Insurance Claim Guide

What is an insurance claim?

An insurance claim can be defined as a formal request made by a policyholder (the insured) to an insurer (insurance company) for compensation for a policy event or covered loss. For instance, if you suffer a personal injury (because of some else’s recklessness), you can launch an insurance claim to get compensated. Before an insurance claim is acted upon, it must be validated and approved after which payment is issued to the insured or interested party.

Insurance claim process: Important steps

Assessment of insurance policy terms

Insurance claim processes can vary depending on the type of insurance in question. However, most processes tend to be the same. To get started, you must familiarize yourself with your rights and responsibilities as per the policy.

Check if your policy covers the eventuality you are facing. For instance, you can’t launch a personal injury insurance claim if your policy or the policy in play doesn’t cover such claims. You also need to file claims within the stipulated timeline. Most insurance policies want claims launched within a day.

It’s also important to check if there are multiple policies covering the same thing. Insurance companies demand that you act in good faith at all times and make all the relevant disclosures. Last, but not least, check if the policy has deductibles. In some cases, you can’t be able to launch a claim if it doesn’t reach a certain amount. Assessing insurance policy terms ensures you don’t pursue claims that aren’t worthwhile.

Notifying your insurance company

The assessment stage should be followed by contacting your insurance company. During this stage, you should know the forms and information you must submit to launch a claim. Record all your correspondence, the people you speak with and the expenses you incur because of the claim. Such expenses include, but aren’t limited to medical costs, lost profits, lost income, etc.

When informing the insurance company, be 100% honest about your injuries, resulting in costs, property damage, etc. — lying about anything amounts to committing insurance fraud. Your claim can be invalidated if you are found to be dishonest. You could also face civil and criminal charges.

Insurance companies are also prone to malpractices when dealing with claims. If you feel your insurance company isn’t fulfilling their obligations or is acting in bad faith, you should consult an insurance claim attorney immediately.

Insurance claim process based on the type of claim

a. Injury/accident claim

Accident-related policies such as home, liability, and auto insurance have short periods for filing claims. To increase your odds of getting a claim settlement, you must offer visual evidence i.e., pictures and/or videos of the scene as well as have contacts of witnesses if any. Doing this can be challenging in serious accidents; however, it can be the difference between a successful and failed claim.

If the accident results in property damage, you may be forced to hire an insurance adjuster to give an accurate damage assessment if you need another assessment apart from the one offered by the insurance company. If you are injured, you may need to undergo an independent medical exam.

b. Health insurance claim

Health care providers can submit insurance claims directly on your behalf if you can provide your insurance information, and they offer that service. If you must file a health insurance claim on your own, make sure you have the right forms and additional information needed by your health care provider i.e., bills.

c. Life insurance claim

Life insurance claims are submitted alongside a certified copy of the death certificate of the insured alongside other forms that may be required. Most life insurance companies need claims to be launched within 60 days after death.

Insurance company obligations

Insurance companies have responsibilities when handling claims. For instance, an insurance company must offer prompt communication/feedback with the insured. Insurance companies must also defend the insured if the underlying claim is covered, deal with claims within a reasonable timeline, offer fair settlements, and give detailed reasons when rejecting claims.

You have grounds for suing your insurance company if they don’t meet their obligations stipulated in the insurance laws applicable in your state. You need an insurance claim attorney to tackle insurance claim related issues.

Stambaugh Law is among the top York, PA insurance claim attorney firms with a 30-year record getting fair insurance settlements for clients.

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