Your insurance company provides you with this application so that you can apply for the benefits of your insurance policy, whether it is life, auto, or health. You must file a claim before money can be paid to any contracted service, such as a hospital or a repair shop for your car. When you file insurance claims, the company, depending on its assessment of the situation, may or may not pay the claim.
When you take out an insurance policy, you must continue to make monthly payments to the insurance company. These are called premiums. Generally, these premiums are used to increase the company’s available assets or to settle someone else’s claim. Occasionally an accident will occur that can cause financial damage such as a tornado, car accident, or work related accident. When this happens, the injured policyholder can file an insurance claim to receive money from that company.
When filing an insurance claim, you will file it with a local agent who works for the company and is responsible for initiating the specific details of the claim. The agent then negotiates payment from the primary insurance company. Many times, a recognized authority, such as a repair shop, building contractor, or medical professional, can file the necessary forms directly with the insurance company. If another party has agreed to pay for your mistake out of pocket or the damage is minor, the policyholder may not want to file an insurance claim.
Once an insurance claim is filed, the insurance company typically has an impartial appraiser or adjuster assess the damage and determine if the repair estimates the policyholder obtained are realistic. This can help prevent fraud by companies inflating their estimates in order to obtain additional compensation. Most insurance companies will accept the appraiser’s or adjuster’s assessment as the last word. There are some insurance claims that cannot be paid for many reasons. Some of these reasons may include:
• The claimant’s premiums have not been paid each month and are in arrears
• Policy may be inactive
• Another insurance company may have agreed to pay for the damages listed on the insurance claim. This often happens in car accidents where one party is responsible for the accident.
• Not be under the conditions that are covered because most insurance policies specify specific areas that qualify for benefits
• If the damage or accident claim was an unavoidable “act of God” or caused by carelessness, your insurance company has the right to withhold payment.
The only way to officially apply for benefits is to file a claim. Until your insurance company has evaluated the claim, it will remain as such and not as a payment.