How to File an Insurance Claim

It’s a beautiful day with clear skies and bright sunshine. The birds are singing and there’s a gentle breeze rustling the leaves in the trees. You take a deep breath and savor the sweet scent of honeysuckle. You think all is right with the world, and then… it happens.

It can be a car slamming into your rear end at a traffic light. The load in your washing machine getting out of balance and walking itself away from its resting place, ripping the drainage hose from the wall. Worst of all, it can be the phone call telling you that a loved one has died.

Life events happen on beautiful, sunny days just like they happen on gray, overcast days. In fact, accidents can occur anytime, and an important part of dealing with those events often includes filing an insurance claim. Any incident that warrants an insurance claim is going to be, by its nature, unpleasant at best. But not knowing how to navigate the process of filing an insurance claim can quickly turn the unpleasant into the horrific and render the tragic unbearable.

Car Insurance Claims

You may be the world’s most cautious driver who only travels on crystal clear days, but still the odds are that you will be involved in at least one accident every 18 years and a total of three to four over the course of your driving lifetime. That means sooner or later you are going to have to file an auto insurance claim. It doesn’t matter how the accident happened or whose fault it was — what you do afterward can make a huge difference in how the situation is resolved.

After you make sure you and any passengers are ok, you should call the police. An official record of the accident, including who and what was involved, will stop any surprise victims from popping up later to claim they were harmed. Official documentation of an accident scene is not enough. If you are able, you should create your own record of the scene, conditions, people involved, and what happened. Taking notes, whether on paper or digitally, about what occurred immediately afterward ensures that your recollection of events won’t be tainted by false memories created by retelling the story repeatedly.

At the very least you should gather basic information about the other vehicle(s) and driver(s), including license plate numbers, make and model of vehicles, and other drivers’ names, license numbers, and insurance information. Since most cell phones have cameras, it’s a good idea to supplement your notes with pictures. Photograph the scene, damage to the vehicles, any skid marks, road hazards (potholes, obstacles, etc.), and signs. This is a good opportunity to play CSI and document the scene, safely, from multiple angles.

Filing the Claim

Never, ever forgo reporting the accident to your insurance company, ever! That cannot be stressed enough. Reporting an accident is not the same as filing a claim, and if you choose not to file a claim, chances are your premium won’t increase. However, if you don’t report the accident, your insurance can be cancelled because your policy says you are required to report all accidents. That includes cases where the other driver is clearly at fault, such as a rear-end collision, even when the other driver insists they will pay you out of their pocket to avoid reporting it.

As a rule, you have 24 hours from the time of an accident to report it to the insurance company, so don’t feel pressured to use your cell phone to call from the scene. In fact, it’s often best to wait a while for the adrenaline to leave your system so that when you call your insurer you will be calm and less apt to say something you might not really mean — such as, “It’s all my fault.” When you do call, make sure you note the day and time and be sure to get a claim number, the name and phone number of the adjuster, and when you can expect a call.

The most important thing you can do at each step of the claims process is to ask questions. If something is unclear, ask for an explanation. If the other driver is at fault, ask what you can do to avoid having to pay your deductible out of pocket while waiting for reimbursement from the other driver’s insurance. If you need to rent a car while yours is being repaired and your policy covers that expense, ask what the limits and rules are and how you go about being reimbursed.

The adjuster and the insurance company will both try to pressure you to sign off on the amount they are offering and to have the work done at a shop they recommend. It is important to understand that you do not have to accept the adjuster’s estimate and you can go to another shop if you wish. You can even hire your own adjuster to estimate the damages, although this cost is a 100% out-of-pocket expense for you.

Resolving Disputes

You are entitled to question how the adjuster arrived at their estimate, including whether or not they specified original equipment manufacturer (OEM) parts or less expensive replacement parts. You are not obligated to accept the less expensive parts and can insist that the claim be redone to include OEM parts only. If you are still not satisfied with the offer, you can take your dispute to the claims manager at the local or regional office. It is not uncommon for the adjuster and claims manager to be paid based on performance, so a call from the home office is something they will want to avoid.

If you cannot come to an acceptable agreement with the claims manager and still believe you are being low-balled and treated unfairly, contact your state insurance department. Each state’s department can be found online, and they all offer some form of dispute resolution or investigation. A call from the commissioner’s office may be just the thing you need to loosen the claim manager’s grip on payments. If all else fails and the potential difference between what you’re being offered and what you think you should be getting is significant enough, call an attorney.

Homeowners Insurance Claims

Damage to your home can be especially traumatic, because home is where we expect to be safe. Homeowner damage can be non-life-threatening, such as a broken pipe in the basement that causes extensive water damage, or extremely dangerous, like a tree crashing through your roof. As with an auto accident, the first thing to do is to make sure everyone is accounted for and safe. Next, you should take whatever steps you can safely take to prevent further damage, such as turning off the water main in the case of a broken pipe.

If your loss or damage was the result of someone else, such as a burglary or a car that crashed into your house, you will need to notify the police and have a report prepared. If a guest is injured in a slip and fall on your property, your first action should be to get them medical attention. Just like with a car accident, as soon as possible after the incident you should make notes about what occurred and document as much as possible with photographs.

The Claims Process

Unlike car insurance, there are no reporting requirements when it comes to damage or losses to your home. That means if you have a $1,000 deductible and $750 worth of damage or loss, you might be better off not reporting it to the insurance company at all. If the damage or loss is greater than your deductible, you may still want to exercise restraint in filing a claim for a few hundred dollars that may result in a long-lasting hike in your premium rate. There are also no requirements that a report be made within 24 hours, although sooner is always better.

Theft Claims

If your home was burglarized or vandalized, your insurance company will send you claim forms that must be filled out in order to process your claim. You will need a copy of the police incident report, which should include the case or file number along with the date and time of the incident and the officer’s name. Using your home inventory, carefully document everything that was taken or damaged. Gather any original receipts or other documents that can be used to help substantiate the value of the stolen items. Include photographs of any damage that occurred as part of the break-in, as well as any photos you have of your missing possessions.

Physical Damage

Document damages thoroughly with pictures taken from different angles. Take whatever steps are necessary to prevent further damage to your home. This includes pumping out standing water, or covering broken widows and other breaches in your home’s exterior to prevent the elements from getting in and making things worse.

When you contact your insurance company, ask how quickly an adjuster can be dispatched to appraise your damage. If it is going to be an extended period of time, ask what steps you can take to temporarily patch things up without inhibiting the adjuster’s ability to accurately access the damage.

Keep receipts for everything you spend to secure your home, including the cost of tarps and other materials. If you need to bring in a professional to board up windows, remove a tree, or climb up on your roof to secure a tarp, document the work performed and the cost. When the adjuster arrives, escort him as much as possible as he inspects to make sure he’s aware of and makes note of all of the damage. Make copies of all documents that you give to the adjuster and be sure to carefully review his entire report and question anything that appears incorrect. If the adjuster disagrees with your opinion on missing items or other information, ask that your objections be noted in the report.

Keep detailed records of all conversations you have with the adjuster as well as other company representatives. Do not begin any work without written authorization from the adjuster giving you permission to begin repairs. Ask that any assurances or promises the adjuster makes be put in writing and signed. Ask the adjuster or company representative how much time you have to get repair estimates and what types of documentation the insurance company will need to pay the claim once work is completed.

Final Payments

If you have to relocate from your home while repairs are being made and your policy pays for temporary housing, be sure to ask about reimbursement limits. Do not sign off on any payments as being final until you are completely satisfied with the repairs and back in your home.

Disputes

Homeowner claims can run from a few hundred dollars to hundreds of thousands of dollars, and that means there is plenty of room for disagreements. This can often occur when homeowners believe they were told one thing by an agent but the reality turns out to be different. If this occurs, ask that everything you are being told about limits and exclusions be provided in writing. In most cases, the only recourse for these types of issues is to hire an attorney who specializes in insurance law.

In cases where the insurance company’s adjuster delivers an estimate that is out of line with the estimate you received from contractors and you are unable to reach an agreement, you have the right use a public adjuster. The National Association of Public Insurance Adjusters has a referral service. Look for an adjuster with several years of experience, solid references, and a valid state license.

Life Insurance Claims

Filing a life insurance claim can be done at anytime after a loved one dies. The process is straightforward and begins with a call to the insurance company to request claim forms. A completed form must be submitted for each beneficiary and accompanied by a certified copy of the policyholder’s death certificate.

Insurance companies are under no obligation to track down the policyholder’s beneficiaries, no matter how long the policy has been in effect. That means that even if the insurance company has an unpaid policy on record where the policyholder would be 120 years old, they do not have to find the beneficiaries to pay the benefit. If after several years you believe there may still be outstanding policies, contact the National Association of Unclaimed Property Administrators to search for unclaimed benefits. The MIB Group will conduct a search of 500 member insurance companies for surviving spouses or children of deceased individuals at a cost of $75.

Benefit Disputes

Insurance companies can and do seek to delay or deny payments, particularly when the policyholder dies within two years of buying the policy. Insurance companies often use the pretext that the policyholder may have concealed a medical condition that would have made him or her ineligible for coverage. Many times the problem occurs when an agent assures an applicant that they don’t have to mention certain conditions. If a claim is denied, the only recourse is to hire an attorney who is familiar with life insurance law and claims.

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