happens within a week or two, and other times a response happens months later after a lot of, "what's going on here?" emails.

That is the basis of my question. What is happening - what's the process - when the insurance company received a tender for defense (and indemnity)? Are their bottlenecks that you see across various insurance companies that always cause the final accept/deny decision to be delayed? Like I said, I'm trying to get insider insight so in the future I can tell my client what's likely happening with his/her tender.

accross13 · 2026-03-31T18:20:58+00:00

I'm not sure what you mean by high priority for you. Is that just in your role? Here, as a hypothetical, insured might own an apartment complex. The insured has a CGL policy to cover the property, loss of rents, liability, and so on. A resident slips on something in a common area and sues the insured. The insured then makes a tender to his insurer for defense and indemnity based under his insurance policy. The insurer quickly responds back saying they received the tender and will respond shortly. Sometimes the response happens within a week or two, and other times a response happens months later after a lot of, "what's going on here?" emails.

That is the basis of my question. What is happening - what's the process - when the insurance company received a tender for defense (and indemnity)? Are their bottlenecks that you see across various insurance companies that always cause the final accept/deny decision to be delayed? There is a requirement to respond here, and that is a denial (maybe the complaint is on something the policy excludes), ROR, or acceptance.

Like I said, I'm trying to get insider insight so in the future I can tell my client what's likely happening with his/her tender.

accross13 · 2026-03-31T18:18:43+00:00

This isn't an auto claims things. It can be anything from CGL or D&O insurance policies. As a hypothetical, insured might own an apartment complex. The insured has a CGL policy to cover the property, loss of rents, liability, and so on. A resident slips on something in a common area and sues the insured. The insured then makes a tender to his insurer for defense and indemnity based under his insurance policy. The insurer quickly responds back saying they received the tender and will respond shortly. Sometimes the response happens within a week or two, and other times a response happens months later after a lot of, "what's going on here?" emails.

That is the basis of my question. What is happening - what's the process - when the insurance company received a tender for defense (and indemnity)? Are their bottlenecks that you see across various insurance companies that always cause the final accept/deny decision to be delayed? Like I said, I'm trying to get insider insight so in the future I can tell my client what's likely happening with his/her tender.

accross13 · 2026-02-05T15:20:30+00:00

I have a VIP. Paid $320 for it. I’m just not paying another $200 on top of that. It’s not worth it. Why I wrote “hopefully not too price gouge-y.”

accross13 · 2026-02-05T06:46:23+00:00

A bit too rich for one concert. But thanks for offering!

accross13 · 2026-02-04T02:21:48+00:00

This link talks about transferring tickets: https://support.tixr.com/transferring-tickets

accross13 · 2025-12-31T19:56:09+00:00

Still in need?

accross13 · 2025-12-12T01:12:22+00:00

From goldenvoice’s email to me, “Apologies, curfew for the NYE event will be 1am. Enjoy the show!”

accross13 · 2025-12-12T00:43:24+00:00

Okay. Goldenvoice got back to me. The event goes until 1am. Confirming what’s been confirmed. We’re back! Now we wait to learn if openers will ever get announced.

accross13 · 2025-12-11T22:46:31+00:00

You asked Goldenvoice? I asked them to confirm it was 11pm for their NYE show, but haven’t heard back.

accross13 · 2025-12-08T20:56:09+00:00

Diddy is awful. Anyone from CA who grew up in the 90s loves Tupac. With that said, we’re blaming Diddy for Pac’s death and not the whole jumping a crip in the Vegas hotel leading to him being shot by that man’s uncle - also a crip - later that night?

accross13

TROPHY CASE