What is an Insurance Claim?

Insurance claims are written records submitted by policy holders to an insurance company with which they have an active policy. This submission is made in the hopes of receiving monetary benefits. The claim serves as the application form for compensation under the terms of the policy, and must be filed by the policy holder before the insurance company will release funds to any medical facility, repair shop or eligible contracted service. Submission of an application is not a guarantee of approval; the insurance company will assess the situation before approving or denying the claim, and their decision is based on an independent investigation into whether the claim is meritorious and valid based on the terms of the claimant?s policy.

Those taking out policies for life, home, health, or vehicular insurance have to make payments, or premiums, regularly to the insurers. Usually such premiums are used for the purpose of settling others? insurance claims or for building up the insurer?s available assets. But sometimes accidents occur that cause true monetary damage, like car wrecks, tornadoes, or even accidents that are work-related. Then, the policy holder who is injured maintains the right to file a claim so that he or she will be able to obtain some money from the insurer.

Generally, you will work with an agent of the insurance company that is located in your area to file the insurance claim. The role of the agent is to review the specific elements of the claim and to work with the insurers to secure payment. In some cases, a local authority (such as a lawyer or construction contractor) may work directly with the insurance company to file the required documentation. But, if the injury is minor in nature or the issue may be settled without involving the insurance company, the policy holder can elect not file involve the insurance company by filing a claim.

Once your insurance claim is filed, an investigator (called an adjustor or appraiser),may be sent out by the insurance company. Their job as an adjustor is to evaluate your claim and determine is the amount of the claim is reasonable. This prevents fraud by contractors who may inflate bills for more compensation. Insurance companies accept the evaluation by the adjustor or appraiser as final word on 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.

Not all insurance claims will be recognized by the insurance company. Claims may be rejected for many different reasons. For example, a claim may be rejected if the claimant has not paid their premiums in full, causing their policy to lapse and become inactive. Claims may also be denied if another insurance company covers the damages itemized in the claim. This is often the case with car accidents where the other party is found to be at fault. Another reason for rejection is that the type of accident or damage claimed does not fall under the type of incident covered by the policy. The majority of insurance policies have guidelines that clearly set out what type of damages will be covered. If the claim is made for an incident that resulted from negligence or a natural and inescapable ?Act of God?, then the insurance company is within its rights to withhold benefit payments.

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 .