September 25, 2025
One of the more frustrating aspects of claims handling is the lack of response. You’ve left voicemails, sent emails, maybe even mailed letters —yet there you get no response from the people who have information you need to resolve their claim. Sometimes the reasons for their silence are legitimate. Other times, its classic avoidance behavior, misplaced distrust or a lack of understanding of the claims process itself. Regardless of the cause, the lack of communication can feel like a roadblock, especially when you’re trying to move a claim forward.
Spelling out the duty to cooperate
When adjusters hit this wall, the natural instinct is to reach for the policy. To flip to the conditions section and find the area we typically call the duty to cooperate clause. In most standard ISO Commercial General Liability (CGL) policies, it reads something like this:
Duties in the Event of an Occurrence, Offense, Claim or Suit
You and any other involved insured must:
(1) Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the claim or “suit”;
(2) Authorize us to obtain records and other information;
(3) Cooperate with us in the investigation or settlement of the claim or defense against the “suit”; and
(4) Assist us, upon our request, in the enforcement of any right against any person or organization which may be liable to the insured because of injury or damage to which this insurance may also apply.
This language seems clear. The insured must cooperate in the investigation. But what happens when trying to get their cooperation feels like a seemingly futile task?
Uncooperative claimants and claims
It’s tempting to treat this non-cooperation as grounds for a coverage denial. After all, if the insured won’t talk, how can we properly investigate the claims? But courts have consistently held that refusal to communicate alone does not create a prima facie case for denial. The key legal concept here is prejudice.
Legal prejudice occurs when the insurer is materially disadvantaged in its ability to investigate or defend a claim. That means the missing information must be irreplaceable, not just frustratingly inconvenient to obtain. If the facts can be reconstructed from other sources, the lack of cooperation may not be enough to merit denying coverage.
Consider a two-car accident. There’s a police report and an independent witness. The insured refuses to speak with the insurer. Frustrating? Absolutely. But not fatal to the claim. The insurer can still determine whether a covered vehicle was involved, whether the driver qualifies as an insured and even assess liability with reasonable certainty without the insured’s direct input.
In this scenario, denying coverage based on non-cooperation likely wouldn’t hold up. There’s no legal prejudice because the insurer wasn’t materially disadvantaged. The facts were accessible through other means.
Working through challenges
Rather than viewing non-cooperation as fatal to coverage, adjusters should treat it as a challenge to be navigated around. The real question isn’t whether the insured ever called you back, it’s whether their silence created a gap of information that couldn’t be filled. Will it cause you more work? Yes. Will you have to dig for more information from more places? Quite possibly. But it likely does not equate to grounds for a coverage denial.
In other words, non-cooperation should be understood as ‘non-cooperation with prejudice.’ Only when the silence results in a loss of critical, irreplaceable information does it rise to the level of a coverage issue.
