Your insurance company makes this application available to you so that you can claim benefits on your insurance policy, whether it’s life, auto, or health insurance. You must file a claim before money can be paid to a contracted service, such as a hospital or repair shop for your car. When you file insurance claims, based on their evaluation of the situation, the company may pay the claim or not.
If you take out insurance, you must continue to pay monthly to the insurance company. These are called premiums. Generally, these premiums are used to increase the company’s available assets or to settle another’s claim. Occasionally an accident occurs that can cause financial damage, such as a tornado, a car accident or an accident at work. When this happens, the injured policyholder can file an insurance claim to receive money from that company.
When you file an insurance claim, you submit it to a local agent who works for the company and they have the responsibility to initiate the specific details of the claim. Then the agent negotiates payment from the main insurance company. Often, a licensed agency, such as a repair shop, contractor, or medical professional, can submit the necessary forms directly to the insurance company. If another party has agreed to pay for their mistake out of pocket or if the damage is minor, the policyholder may not want to make an insurance claim.
Once an insurance claim is filed, the insurance company usually has an unbiased appraiser or loss adjuster evaluate the damage and determine whether the repair estimates the policyholder has been given are realistic. This can help prevent fraud by companies inflating their estimates so they can get additional compensation. Most insurance companies accept the appraiser or appraiser’s appraisal as the final word. There are some insurance claims that may not be paid for various reasons. Some of these reasons may include:
• The applicant’s premiums have not been paid monthly and are in arrears
• Policy may be inactive
• Another insurance company may have agreed to pay for the damage stated in the insurance claim. This often happens in car accidents where one of the parties is held responsible for the accident.
• Failure to meet the conditions covered because most insurance policies specify specific areas that are eligible for benefits
• If the damage or accident claim was an unavoidable “force majeure” or was caused by negligence, your insurance company has the right to withhold payment.
The only way to officially claim benefits is to file a claim. Until your insurance company reviews the claim, it will remain that way and no payout.