Insurance Claim Overview
Created by FindLaw's team of legal writers and editors | Last reviewed August 06, 2018
Accidents are an unfortunate part of life. Most of us will, at least once in our lives, be faced with unpleasant life events, like a car accident or an injury from a fall. Often times, we rely on insurance to reimburse us for losses related to these events. You can recover payment from your insurance company by submitting a claim. Read on to learn more about the insurance claim process.
Submitting an Insurance Claim
Before starting the insurance claim process, it's important to remember that an insurance claim may take some time to resolve from start to finish, and at times you may feel frustrated by the process. Beginning with an optimistic and patient attitude may help you survive the process with your sanity intact.
Reporting the Incident
When you are in an accident or experience a loss, your first step is to promptly inform your insurance company. By reporting the incident to your insurance company, you are officially "making a claim" for reimbursement. Depending on the type incident that occurs, you may also want to file a police report. This is particularly true if you were in a car accident, or if you suffered a loss due to theft, burglary, or fire.
Also, there may be circumstances in which the relative fault of the people involved will determine which insurance company you'll need to contact. For example, if you were in a car accident that was completely your fault, you'll want to contact your own insurance agency. However, if you were struck by another driver who was completely at fault, contact that person's insurance company. If fault is shared, or it's unclear who was at fault, it's a good idea to first contact your own insurance company, and they will help you determine if there's a third party insurance carrier you should also contact.
Keep in mind, it's important to promptly contact your insurance company. Typically, you have a limited time period during which you can report the incident in order to be eligible for reimbursement. Carefully review your policy to understand any applicable time limits so you don't miss out.
Insurance Claims Adjuster and Investigation
Once it receives your claim, your insurance company will appoint a claims adjuster to your case. The role of an insurance adjuster is to investigate the claim, determine the amount of loss suffered, and determine if you are eligible for payment under your policy. The insurance adjuster assigned to your case will commence an investigation of the facts relevant to your claim.
The adjuster will want to interview you about how the accident occurred. Keep in mind that this conversation will usually be recorded. Under certain circumstances, you may want to speak with an attorney before giving a statement to an insurance company. Your adjuster may also interview witnesses to the incident, and may want to review photographs and other relevant documents (like police reports). Be sure to retain copies of any photographs or other important documents.
If the claim involves damage to your home, the adjuster may visit your home to assess the damage. In some home damage cases, you may get an advance towards the total amount your insurance provider will pay out, so that you can make immediate repairs.
During the process, it's a good idea to remain in frequent contact with your insurance adjuster. Respond to all requests, and follow up as needed to be appraised of the status of your claim. However, keep in mind that your appraiser works on several claims at once, so the process may not always move as quickly as you would hope.
Resolution of the Claim
Once the insurance adjuster has completed the investigation, he or she will resolve your claim by either:
- Approving your claim and giving you payment in full;
- Approving your claim but only giving partial payment; or
- Denying your claim.
If your claim is paid in full, you'll be made whole again, and the process is complete. You will be required to sign a release stating that you accept payment in exchange for the resolution of the case—which essentially means that you won't be able to bring another claim or lawsuit in the future based on the same set of circumstances.
However, if the amount of damage you sustained exceeds the limits of your policy, or some element of your claim is outside of the scope of your policy, then your insurance company may only reimburse you in part. Or, for various reasons, your insurance company may deny your claim completely. This may occur because you did not file your claim within the time period specified in your policy, you failed to submit to a medical exam, or the accident or incident in question was not covered by your particular policy.
If your claim is denied, you have the option of filing an appeal. The appeals procedure differs widely depending on the insurance company. Review your policy carefully to be sure you fully comply with the appeals process.
Get Legal Help with an Insurance Claim
Unfortunately, insurance claims do not always go according to plan. If you are experiencing issues with an insurance claim, such as an unreasonable delay in its resolution or denial of the claim seemingly without basis, you may want to speak with an attorney. Contact an insurance law lawyer in your area to learn more.
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