An insurance claim is the request which is sent to an insurance company in order for the insured to obtain the actual benefits of the policy. The filing of the claim is part of an important process that needs to be completed before any amount could be disbursed. This applies when a policy holder needs the insurance provider to shoulder some or the entire cost of hospitalization, repair on a vehicle, and payment to other institutions as stated in the contract.
It is the prerogative of the insurance company to approve or deny a claim. The insurer needs to assess the circumstances surrounding the incident that a policyholder would like to get compensated for. In addition, they will also review the policy to determine whether the claim falls under the conditions for coverage. Regardless of the type of insurance an individual has availed of like, life insurance, health insurance or car insurance; payments or premiums must always be sent on time to the companies. This is to avoid any difficulties in cases when, indeed, a claim has to be filed.
Often, the premiums are used by the insurance provider to pay for the settlement of another policyholder’s claim. Another scenario could be, for the insurance company to use the premiums in order to further strengthen its financial capacity by keeping it in company stocks or by re-investing the money. The amount will remain there until the policyholder needs it for a settlement in situations like a car accident or a destroyed home caused by fire.
The typical procedure of filing is usually done through a local representative of your insurance carrier. This person will be in charge of inquiring, investigating, and gathering details pertaining to the insurance claim. When the claim gets approved, the representative will also be the one to negotiate for the settlement. In most circumstances, other recognized authorities can also give their recommendations or certifications. Examples of such are medical doctors, repair shops, and building contractors. Many insurers will allow a claim to be directly processed by these entities.
There are also situations where a policyholder doesn’t want to file an insurance claim especially if the damage was not caused by him or her. For minor damages and when the party at fault offers to shoulder the expenses for their mistake, in such cases, most policy holders would prefer not to use the benefit from their own insurance plan.
After the insurance claim is filed and received your insurance provider, an insurance appraiser or adjuster may be sent to do an inquiry and a physical inspection. The adjuster will give an objective evaluation on the claim to ensure that the compensation is just and reasonable. This is one way of preventing fraud which might be committed by some contractors since it is possible for them to increase fees for services provided like repairs. Generally, the assessment and recommendation of these professionals are considered final by the insurance carriers.
Rejection of a claim might be possible for several reasons. If payments are not sent regularly, a policy might have turned inactive over time. If another insurance provider has already agreed to pay for expenses listed in your claim, its compensation will also be denied. Read the conditions of your policy carefully before filing.