An insurance policy is a promise of assistance to you when things go awry, provided they fall within the policy’s terms and conditions. When such an event occurs, the policyholder needs to lodge a claim with the insurance company to activate the insurer’s response. After the claim is processed and accepted, the insurance company will hold up their end of the promise made in the policy. This is usually done by repairing or replacing damaged property or items, covering any legal fees or through payment.
What is a claim?
All insurance policies are designed with the intention of providing the insurer with financial compensation at a time when they would need it the most. When disaster strikes or something unexpected happens like a car accident, incurring sudden medical expenses or any other loss that is covered by your insurance policy, you are then eligible to make a claim with your insurance provider.
When a claim is made on an insurance policy, it is a formal notice to the insurance company that you have suffered a loss or damage that is covered under the policy and are requesting them to take action.
The claims process
Insurance companies usually try to make claims as smooth as possible but the policyholder must go through a few steps before it is processed.
When a claim is made, the insurance company will start to process the claim by assessing the event or circumstance leading up to it and determining if they fit the risks covered by the policy.
To start, it is critical for the policyholder to get in touch with the insurance provider as soon as possible when making a claim and having as much accurate information available as possible.
The policyholder will be expected to provide proof about it being a genuine claim as the insurance company will need to be certain the claim is covered under the terms and conditions of the insurance policy.
It is also important to keep all damaged items for inspection. Paperwork, notes, and other supporting materials should be kept ready as well along with any receipts or bills related to the claim. It is also a good idea to take pictures or videos that would support your claim.
Before Paying Claims
If the insurance company is not satisfied with the information you have provided, they will inform you regarding what information is needed from you within 10 business days of receiving the claim.
The insurance company might also decide to appoint a loss assessor, loss adjuster or even an investigator to get the more detailed information regarding the claim. Accordingly, the insurance company will give an estimate about how much time it will take to make a final decision about the claim. The policyholder will be notified within 5 business days of appointing that person and will be kept updated regarding the progress of the claim every 20 business days.
If the claim is complex, then the insurance company will confer with the policyholder to determine a different time frame for settling the claim.
The policyholder is entitled to have access to any information that was used by the insurance company to assess the claim unless the company is investigating the said claim. Insurance companies are not allowed to be unreasonable in denying requests for information and reports about insurance claims.
In the event that a mistake is identified with the claim, the insurance company is obliged to correct that information straight away.
If the claim is denied, the insurance company will then provide the policyholder with written reports detailing the reason to deny the claim and information regarding their complaints handling procedures.
Upon request, the insurance company will provide the policyholder with copies of any reports from the service providers that were used in assessing the claim.
Once the claim is accepted, the policyholder is eligible for repair, replacement or compensation of property by the insurance company. This is known as the benefit or payout. The insurance company will then figure out the value of the claim and provide appropriate benefits that the policyholder is entitled to according to the insurance contract.
For further information regarding the claims process or any other insurance-related query, please visit: www.nrilifeinsurance.com