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» Insurance Claims
This section is dedicated for helping consumers and claims specialists to understand Insurance claims and related topics. We have also aggregated many useful resources to help you with the claims process. For country specific claims resources please visit the country portals. Since this is the main page for this portal we have created links to specific pages within our site which will help you understand each topic further.
Insurance Claim is the application that you file with the Insurance Company requesting a certain type of benefits or pay out. For instance if you end up in an car accident you would have to report the accident to the insurance company and then claim some money for the damages. Insurance claim is the first step in the settlement process, unless you claim the Insurance company is not going to pay any money. once you do claim the Insurance company is not going to pay you outright. They are first going to check the validity of the claim that you have made and then try to study the claim you have made and tally them to their valuation through special professionals called Insurance adjusters or claims specialists.
Insurance Adjustors are specialists in determining the repair costs for the damages. They could be working for the Insurance company or could be a third party investigator or could be an independent professional who is hired for this specific claim management. These folks are have a tough line to tread without falling on either side of the fence. They have to evaluate the damages correctly finding the most reasonable pay out. If they accept the claims outright or bloat the pay out by the influence of the policy holder they are going to be in trouble when the claim gets audited by another specialist. If they try to cut down the pay out more than the reasonable amount they are going to be ethically and some times legally challenged by the policy holder.
Before you make a claim with the insurance company you may have to have a few things in mind:
Is this covered by the policy?
Is your payments up to date and the policy active?
Did you get paid by the other party in private settlement?
Did this happen because of your negligence or carelessness?
The third point is worth noting. Sometimes during accidents or damage caused by someone else they may wish to settle this privately due to many reasons::
Keep this issue completely private
they are not covered by their insurance
they don't want their ratings to go down
They have defaulted on their premium payments
If they do settle privately you should not make any claims for the second time with your insurance company. Insurance companies can get back at you any time in the future through private investigators if they think a fraud has been committed. You are obliged to tell the the truth about the accident and let the company know about settlements and the difference could be settled by the company if they think it is part of the policy.
To summarize the Insurance claim is the process through which as a policy holder you request your Insurance company to pay the benefits. This could be done online, phone or through paperwork or just automatic through third parties like auto shops. Please bear in mind don't claim what you are not entitled to, don't keep quiet when you are entitled to claim a certain benefit. There are some helpful sections in this website which deliberates the rating risks after claims as well.
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