{"id":352611,"date":"2017-06-28T17:02:23","date_gmt":"2017-06-28T22:02:23","guid":{"rendered":"https:\/\/content.findlaw-admin.com\/ability-law\/consumer\/insurance\/the-insurance-claim-process.html"},"modified":"2024-03-29T15:31:52","modified_gmt":"2024-03-29T20:31:52","slug":"the-insurance-claim-process","status":"publish","type":"page","link":"https:\/\/www.findlaw.com\/consumer\/insurance\/the-insurance-claim-process.html","title":{"rendered":"The Insurance Claim Process"},"content":{"rendered":"\n<div class=\"wp-container-core-columns-is-layout-8f761849 fl-sectionWithSidebar fl-container fl-flex fl-flex-wrap fl-gap30\">\n    \n    <div class=\"fl-page-articles fl-section-main fl-section-main-full-width\">\n        <h1 class=\"fl-no-margin-top\">The Insurance Claim Process<\/h1>\n<section class=\"fl-gutenberg-byline\">\n    <div class=\"fl-gutenberg-byline-content\">\n                    By <a href=\"https:\/\/www.findlaw.com\/company\/our-team\/oni-harton-j-d\/\">Oni Harton, J.D.<\/a> | Legally reviewed by <a\n                href=\"https:\/\/www.findlaw.com\/company\/our-team\/melissa-bender-esq\/\">Melissa Bender, Esq.<\/a>\n                | Last updated\n        <time>\n                            March 29, 2024\n                    <\/time>\n    <\/div>\n\n    \n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-legally-reviewed\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Legally Reviewed\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>This article has been written and reviewed for legal accuracy, clarity, and style by <a href=\"https:\/\/www.findlaw.com\/company\/our-team.html\">FindLaw\u2019s team of legal writers and attorneys<\/a> and in accordance with <a href=\"https:\/\/www.findlaw.com\/company\/company-history\/editorial-policy.html\">our editorial standards<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n\n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-fast-checked\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Fact-Checked\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>The last updated date refers to the last time this article was reviewed by FindLaw or one of our <a href=\"https:\/\/www.findlaw.com\/company\/our-team\/contributing-authors.html\">contributing authors<\/a>. We make every effort to keep our articles updated. For information regarding a specific legal issue affecting you, please <a href=\"https:\/\/lawyers.findlaw.com\/?fli=bylinelink\" target=\"_blank\" rel=\"noopener\">contact an attorney in your area<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n<\/section>\n<p>Accidents happen to everyone.&nbsp;Dealing with a car accident, damage to your home, health care bills, or a&nbsp;<a href=\"https:\/\/www.findlaw.com\/injury\/accident-injury-law\/personal-injury-law-the-basics.html\">personal injury lawsuit<\/a>&nbsp;can be overwhelming.&nbsp;<\/p>\r\n<p>You pay insurance premiums for a reason. If you&nbsp;need to make an auto insurance claim following a major accident where you&#8217;re at fault, you&#8217;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.<\/p>\r\n<p>No matter what type of insurance claim you must file, it&#8217;s helpful to know the process for a claim. Being familiar with the&nbsp;<a href=\"https:\/\/www.findlaw.com\/hirealawyer\/choosing-the-right-lawyer\/insurance-law.html\">insurance claim<\/a>&nbsp;process&nbsp;and&nbsp;understanding how an insurance claim works&nbsp;can help you get the most out of your insurance coverage. It&nbsp;will also&nbsp;set realistic expectations to minimize the frustration of the process.<\/p>\r\n<p>The following article discusses critical points to remember as you embark on the insurance claim process.<\/p>\r\n<h2>Preliminary Steps in the Insurance Claim Process<\/h2>\r\n<p>Insurance claims processing varies based on the type of insurance. There are common tips to remember regardless of the type of claim.<\/p>\r\n<p>In all cases, a policyholder must examine the&nbsp;<a href=\"https:\/\/www.findlaw.com\/realestate\/owning-a-home\/glossary-insurance-terms-and-concepts.html\">insurance policy<\/a>. This will help you understand your rights and responsibilities. These rights and responsibilities include the following:<\/p>\r\n<ul>\r\n<li>Whether your issue is a covered loss<\/li>\r\n<li>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)<\/li>\r\n<li>Whether you have multiple policies that could cover the same event (for example, an umbrella policy provides coverage in addition to specific existing policies)<\/li>\r\n<li>If you&nbsp;<a href=\"https:\/\/dictionary.findlaw.com\/definition\/deductible.html\" target=\"_blank\" rel=\"noopener\">have deductibles<\/a>&nbsp;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)<\/li>\r\n<\/ul>\r\n<h2>Contact Your Insurance Company<\/h2>\r\n<p>Contacting your insurance agent within the required timeframe is essential. The insurance company informs&nbsp;you what forms and information you must submit. There is a time limit for filing claims, whether provided by your insurer or by law.<\/p>\r\n<p>Take detailed notes of all correspondence you have with the insurance company. Details you should document include the following:<\/p>\r\n<ul>\r\n<li>The names of people with whom you speak,&nbsp;including the claims representative and claims adjuster<\/li>\r\n<li>The&nbsp;<a href=\"https:\/\/www.findlaw.com\/injury\/accident-injury-law\/worksheet-damage-estimate.html\">expenses you incur<\/a>&nbsp;as a result of pursuing your insurance claim<\/li>\r\n<li>Expenses&nbsp;stemming from the accident that include&nbsp;medical expenses, lost income, living expenses, lost profits, and more<\/li>\r\n<\/ul>\r\n<p>Be honest about your damages. Never inflate the extent of your injuries,&nbsp;cost of repairs, replacement costs, or actual cash value of your losses.<\/p>\r\n<p><a href=\"https:\/\/www.findlaw.com\/criminal\/criminal-charges\/insurance-fraud.html\">Insurance fraud<\/a>&nbsp;is a serious offense. If proven, you&nbsp;risk forfeiting any payout. Committing insurance fraud can invalidate your policy and&nbsp;lead to both civil and criminal consequences.<\/p>\r\n<h2>Insurance Claim Process for Particular Types of Insurance<\/h2>\r\n<p>The insurance claim process will differ between types of insurance.&nbsp;<\/p>\r\n<h3>Accidents and Injuries<\/h3>\r\n<p>The insurance claim process for&nbsp;<a href=\"https:\/\/www.findlaw.com\/injury\/accident-injury-law\/insurance-claims-after-an-accident-the-basics.html\">accident-related policies<\/a>&nbsp;involves a short window for filing a claim. Policies include those such as:<\/p>\r\n<ul>\r\n<li>Auto insurance<\/li>\r\n<li>Home insurance<\/li>\r\n<li>Liability insurance<\/li>\r\n<\/ul>\r\n<p>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.<\/p>\r\n<p>In addition to filing a claim with your insurance company, you must determine whether you should file a&nbsp;<a href=\"https:\/\/www.findlaw.com\/injury\/car-accidents\/what-to-do-after-a-car-accident-thats-not-your-fault.html\">third-party claim<\/a><span style=\"background-color: transparent; font-size: 0.8125rem;\">. Such claims are made if someone else is at fault. You can file a claim with their insurer if they&#8217;re at fault for the accident.<\/span><br>\r\n<\/p>\r\n<p>For property damage claims, consider hiring a public insurance adjuster. They can provide expert guidance on assessing damages the insurance company&#8217;s adjuster provides.&nbsp;<\/p>\r\n<p>If you suffered injuries, you may have to submit to an&nbsp;<a href=\"https:\/\/www.findlaw.com\/injury\/accident-injury-law\/independent-medical-examination.html\">independent medical examination<\/a>&nbsp;as part of the claims investigation.&nbsp;<\/p>\r\n<p>Don&#8217;t feel pressured to automatically accept a settlement offer made by the insurance company. If the offer doesn&#8217;t seem adequate, consult an independent adjuster. You can also contact an insurance attorney for another independent opinion.<\/p>\r\n<h3>Health Insurance Claim Process<\/h3>\r\n<p>Your healthcare provider can submit a claim&nbsp;to your&nbsp;<a href=\"https:\/\/www.findlaw.com\/consumer\/insurance\/health-insurance.html\">health insurance<\/a>&nbsp;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.<\/p>\r\n<h3>Life Insurance Claim Process<\/h3>\r\n<p>To file a&nbsp;<a href=\"https:\/\/www.findlaw.com\/consumer\/insurance\/life-insurance.html\">life insurance<\/a>&nbsp;claim, you must submit certified copies of the insured&#8217;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.<\/p>\r\n<h3>Homeowners Insurance Claim Process<\/h3>\r\n<p>If your home is damaged, your home insurance company will send a claim adjuster to evaluate the damage. Next, the company will calculate&nbsp;the total loss based on the damage. This&nbsp;will determine your settlement amount or how much you&#8217;ll be reimbursed under your homeowners&#8217; policy.&nbsp;<\/p>\r\n<p>The insurer will either provide replacement costs or actual cash value. Your homeowners&#8217;&nbsp;insurance company will&nbsp;pay your settlement check made out to you and your mortgage servicer or lender.<\/p>\r\n<h2>Insurance Company Obligations During the Insurance Claim Process<\/h2>\r\n<p>Each state has laws&nbsp;<a href=\"https:\/\/www.findlaw.com\/hirealawyer\/choosing-the-right-lawyer\/what-is-bad-faith-insurance-law.html\">regulating the insurance claim process<\/a>&nbsp;and the conduct of insurance companies. Insurance companies are expected to act in good faith and fair dealing. This often&nbsp;includes the following:<\/p>\r\n<ul>\r\n<li>Providing prompt, ongoing communication with the insured about their claim<\/li>\r\n<li>Defending the insured in a&nbsp;<a href=\"https:\/\/www.findlaw.com\/injury\/accident-injury-law\/who-is-liable.html\">liability action<\/a>&nbsp;where the policy may&nbsp;cover&nbsp;the underlying claim<\/li>\r\n<li>Acknowledging, investigating, and either approving or denying an insurance claim within a reasonable&nbsp;and often specified&nbsp;amount of time<\/li>\r\n<li>Effectuating prompt, fair, and equitable settlements of claims<\/li>\r\n<li>Proving detailed reasons for denying an insurance claim<\/li>\r\n<\/ul>\r\n<p>Failure to abide by these standards and&nbsp;<a href=\"https:\/\/corporate.findlaw.com\/corporate-governance\/obligations-of-insurance-companies-when-handling-claims.html\" target=\"_blank\" rel=\"noopener\">other requirements<\/a>&nbsp;outlined in your state&#8217;s insurance laws could give you grounds to sue your insurance company for bad faith or&nbsp;<a href=\"https:\/\/www.findlaw.com\/smallbusiness\/business-contracts-forms\/breach-of-contract-and-lawsuits.html\">breach of contract<\/a>. You can also file a complaint with your&nbsp;<a href=\"http:\/\/www.naic.org\/state_web_map.htm\" target=\"_blank\" rel=\"noopener\">state&#8217;s insurance commissioner<\/a>&nbsp;if you suspect misconduct.<\/p>\r\n<h2>Dealing With an Insurance Claim Denial<\/h2>\r\n<p>If your&nbsp;<a href=\"https:\/\/www.findlaw.com\/injury\/car-accidents\/the-other-partys-insurance-denied-the-claim-now-what.html\">insurance claim is denied<\/a>, 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&nbsp;include either&nbsp;a&nbsp;<a href=\"https:\/\/www.findlaw.com\/healthcare\/patient-rights\/what-to-do-if-your-health-insurance-claim-is-denied.html\">health insurance claim<\/a>&nbsp;or&nbsp;<a href=\"https:\/\/www.findlaw.com\/injury\/accident-injury-law\/what-to-do-if-your-car-insurance-claim-is-denied.html\">car insurance claim<\/a>&nbsp;denial.&nbsp;<\/p>\r\n<p>When you understand the company&#8217;s reasons for denying your claim, you can provide more information. You can request explanations to get them to reverse their decision.&nbsp;<a href=\"https:\/\/lawyers.findlaw.com\/insurance-law\/-law?fli=dcta\" target=\"_blank\" rel=\"noopener\">An insurance law&nbsp;attorney<\/a>&nbsp;can help with this process and, if the appeals process fails, can advise you on additional options, including a lawsuit.<\/p>\r\n<h2>If Your Insurer Fails To Meet Its Obligations<\/h2>\r\n<p>If your insurance company is not&nbsp;<a href=\"https:\/\/www.findlaw.com\/realestate\/owning-a-home\/payment-of-home-insurance-claims-and-good-faith.html\">fulfilling its obligations<\/a>, consult&nbsp;<a href=\"https:\/\/lawyers.findlaw.com\/insurance-law\/-law?fli=dcta\" target=\"_blank\" rel=\"noopener\">an independent attorney<\/a>. They can help protect your rights during the insurance claim process.<\/p>\r\n<h2>Protect Your Rights Throughout the Insurance Claim Process<\/h2>\r\n<p>Filing and following through on an insurance claim can be laborious. Whether&nbsp;your claim has been denied, you&#8217;re battling an uncooperative insurance company, or you want a second opinion on your claim options, contact a&nbsp;<a href=\"https:\/\/lawyers.findlaw.com\/insurance-law\/-law?fli=dcta\" target=\"_blank\" rel=\"noopener\">local insurance attorney<\/a>. They can explain your options and protect your rights under your state&#8217;s insurance laws.<\/p>\r\n<div class=\"was-this-helpful\">\n    <div\n            class=\"was-this-helpful__question-container\"\n            aria-labelledby=\"was-this-helpful__question\"\n            role=\"group\"\n    >\n        <span\n                id=\"was-this-helpful__question\"\n                class=\"was-this-helpful__question fl-text-lg-bold\"\n        >Was this helpful?<\/span>\n        <button\n                class=\"was-this-helpful__button fl-text-sm\"\n                aria-label=\"Yes\"\n                value=\"yes\"\n        >\n            <span class=\"was-this-helpful__button-text fl-text-bold\">Yes<\/span>\n            <i class=\"was-this-helpful__button-icon\">\n                <svg width=\"22\" height=\"22\" viewBox=\"0 0 22 22\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <g id=\"thumbs-up\" clip-path=\"url(#clip0_604_3418)\">\n                        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was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--understandable\"\n                        >Easy to understand<\/label>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--solved-problem\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"positive-feedback\"\n                                value=\"Solved my problem\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--solved-problem\"\n                        >Solved my problem<\/label>\n                    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class=\"was-this-helpful__feedback-form-title\" tabindex=\"0\">Why was this not helpful?<\/legend>\n                    <div class=\"was-this-helpful__choose-option-message\" role=\"status\">\n                        <p class=\"was-this-helpful__choose-option-message-text\"><\/p>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--missing-info\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"negative-feedback\"\n                                value=\"Missing Information\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                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     class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"negative-feedback\"\n                                value=\"Other\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--negative-other\"\n                        >Other<\/label>\n                    <\/div>\n                <\/fieldset>\n            <\/div>\n            <div class=\"was-this-helpful__form-buttons-container\">\n                <button\n                    class=\"was-this-helpful__feedback-button was-this-helpful__feedback-button--positive at-feedback-submit fl-button secondary\"\n                    type=\"submit\"\n                >\n                    <span class=\"fl-button-content\">Submit<\/span>\n                    <i\n                        class=\"fa fa-angle-right medium\"\n                        aria-hidden=\"true\"\n                    ><\/i>\n                <\/button>\n                <button\n                    class=\"was-this-helpful__feedback-button was-this-helpful__feedback-button--cancel fl-button primary disabled\"\n                    type=\"reset\"\n                >\n                    <span class=\"fl-button-content\">Cancel<\/span>\n                    <i\n                        class=\"fa fa-times-circle medium\"\n                        aria-hidden=\"true\"\n                    ><\/i>\n                <\/button>\n            <\/div>\n        <\/form>\n    <\/div>\n    <div class=\"was-this-helpful__thank-you-message\" role=\"status\">\n        <i class=\"was-this-helpful__thank-you-message-icon fa fa-check\"><\/i>\n        <p class=\"was-this-helpful__thank-you-message-text\" aria-live=\"polite\"><\/p>\n    <\/div>\n<\/div>\n\n\n    <\/div>\n    \n    <div class=\"fl-section-sidebar\">\n        <div class=\"fl-editors-summary\" data-testid=\"fl-editors-summary\">\n    \n    <div class=\"fl-editors-summary-content\" data-testid=\"fl-editors-summary-content\">\n                    <h2>Can I Solve This on My Own or Do I Need an Attorney?<\/h2>\n                <div class=\"fl-editors-summary-content-main\" data-testid=\"fl-editors-summary-content-main\">\n            \n        <\/div>\n        <ul class=\"fl-list-style-none\">\n                            <li data-testid=\"fl-editors-summary-content-item\">\n                    <i class=\"fa fa-check medium fl-editors-summary-content-item-icon\" aria-hidden=\"true\"><\/i>\n                    Consumer legal issues typically need an attorney&#8217;s support\n\n                <\/li>\n                            <li data-testid=\"fl-editors-summary-content-item\">\n                    <i class=\"fa fa-check medium fl-editors-summary-content-item-icon\" aria-hidden=\"true\"><\/i>\n                    You can hire an attorney to enforce your rights for safe products, fair transactions, and legal credit, banking and related financial matters\n\n                <\/li>\n                    <\/ul>\n                    <div class=\"fl-editors-summary-content-description\" data-testid=\"fl-editors-summary-content-description\">\n                <p>Legal cases for identity theft, scams, or the Equal Credit Opportunity Act can be complicated and slow. 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<\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>When an unfortunate event occurs, you&#8217;ll need to be familiar with the insurance claim process to mitigate those headaches as much as possible. 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