What Is Insurance Claims? Everything You Need To Know

An image showing disability insurance

A policyholder formally requests coverage or reimbursement for a covered loss or policy occurrence by submitting an insurance claim to their insurance company. After reviewing the claim, the insurance company either approves or rejects it. The insurance company will pay the insured or someone they authorize if the claim is authorized. Life insurance death benefits, as well as regular and extensive medical checkups, are all covered by insurance claims. Someone other than the insured may be able to submit a claim under certain situations. But usually, only the named policyholders may get their hands on the money.

An image showing disability insurance

What Is An Insurance Claim?

An insurance claim is a written request from a policyholder to their insurance company for help or payment for a loss or event covered by their policy. The insurance company either agrees with the claim or says no. If accepted, the insurance company will pay the insured person or an interested party approved to act on their behalf.

The insurance company will check the claim to ensure the event happens and that the policy covers it after the claim is mentioned. If the insurance company agrees with the claim, they will pay the covered person or any third parties involved.

Types of Insurance Claims

There are different types of insurance claims; here are a few of them;

Health insurance claim

A health insurance claim was made to pay for the hospital bills. The hospital or doctor usually takes care of these claims, so the covered person doesn’t have to do anything. The policyholder might have to step in if the claim is turned down.

Accident and Property Claims

A house is usually one of the biggest things a person will buy their whole life. When someone files a claim for damage caused by a covered peril, the claim is first sent over the Internet to an insurance company official, usually called an agent or claims adjuster.

Unlike health insurance claims, it is the policyholder’s responsibility to report property damage they own. Based on the type of claim, an adjuster looks at the damage to the property and decides how much the cover should be paid. Once the damage is confirmed, the adjuster pays or reimburses the person under protection.

Claims on life insurance

The nominee files a life insurance claim if the insured dies, which is undoubtedly awful. Along with a claim form, the recipient may need to send in things like a copy of the death certificate, FIR, PAN, and other papers. After the insurance company checks everything, they send money to the beneficiary’s account.

Renters Insurance

Your renter’s insurance may cover things that happen in your apartment or other rented property, like:

  • Taking something from your home or car
  • The harm is done to your things. People are getting hurt while they’re in your rented home.
  • Damage from natural disasters or other planned events

Group Life insurance

A group life insurance plan allows companies to give their workers life insurance. In the sad event that an employee dies, the plan’s nominee can make a claim and get the sum guarantee.

Auto Insurance

Anyone who has car insurance must claim after an accident, even if someone else was at fault. It could be anything from personal injury and rental car coverage during the service time to loss of vehicle value and payment for property repairs.

How Insurance Claim Works

When an insurance claim is paid, the insured is not financially hurt as payment for the contract between an insured party and an insurance company. A person or group pays premiums.

The most common types of insurance claims are for medical supplies and services, property damage, death, responsibility for people who own homes (homeowners, landlords, and renters), and liability for driving a car.

Regarding property and liability insurance, the rate you pay for coverage (usually in the form of monthly payments called insurance fees) is directly related to the number of claims you file.

This is true no matter how bad the accident was or who was at fault. The more claims an insured files, the more likely it is that their rates will go up. Sometimes, the insurance company may decide not to cover you because you’ve made too many claims.

If the claim is about damage you did to someone else’s property, your rates will almost certainly go up. Should your rates go up, however, you are not to blame; they might not. For instance, getting hit from behind while parking your car or having the siding on your house blown off during a storm is not the policyholder’s fault.

But things like the number of claims you’ve made in the past, the number of speeding tickets you’ve gotten, the number of natural disasters (earthquakes, hurricanes, floods) that happen in your area, and even a bad credit score can make your rates go up, even if the most recent claim was for damage you didn’t cause.

How to Initiate a Claim

If you have insurance and have been damaged in a way that is allowed by your policy, you can file a claim by calling your insurance company. You can do this over the phone or, more and more often, online.

After you file a claim, the insurance company will ask you for relevant information and may also ask for proof (like photos) or supporting documents. The insurance company may also send an adjuster to talk to you about your claim and decide if it is valid.

How Is Insurance Claim Paid?

People who buy homeowners or other types of property insurance may get either cash or a settlement based on the cost of rebuilding their home.

Considering how much the property has lost in value over time, its present value is its actual cash value. On the other hand, a substitute cost is how much it would cost to buy a new piece of property or personal property inside the property.

If you are paying based on the item’s real cash value, you will not get enough money in the claim to cover the total cost of buying it in the first place. This is because things lose value over time.

Take the case of a computer you got five years ago for $1,000. The things in your house, including the computer, are now broken because of a fire. Because of wear and tear over the past five years, your computer is now only worth $700, so the insurance company will pay you that amount.

If your insurance covers the cost of replacement, on the other hand, you will be able to get the total value of a brand-new computer of the same type.

You may also be able to choose a replacement cost settlement over a cash settlement, but this may cost more depending on your insurance policy. Besides property insurance, you can also choose to get a settlement for the cost of replacing your car.

If you file insurance claims, it could change how much your price is when you buy insurance again. When you make more insurance claims, there’s a greater chance that the insurance company will have to pay you for your coverage.

Because of this, the more insurance claims you make, the more likely your price will increase. Things like damage you did to someone else’s property or having bad credit can also make your rate go up.


It is wise to consult with your insurance agent before making a claim. Some agents must inform the firm if they explore filing a claim but ultimately decide not to. For the same reason, you shouldn’t ask your agent about your insurer’s policy on consultation until you need to file a claim.

Leave a Reply