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.
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.
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.
Several things affect how long it takes an insurance company to approve or deny a claim for payment. The day and time when the policy holder makes the claim can affect turnaround time. For instance, claims made on a Friday afternoon or evening, Saturday, or Sunday are often not processed until Monday. Additionally, the evidence presented can affect the process. Self-evident claims can be processed fairly quickly because the evidence is straightforward. More complicated claims can take longer to process, as the insurance company may decide to investigate the case further, and police reports, property assessments, etc. may come into play.
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.
The only way to request payment under the terms of a policy of insurance is to complete an official claim form. However, whilst the insurance company is reviewing the circumstances it stays as just a claim, and payment is not guaranteed.
Graham McKenzie is the syndication coordinator a leading South African Insurance information website, which amongst others specialises inCar Insurance.