Insurance claims are the forms that policyholders fill out and turn in to the insurance company. They must have an active policy to receive any benefits related to the accident. The insurance claims must be turned in before any money can be used for any damages caused during the accident. It is completely up to the insurance company to decide if the insurance claim has any merit and if it is approved for payment. They use their own assessments of each given accident to decide if it has merit.
People who purchase health, life, auto, or home insurance have to pay premiums (regular payments) to their insurance company or companies. The insurance companies usually use the premiums to settle the claims other people make or to boost their capital reserves and assets. When accidents and natural disasters cause severe financial damage, such as car wrecks, hurricanes and tornadoes, or large-scale accidents in the workplace, the policy holder can file a claim. He or she can then receive money from the insurance company to cover the costs outlined in his or her policy.
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 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.
A number of variables will determine how long it will take for claims to get approval and paid or else denied. First, the day and time that the claim is made by the policy holder determines turnaround time. If, for example, the claimant makes the claim at 7:00pm on a Friday, the insurer may not initiate the process until the following Monday. Also, the proof that is given may determine just how lengthy this process is going to be. If a claim is simply self-evident, it?s going to be approved right away?but if not, the process will require more time.
There are several reasons an insurance company may choose not to pay claims. One of the most obvious reasons is that the premiums have not been fully paid, thus inactive. In the case of automobile accidents in which one party is held responsible, the claim could be paid by another insurance company. Another reason accident or damage claims are rejected is because the policy does not cover one or more conditions outlined in the policy, such as carelessness or “Acts of God”. For example, an unavoidable “act of God” may be covered if it qualifies as a covered condition, but carelessness may not be if it is not a covered condition. If claims do not meet the specified “covered conditions” in the policy, the company has the right to deny coverage.
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.
Graham McKenzie is the syndication coordinator a leading South African Insurance information portal, which amongst others specialises in Car Insurance.
Tags: auto insurance, car insurance, finance, Household Insurance, insurance, life insurance, money, personal finance