An insurance claim is a request for benefits from an insurance company, which may or may not be approved based on the circumstances. Premiums are paid to insurers, and claims can be filed for accidents or damages. An adjuster assesses damage and fraud prevention, and claims may be denied for various reasons.
An insurance claim is the actual request for benefits provided by an insurance company. Policyholders must first file a claim before money can be disbursed to the hospital or repair shop or other contracted service. The insurance company may or may not approve the claim, based on its own evaluation of the circumstances.
People who take out home, life, health, or auto insurance policies must maintain regular payments called premiums to insurers. Most of the time, these premiums are used to settle someone else’s claim or to accumulate the available assets of the insurance company. Occasionally, however, an accident will happen that causes real financial damage, such as a car accident, tornado, or workplace accident. At this point, the injured insured has the right to file an insurance claim to receive money from the insurance company.
Generally, the insurance claim is filed with a local representative of the insurance company. This agent is responsible for investigating the specific details of the claim and negotiating payment from major insurers. Many times, a recognized authority, such as a medical professional, repair shop, or building contractor, can file the necessary forms directly with the insurance company. However, the policyholder may not want to apply if the damage is minor or if another party has agreed to pay out-of-pocket for their mistake.
After you file a claim, the insurance company may send an investigator called an adjuster or appraiser. This person’s job is to objectively assess the damage and determine if the repair estimates are reasonable. This is to prevent potential fraud by contractors who may inflate your invoices for additional compensation. Insurance companies tend to accept the adjuster’s or appraiser’s evaluation as the last word.
Some insurance claims may not be recognized by the insurance company for various reasons. If a claimant’s premiums have not been paid in full, the policy itself may not be active. Another insurance company may have also agreed to pay for the damages listed in the claim. This happens quite often in car accidents where one party is at fault.
Another reason a claim may be denied is failure to meet covered conditions. Most insurance policies detail specific areas that qualify for benefits, and if the accident or damage claim was caused by carelessness or an unavoidable “act of God,” the insurance company has the right to withhold payments. A claim is the only way to officially apply for benefits under an insurance policy, but until the insurance company has evaluated the situation, it will remain just a claim, not a payment.
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