Insurance Claim – What Are They?

July 31, 2022 Stan

Your insurance company provides this application to you so you can apply for benefits on your insurance policy whether it is life, auto, or health insurance. You must file a claim before any money can be paid to any contracted service like a hospital or repair shop for your car. When you file insurance claims the company, based on their evaluation of the situation, may pay the claim or they may not.

When you take out an insurance policy, you must continue making monthly payments to the insurance company. These are called premiums. Generally, these premiums are used to increase the available assets of the company or to settle another person’s claim. Occasionally an accident will happen that can cause financial damage like a tornado, automobile wreck, or work-related accident. When this happens, the injured policyholder can file an insurance claim to receive money from that company.

When filing an insurance claim you will file it with a local agent that works for the company and they have the responsibility to instigate the specific details of the claim. Then the agent negotiates the payment from the main insurance company. Many times a recognized authority such as a repair shop, building contractor, or medical professional can file the necessary forms with the insurance company directly. If another party has agreed to pay for their mistake out-of-pocket or the damage is minor, the policyholder may not want to file an insurance claim.

Once an insurance claim is filed the insurance company usually has an appraiser or adjustor without bias evaluate the damage and determine if the estimates for repair the policyholder got are realistic. This can help prevent fraud by companies who inflate their estimates so they can get additional compensation. Most insurance companies will accept the appraiser or adjustor’s valuation as the last word. There are some insurance claims that may not be paid for many reasons. Some of these reasons can include:

• The claimant’s premiums have not been paid each month and they are behind
• Policy may be inactive
• Another insurance company may have agreed to pay for the damages that were listed in the insurance claim. This happens often in car accidents where one of the parties is held responsible for the accident.
• Failure to not be under the conditions that are covered because most insurance policies specify specific areas that qualify for benefits
• If the damage or accident claim was an unavoidable “Act of God” or caused by carelessness your insurance company has the right to withhold payment.

The only way to apply officially for benefits is to file a claim. Until your insurance company has assessed the claim, it will remain as that and not a payout.