What is an Insurance Claim?
Insurance claims are the forms that policyholders fill out and turn in to the insurance company. They must have an active policy to receive any benefits related to the accident. The insurance claims must be turned in before any money can be used for any damages caused during the accident. It is completely up to the insurance company to decide if the insurance claim has any merit and if it is approved for payment. They use their own assessments of each given accident to decide if it has merit.
Every insurance policy maintains regular payments called premiums. Whether you take out a policy for home, life, health, or automobile, your insurance premiums are the means insurance companies use to create their assets. These accounts can settle any problem you or other insured victims have. When an accident or claim occurs, whether it is a small accident or a major natural disaster, you then have the right to file a claim for restitution from your insurance company. As an injured policyholder, you want a responsive and compassionate response from your insurance company to help you through the financial difficulties you face.
It is standard practice for policy holders to file their claims with an agent at the local branch of their insurance company. It then becomes this representative?s responsibility to verify the details of the claim as well as work out the terms of any resulting benefits payments from the main insurer. Not all claimants deal with local agents, however. Frequently claim forms will be filed directly by an approved authority such as a medical professional, contractor or automobile repair shop, or the policy holder may even decide not to file an insurance claim at all. This usually occurs if the injury is negligible or another party has agreed to pay for the damage.
Following the filing of an insurance claim, the insurer may choose to have the claim investigated by an adjustor or appraiser. The adjustor or appraiser is a professional investigator who is responsible for making an objective evaluation of an insurance claim. The adjustor or appraiser is also responsible for determining if repair estimates are reasonable, in order to prevent repair contractors from presenting fraudulent or inflated bills. The adjustor or appraiser will usually have the final say as to the validity of the insurance claim.
A number of variables will determine how long it will take for claims to get approval and paid or else denied. First, the day and time that the claim is made by the policy holder determines turnaround time. If, for example, the claimant makes the claim at 7:00pm on a Friday, the insurer may not initiate the process until the following Monday. Also, the proof that is given may determine just how lengthy this process is going to be. If a claim is simply self-evident, it?s going to be approved right away?but if not, the process will require more time.
There are a multitude of reasons why an insurance company would not approve an insurance claim. The most obvious reason would be if the individual holding the policy (the claimant) has not paid his or her premiums; this renders the policy invalid. In cases where multiple individuals and policies are involved, another insurance company may have paid for services. This is most common for auto policies; the insurance company of the party responsible for the accident will most often be required to pay. Lastly, the payment requested must be for something covered in the policy. Several examples of claims that might not be covered are ?Acts of God,? an accident or damage caused by an unavoidable storm, and damage caused by recklessness or carelessness. It is always a good plan to read your policy closely to determine whether or not you qualify for benefits.
To apply for benefits under an insurance policy, you must first submit an insurance claim to the insurance company. The insurance company must first assess the situation to determine if it can pay benefits on the claim. Once the insurance company has completed its assessment, it will determine whether benefits can be paid.
Graham McKenzie is the syndication coordinator a leading South African Insurance information website, which amongst others specialises in Household Insurance .
