- Insurance Claims

Insurance Claims Introduction

If you have an insurance policy on your home, life, health or car, and have kept up regular payments (called premiums) to the insurance company, the time may come when you need to make a claim. An insurance claim is an application for benefits provided by an insurance company. With this application you are asking the company for money to be given to a hospital, or other service. Once the insurance company receives your claim they will perform an assessment of the situation and decide whether or not to pay the amount requested.

Generally, you will file an insurance claim with a local representative of the insurance company. This agent will investigate the specific details of your insurance claim and will act as the go-between for your negotiations with the main insurers. In many situations a recognized authority such as a doctor, repair shop, or building contractor will be able to file your insurance claim forms directly with the insurance company.

Sometimes after you file your insurance claim, the insurance company may send out an investigator, called an adjustor or appraiser. His job is to evaluate your insurance claim and figure out if the estimates are reasonable. Insurance companies do this to prevent possible dishonesty by contractors who may present inflated estimates.

There are a number of reasons an insurance company may not accept a claim. Of course, they won’t pay if your premiums have not been fully maintained. In case of an automobile accident when another insurance company has already agreed to pay for damages, your claim will be refused, as it will if your claim falls into an area that is not specifically covered in your policy. If the reason for your claim is carelessness or an unavoidable "Act of God" payment will be withheld.

When the insurance company has assessed the situation and agrees to pay your claim, it will become a pay-out.