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What Is an Insurance Claim?

insurance claim form

You might claim to cook the world’s best chili or claim that your boss is insane. But a “claim” in the insurance world is a whole different ball of wax.

An insurance claim is your formal request for payment based on coverage provided by your insurance policy. Here are some common examples:

• Home insurance claims are filed when you need reimbursement to repair or replace damaged or stolen property—for instance, if a heavy tree limb crashes through your roof during a storm.

• Car insurance claims are filed when you need reimbursement for repairs to your car or to pay for damage you cause to someone else’s vehicle or property.

• Health insurance claims typically are filed on your behalf when you visit a doctor, dentist, or other health care provider. However, if you pay for covered services (like a flu shot) out of your own pocket, you typically need to submit a claim for reimbursement.

• Life insurance claims are filed when an insured person dies so his or her beneficiary receives the death benefit payout.

Once received, a claim is reviewed by your insurance company to make sure it’s valid. You also may be asked to provide additional information, such as receipts or invoices, to prove what you paid for damaged property.

Certain types of insurance, like auto and home, may require that a claims adjuster or company representative inspect your damage. The adjuster also will estimate your losses and decide how much money you’re entitled to receive.

If a claim involves personal injury — like breaking your arm in a car crash or hurting someone else — always file a claim. Additionally, consider hiring an attorney who can negotiate with your insurance company to make sure you’re protected and receive a fair settlement.

5 Tips for a Successful Insurance Claim

Here are five tips to make your insurance claim go as smoothly as possible:

1. Contact your insurance agent for help if you have questions or think your settlement offer is too low.

2. Get the adjuster’s contact information so you can communicate directly with him or her if you have questions or concerns.

3. Request a different adjuster if you don’t think he or she is doing a good job. Ask to speak to the claims supervisor, claims manager, or customer service manager to voice your opinion.

4. Hire an attorney when there’s a lot of money at stake or if it’s possible that you or an injured person may rack up expensive medical bills in the future.

5. Consider not filing a claim that involves a small amount of damage, as it can cause a hike in your rates. First, ask your insurance agent or company what effect making a claim will have on your rates so you can evaluate the cost versus the potential benefit.