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What is an Insurance Claim?

An insurance claim form is an application for the applying benefits provided by the insurance company. The insurance claims are documents that must be submitted to an insurance company from the policy holder. Then, before any money is disbursed to any medical or repair shop expenses, the policy holders must first file a insurance claim form. These submitted documents provide policy holders with an active policy to receive monetary compensation. Lastly, although the insurance forms are submitted and you are qualified, the final decision rests solely on the insurance company. Based on their own assessment, before any merit is paid they can approve or not approve a claim based on the evidence provided.

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.

Usually insurance claims are filed with the insurer?s local representatives. This person will become liable for checking out the particular details of the claim and then negotiating payments from the primary insurers. Usually, a recognized expert such as a building contractor, repair shop, or physician will file the needed insurance claim forms with the insurer directly. But at other times, the policy holder might not wish to file a true insurance claim if there are only minor damages or if the other party has chosen to pay for their mistake out-of-pocket.

Once your insurance claim has been filed, the company generally schedules an adjustor to review the case. Basically, the adjustor will determine if the claim is reasonable and whether the estimates for repair are fair. The rationale for the adjustor is to avoid fraudulent claims whereby some companies may increase their bills based on the fact that the damage is covered by insurance. In most cases, the insurance company will accept the adjustor’s analysis of the situation as the final word.

Many factors come into play in determining the time period for approval or denial of a claim. One deciding factor is the date and time the claim is made by a policy holder, which has a significant effect on turnaround time. For instance if the claim is made after close of business on a Friday, the insurance company will not receive the claim for processing until they open again on the following Monday. Another factor that determines processing time is the type of evidence presented in support of the claim. If the claim is obvious and clear cut, a decision can be made on the spot. If the claim is more complicated or missing information, then it will take longer to process.

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.

The only legally recognized manner of applying for benefits under an insurance policy is the filing of a claim with the insurer. However, until the insurer has completed its assessment of the circumstances, the claim will remain pending and there will be no pay-out.
About the Author:
Graham McKenzie is the syndication coordinator a leading South African Insurance information website, which amongst others specialises in Household Insurance .

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This entry was posted on Thursday, April 29th, 2010 and is filed under Auto Insurance. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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