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What is an Insurance Claim?

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insurance claim formOn the day we need to make an insurance claim it is then that we most appreciate our decision to actually choose a policy. This is when we apply for the benefits of the claim because we are now entitled to them. Just because we make a claim it doesn’t mean that it will automatically be granted; the insurance company might refuse to pay if they believe they have a good reason to do so. If they do decide to pay out then in a lot of cases we won’t see any of the money, but instead it will be given directly to those who provided the service that the insurance covered. For example, if we have health insurance the insurer will usually pay the money claimed directly to the health care facility.

How to File an Insurance Claim

We will take out an insurance policy to cover certain eventualities such as damage to our property, loss of our property, damage that we cause to other people’s property, and the costs we incur due to health problems. Once we choose a policy we will be expected to make the premium payments each month to keep the policy alive; if we fail to meet these payments then this could invalidate the policy. Sometimes the event we have been insuring against will occur and it is then that we will need to make a claim.

Once we have decided that we are entitled to benefit from the policy we will make a claim with our local insurance representative. It will be then up to them to investigate if we are entitled to make such a claim before they will agree to pay out. With something like health care costs it will often be that the hospital where we received treatment will make the insurance claim on our behalf.

Just because we have to right to make a claim doesn’t always mean that we will make such a claim. If we happen to scratch somebody else’s car, or they dent ours, we might just decide that this is minor enough to settle without involving the insurance companies – that way we will hold onto our no claims bonus. The usual outcome will be that the person who caused the minor damage will pay out of their own pocket.

An adjustor is a representative of the insurance company that will sometimes be sent to investigate the claim. They will be looking for anything that could invalidate the claim and to determine how much money needs to be paid out. When they are finished the adjustor will submit a report.

The Reasons Why an Insurance Claim Might be Denied

There are many possible reasons why an insurance claim might be denied. It could be that the event that has occurred isn’t actually covered by the claim, or that there is some evidence of fraud. This is why it is so important that you fully understand any insurance policy you have bought. Another reason why an insurance claim might be denied is that you have failed to meet your side of the bargain; i.e. you have failed to make regular payments.

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Meet the Author

Anthony Carter currently resides in Fife, Scotland with his wife Lisa, and their three wonderful children. As a senior editor for various publications, if he's not reading and writing, you would find him photographing and traveling to some of the most far-flung locations around the world.


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