Everything You Need to Know About Insurance Claim

Everything You Need to Know About Insurance Claim

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Despite many safety procedures and risk management measures, disasters may still occur, leaving room for a policyholder to file an insurance claim. From worker’s compensation insurance, which is required by law, to property and auto insurance, cyber insurance, employment practices liability, etc., it is important to understand insurance claims and what to do if the need arises.

In this article, we will look at insurance claims, how to write a claims report, claims and deductibles, and more. We will try to provide you with a general guide on insurance claims, but if you need specific information that is not covered in this article, be sure to refer to your policy document or contact your insurer for clarity.

What is an Insurance Claim?

An insurance claim is a formal request by an agent or a policyholder to an insurance company or regulatory agency for compensation after incurring a loss. The request is expected to contain the following:

  • A detailed description of the loss
  • Cause(s) of the loss
  • Claims based on the policyholder’s insurance coverage

The claim payment is typically based on the deductible, which is on the policyholder policy document and is issued to the person, business named on the policy, or any designated beneficiary (in the case of life insurance) to pay for expenses incurred during a loss.

How Insurance Claims Work

From research, prompt reporting of insurance claims can speed up the management and resolution process – Everythinginsurance.wiki

As a policy holder, you need to look at your policy document to see if the incident you wish to file for a claim is included in your policy cover and if there is a time limit for filling a claim. From research, if you delay in filling for claims, the insurer will check the reason for the delay and this may delay the whole process.

Step I: The policy holder or an insured write a formal request informing the insurer on any loss incurred  based on the insured policy document.

Step 2: After receiving the request, the Insurer will then notify the insured on procedures to follow. In some cases a Surveyor may be appointed to assess the loan and map same with the claim. It is expected that the policyholder cooperate with the surveyor and provide all required document/evidence to support the request, where there is no cooperation, the insurer will notify the insured of a possible that may arise in assessing the coverage.

Where there is co0peration with the surveyor, the surveyor will access the loss based on laid down code of code and communicate the report to the insurance company.

Step 3: On receiving the report from the surveyor, if the insurer accept the claim, the insurer will issue a claim notice to the policyholder. If the insurer decides to reject the claim based on the  policy document, they will communicate their decision to the insured within 30 days from the period of receiving the surveyor’s report.

Step 4: Once the Insured accept the offer from the Insurer, the insurer will pay the amount due to the Insured based on the claim notice

Types of Insurance Claim

Workers’ Compensation

Worker’s compensation covers medical care and salary replacement for workplace injuries or illnesses.

Health Insurance Claims

When you file a health insurance claim, you are demanding reimbursement for the medical services you received while under your policy cover. In many cases, the medical practitioner will file the claim without your direct involvement.

 Car insurance claims

In Car insurance claims, you are asking your insurance company to pay you for the damages to your vehicle. Different types of claims may include car repair or replacement, robbery, vandalism, or hailstorms.

Life Insurance Claims

This is an agreement between a policyholder and and insurance company that can be claimed following the death of the insured individual’s death by a designated beneficiary stated in the policy document

Homeowners insurance claims

Homeowners insurance claims include the following:

  • Damage to your property
  • Additional living expenses (ALE) if your house becomes uninhabitable and you need to remain in another place for a period of time
  • Structural damages
  • Injuries to guests at your house

Natural disaster Claims

This type of claim are as a result of  damage caused by hurricanes, earthquakes, floods, and similar event

Rental Insurance Claim

This type of claim is for tenant who seek coverage for additional living expenses, personal property coverage, liability insurance, etc.,

Third-Party Insurance Claim

This type of claim is normally filed by a third-party against a policy holder insurance company. For example, if you are involved in an accident, you can submit a third-party claim with the driver’s insurance company for compensation.

What is a deductible?

Deductible is the portion  of the claim that you are liable for. Insurers will take this sum from claim settlements paid to you or on your behalf. If your insurance coverage includes a $2,000 deductible, you agree to pay $2,000 out of pocket for house damage.

How can You Calculate Claims from Deductibles?

Certain insurance plans include a deductible for losses caused by wind, hurricanes, and other disasters. The insurance applies this deductible for calamities that cause damage. If something else damages your house, the “all peril” deductible will apply.
Some insurance may include a deductible for particular parts of your property, such as your roof. The deductible may be a set financial amount or a percentage.

How to File an Insurance Claim

The steps for submitting an insurance claim differ based on the kind of claim.

Health Insurance

In certain circumstances, the provider can write to your insurance company seeking a claim based on your policy, but if the policy restricts you to write, take notice of the following:

  • Fill A claim form on your health insurance website: In your claim form you will include the following, your policy number, the name of the person who received the treatment (it may be you, your spouse or children).
  • Ensure you get an itemized bill from your healthcare provider, this will include lab test, medication and any other medical procedure/process that was carried out while you were in the hospital.

Auto Insurance

The process for filling an Auto Insurance claim include the following:

  • Inform the police so they can file a report. For auto insurance, police report in always required in most cases before you can access your claim.
  • Gather the necessary Evidence: From picture and video of the scene, particular of the other driver including his/her insurance company, and contact information of any witness
  • Contact your insurance company and you will be directed on the next step

Homeowner Claim

  • If there was a burglary, vandalism, or any other connected crime, call the police.
  • Gather relevant evidence: Like taking pictures and videos of the situation. Making a list of all objects that need to be replaced.
  • Contact your insurance company; they may send a surveyor to inspect the damage and advise you on the next steps.


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