Insurance claims can be a handful, especially for first-time claimants. Out of the blue, you are faced with many uncertainties and processes. Some commonly asked questions when filing a claim are; what qualifies as an insurance claim? How does it impact my policy? What should I do if I am in an accident?
An insurance claim is a formal request made to an insurance company for coverage or reimbursement of losses. This request is often filed after an event or series of events that have caused damage to a person’s property or bodily injury.
Filing a claim does not automatically mean that you will have to pay more for your premium. However, each situation is different. Hence, it is advisable to speak with an insurance agent to understand how filing a claim might impact your policy.
Nonetheless, when an accident happens, your insurance company should be there to help you through the process. Here are five tips to ensure your claim is processed fairly and quickly.
But first, let’s look into an example of an insurance claim.
Example of an Insurance Claim
Filing an insurance claim can be a complicated and time-consuming process. And if you’re not careful, it’s easy to make mistakes that could result in your claim getting declined. Here’s Ken’s example:
Ken was working in an insurance firm as a student when he lost his laptop. He was confident the insurance company would settle his claim because he worked for them. But he was wrong. Ken needed to fill out his claim documentation correctly and should have mentioned some vital information. As a result, his claim was declined.
The story reminds us that we should be diligent when filing an insurance claim. Make sure to understand the requirements and provide all the necessary information. If you have any doubts, it’s always best to consult a professional. Otherwise, you could end up like Ken and be left empty-handed and dejected.
This article acts as a guide to assist you in ensuring that your claims are paid fairly and speedily. Here are the five tips you should know.
1. Understand the Various Types of Claims in Insurance.
There are two types of claims in insurance: first-party and third-party.
- A first-party claim is one where the loss directly impacts the insured individual. An example would be if you had a car accident and needed to repair your vehicle. You would file a first-party claim with your own auto insurance company.
- A third-party claim is filed by the insured where the loss directly impacts a person who is not the insured or the insurance company. An example would be if you got into a car accident and caused injury to another person or damaged another person’s property, you would file a third-party claim.
In addition to the types of insurance claims, you should know the following about your policy covers.
I. What Does Your Insurance Policy Cover?
Your insurance policy is a contract between you and your insurance company. It outlines what events are covered and how much the insurance company would pay should a claim arise.
You must know your policy to file the appropriate claim. Filing a claim for an event not covered by your policy will likely result in your insurer denying your claim.
Understanding your policy empowers you to know what’s covered and what’s not. If you have any questions, be sure to ask your insurance agent.
II. What is your Insurance Policy Type?
There are different types of insurance policies. The most common are auto, life, medical, home, and business insurance. We support clients in managing these and many other risks. (see our products page )
Each policy covers certain types of events that others will not. For example, most auto insurance policies will cover you if you get into a car accident. But they may not protect you if someone steals valuable items from within your car because there may be yet another more appropriate policy to cover those items.
Therefore, knowing your policy is critical in aiding you to apply for your rightful claim. Filing a claim for an event not covered by your policy will likely result in your claim being denied.
The second thing is to have a total understanding of your insurance policy.
2. Ensure You Have the Right Policy, and it is Clear to You
Not all policies are the same. Some will have more coverage than others. And some will have exclusions or limitations you need to be aware of from the onset.
It’s necessary that you understand your policy and what it covers. If you’re unsure, ask your insurance agent or company for clarification. They should be able to explain the details of your policy to you.
So, ensure that you have the right policy for your needs.
Once you have the right policy, ensure you understand the claims process, which brings us to tip number three.
3. Follow the Proper Insurance Claim Process.
Contact your agent or insurer as soon as possible after the accident occurs. Doing so ensures you begin the claims process as quickly as possible. Below is an explanation of how to go about your claim.
The Insurance Claims Process
An insurance claims process should not be confusing and overwhelming. Instead, you must understand how it works to file a successful claim.
The claims process has three main steps:
- Filing the claim
- Adjudicating the claim
- Settling the claim
Filing the Claim
The first step in filing a claim is contacting your insurance company and letting them know you must file a claim. They will then give you a claims form to fill out.
Be prepared to provide all relevant information about the accident, including dates, times, locations, and other essential details. Your insurer will need this information to adjudicate your claim correctly.
Be sure to fill out the form completely and accurately. If you make any mistakes, it could delay the processing of your claim.
Adjudicating the Claim
After you’ve filed the claim, your insurance company will adjudicate it. This involves looking at the facts of the case and determining who is liable.
Cooperate fully with your insurer’s claims adjuster. Adjusters are trained professionals who will work to obtain all the necessary facts, determine the proximate cause of the incident, and determine who is liable for the damages.
This can take some time, so be patient. Your insurance company will likely contact you if you need additional information.
Settling the Claim
Once the investigation is complete, your insurance company will settle the claim. This usually involves them paying out a certain amount to cover the damages.
Suppose you’re unhappy with how your insurer resolved your claim. In that case, you can contact your underwriter with your objection or visit the insurance regulatory authority (IRA) to file a complaint.
As you can see, it shouldn’t be a stressful process at all. Understanding the claims process makes it easier as you know what to expect.
P.S. Remember the above stages for the claim process always. They impact your claim as much as this next tip.
4. Provide Correct Details for Insurance Claim Settlement
Always provide correct details when filing an insurance claim.
Your insurer will use the details you provide to determine your settlement amount.
If you provide incorrect information, your insurance company may not pay out the total amount of the claim. Even more severely, you may lose your settlement claim altogether.
Be sure to provide accurate information about the accident and the damages sustained. If you’re unsure about something, ask your insurance agent for clarification.
Ensure you include all documentation related to the incident, including police reports, medical bills, and repair bills. This will help your insurance company process the claim quickly and efficiently.
Our final tip is one we always recommend and is, in fact, a must when it comes to ensuring a smooth and fair insurance claim process.
5. Always Consider Conducting Your Insurance Business with an Intermediary.
An insurance intermediary is a trained professional who facilitates the purchase and placement of insurance. They can help you find the right policy for your needs and assist you with the claims process.
Using an intermediary can be beneficial because they:
- Understand the insurance market and can help you find the right policy at the best price.
- They can help you understand your policy and what it covers.
- Support you with the claim process -assisting with claim forms, following up with insurance companies, and keeping you updated throughout the insurance process.
- They help keep accurate records of all correspondence with your insurance company, including letters, emails, and other documents.
- They help you keep track of the status of your claim and will be helpful if there are any disagreements along the way.
If you’re considering using an insurance intermediary, only use a reputable and licensed intermediary.
Filing an insurance claim is easier if you use an intermediary.
Rightful Insurance Claims
Following these tips can help ensure that your insurance claim is processed fairly and quickly.
When you file a claim, you’re asking for compensation to cover the costs of something that’s happened to you. Maybe your car was in an accident, or your home caught fire. Following the correct process makes your insurance company settle your claim speedily.
Nonetheless, filing a claim is the first step in restoring your life. But what happens when your insurance company doesn’t want to pay your claim? Or when they try to pay you less than you’re owed?
Having an experienced insurance agent on your side can make all the difference. We know the ins and outs of the insurance industry and how to get you the money you deserve. If you have any questions about the claims process, contact us.
Written by Caleb Mutemi, a digital marketer with an impulse for content strategy. Reviewed and approved by Ken Kairu, CEO of Dawit Insurance.