Claim

Glossary

An insurance claim is the place where the rubber meets the road when it comes to an insurance policy - all insurance policies. If you have a auto, health, life, homeowners, or renters insurance policy, you begin paying premiums to the insurance company on a monthly basis, whether you have a problem or not. Usually these premiums are taken by the insurance company and used as profit, for operations, and to settle the claims of other people who have had something significant happen to them. Sooner or later, however (and if you’re lucky, possibly never - with the exception of life insurance), something will happen to you that your insurance policy covers and it will be time for you to make a claim on your insurance policy.

An insurance claim is the actual process of applying for benefit coverage that is provided by your insurance company. This is a request for money or payment based on the terms of your policy. A actual claim being made on an insurance policy is a call for a short-term reversal of the normal insurance/insurer relationship. Rather than paying your premium (though you still have to, even in the month which you suffer a loss), you are requesting that the insurance company pay you in order to help you recover from a loss.

Filling Out a Claim Form

Your insurance company has specific forms to be used in the filing of a claim. Often, depending on the circumstances, you may also fill out a claim over the phone by simply speaking to a customer service representative. Once the claim information has been submitted and received, a representative or adjuster for the insurance company may call you to clarify specific details given on your claim form before the application is actually processed for payment.

Evaluating Your Claim

Once an insurance claim has been filed, the insurance company may want to assign your case to an insurance adjuster whose job it is to evaluate your insurance claim in order to determine if the claim is reasonable. The primary purpose for insurance adjusters in the insurance business is to protect the insurance company from possible fraud from those who may try to file false claims or even to protect against fraudulent work being done by a contractor for repairs if it is a home or auto insurance claim requiring repairs.

Circumstances Dictate Payment

Just because you file a claim with your insurance company for an incident you feel is deserving of payment, that does not automatically mean that you will receive either all of the payment you are requesting or even any payment at all. Insurance companies have exacting policies for determining how they, through an insurance adjuster, will evaluate the circumstances surrounding your claim to determine if it meets the criteria spelled out in your insurance policy. If the insurance claim does not meet the guidelines of hte insurance policy, it may be denied. Other reasons why a claim may possibly be denied include payment by another insurance company (such as in an auto accident), of if the claim is requesting payment for something that is not specifically covered under the insurance policy - for example, if you run a business out of your home and one of your employees gets hurt, your homeowners insurance policy typically will not cover that. If you are covering your employee with workers’ compensation insurance coverage, however, that policy will likely honor a claim for an accident.