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The Insurance Claim Process

Accidents happen to everyone. Dealing with a car accident, damage to your home, health care bills, or a personal injury lawsuit can be overwhelming. 

You pay insurance premiums for a reason. If you need to make an auto insurance claim following a major accident where you're at fault, you'll be grateful that you have collision coverage. Insurance can reduce out-of-pocket costs and may even provide a rental car until yours is replaced or repaired.

No matter what type of insurance claim you must file, it's helpful to know the process for a claim. Being familiar with the insurance claim process and understanding how an insurance claim works can help you get the most out of your insurance coverage. It will also set realistic expectations to minimize the frustration of the process.

The following article discusses critical points to remember as you embark on the insurance claim process.

Preliminary Steps in the Insurance Claim Process

Insurance claims processing varies based on the type of insurance. There are common tips to remember regardless of the type of claim.

In all cases, a policyholder must examine the insurance policy. This will help you understand your rights and responsibilities. These rights and responsibilities include the following:

  • Whether your issue is a covered loss
  • Applicable timelines for presenting the claim form or otherwise requesting a claim payment from the insurance provider (some instruct you to file a claim within 24 hours of the relevant incident)
  • Whether you have multiple policies that could cover the same event (for example, an umbrella policy provides coverage in addition to specific existing policies)
  • If you have deductibles that could apply to your situation (if the amount of your claim is less than your deductible, it may not be worth pursuing a claim that could raise your insurance rates)

Contact Your Insurance Company

Contacting your insurance agent within the required timeframe is essential. The insurance company informs you what forms and information you must submit. There is a time limit for filing claims, whether provided by your insurer or by law.

Take detailed notes of all correspondence you have with the insurance company. Details you should document include the following:

  • The names of people with whom you speak, including the claims representative and claims adjuster
  • The expenses you incur as a result of pursuing your insurance claim
  • Expenses stemming from the accident that include medical expenses, lost income, living expenses, lost profits, and more

Be honest about your damages. Never inflate the extent of your injuries, cost of repairs, replacement costs, or actual cash value of your losses.

Insurance fraud is a serious offense. If proven, you risk forfeiting any payout. Committing insurance fraud can invalidate your policy and lead to both civil and criminal consequences.

Insurance Claim Process for Particular Types of Insurance

The insurance claim process will differ between types of insurance. 

Accidents and Injuries

The insurance claim process for accident-related policies involves a short window for filing a claim. Policies include those such as:

  • Auto insurance
  • Home insurance
  • Liability insurance

Take pictures of the accident. Retain contact information for any individuals who witnessed the accident. This includes getting names and phone numbers. If you filed a police report concerning the incident, keep a copy in your records.

In addition to filing a claim with your insurance company, you must determine whether you should file a third-party claim. Such claims are made if someone else is at fault. You can file a claim with their insurer if they're at fault for the accident.

For property damage claims, consider hiring a public insurance adjuster. They can provide expert guidance on assessing damages the insurance company's adjuster provides. 

If you suffered injuries, you may have to submit to an independent medical examination as part of the claims investigation. 

Don't feel pressured to automatically accept a settlement offer made by the insurance company. If the offer doesn't seem adequate, consult an independent adjuster. You can also contact an insurance attorney for another independent opinion.

Health Insurance Claim Process

Your healthcare provider can submit a claim to your health insurance company for you. If you must submit a claim, contact the insurance company for the appropriate forms. Submit those along with an itemized bill from your healthcare provider.

Life Insurance Claim Process

To file a life insurance claim, you must submit certified copies of the insured's death certificate and any forms required by the insurance company. Most states require life insurance companies to pay insurance proceeds within a specific time, such as 30 to 60 days.

Homeowners Insurance Claim Process

If your home is damaged, your home insurance company will send a claim adjuster to evaluate the damage. Next, the company will calculate the total loss based on the damage. This will determine your settlement amount or how much you'll be reimbursed under your homeowners' policy. 

The insurer will either provide replacement costs or actual cash value. Your homeowners' insurance company will pay your settlement check made out to you and your mortgage servicer or lender.

Insurance Company Obligations During the Insurance Claim Process

Each state has laws regulating the insurance claim process and the conduct of insurance companies. Insurance companies are expected to act in good faith and fair dealing. This often includes the following:

  • Providing prompt, ongoing communication with the insured about their claim
  • Defending the insured in a liability action where the policy may cover the underlying claim
  • Acknowledging, investigating, and either approving or denying an insurance claim within a reasonable and often specified amount of time
  • Effectuating prompt, fair, and equitable settlements of claims
  • Proving detailed reasons for denying an insurance claim

Failure to abide by these standards and other requirements outlined in your state's insurance laws could give you grounds to sue your insurance company for bad faith or breach of contract. You can also file a complaint with your state's insurance commissioner if you suspect misconduct.

Dealing With an Insurance Claim Denial

If your insurance claim is denied, you can appeal the decision with the insurance company. Check your policy or contact the company to figure out what steps you need to take. You may be dealing with a claim denial, which can include either a health insurance claim or car insurance claim denial. 

When you understand the company's reasons for denying your claim, you can provide more information. You can request explanations to get them to reverse their decision. An insurance law attorney can help with this process and, if the appeals process fails, can advise you on additional options, including a lawsuit.

If Your Insurer Fails To Meet Its Obligations

If your insurance company is not fulfilling its obligations, consult an independent attorney. They can help protect your rights during the insurance claim process.

Protect Your Rights Throughout the Insurance Claim Process

Filing and following through on an insurance claim can be laborious. Whether your claim has been denied, you're battling an uncooperative insurance company, or you want a second opinion on your claim options, contact a local insurance attorney. They can explain your options and protect your rights under your state's insurance laws.

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