The Claim Process – How Insurance Claims Work
A Guide To How Insurance Claims Work
If a disaster struck in your home or business, would you know how to make an insurance claim?
Have you read your policy?
Do you understand your policy?
For most people, the answer to these questions is: “No!”
That’s why we’re providing this guide of “The 10 most important things you need to know about how insurance claims work.”
Step 1: Take Photos and Document Everything
- Before ANY action is taken, be sure to properly document all damage relating to the claim with photos and video if possible.
- If you don’t have proof that the damage actually occurred and you make temporary repairs, they may be denied or underpaid.
- Please do not throw anything away until your insurance company has inspected it.
- You may not need all of the photos you took, but it’s much better to have too many than not enough. It can be the difference between a successful and unsuccessful claim.
Step 2: Secure the Scene
- An important step to a property damage insurance claim is to secure the scene. However, do not put your life at risk to secure your home – only secure your property if it is safe to do so.
- Ensure you take action as quickly as possible, for example, if your home floods and you ignore the damage for several days and allow mould to develop, then you might have trouble getting the incident covered in full, as you’ve not mitigated your loss.
- It’s important to remember that you should not actually attempt to carry out full repairs. Instead, focus on stabilising the damage. If the damage is severe, a professional remediation and restoration company should begin the restoration process.
Step 3: Contact Your Insurance Company and Start a Claim
All insurance companies have well-established home insurance claims processes that begin with notification of a claim. Typically, there’s a phone number you can call to start the claims process.
It is important to note that if you think that you may need the services of a loss assessor. Many assessors have a particular process that they go through that helps them in securing the best settlement by presenting the full extent of the damage technically and comprehensively. Best to appoint a loss assessor as soon as possible, even before you notify your insurance company.
- You are obligated to report your claim to insurers as soon as practicably possible. Better still, contact a loss assessor and they can report to insurers once the initial assessment has been made and loss circumstances have been established.
- When reporting an insurance claim, only provide true facts that you are absolutely sure of in regard to the incident.
- Don’t assume, guess, or declare anything that you are uncertain of about your loss and damages, or the cause of loss – doing so can potentially complicate or harm your claim settlement.
- Depending on your situation, your insurance company might provide you with an interim payment or emergency funds that will help cover immediate emergency costs, such as Accommodation, clothing, boarding up etc.,. Make sure you keep the receipts for everything you spend during this period.
Step 4: Check and Understand your Insurance Policy
- Before starting your claim, check your insurance policy.
- Read your policy to understand exactly what is covered. This will put you in a better position to deal with your insurance company. The policy might have a section specific to your type of incident – like a fire or flood. Read that section carefully.
- You would assume that your insurance policy would be “jargon-free” and clearly state the terms of your coverage in a way that’s easy for anyone to understand.
- Unfortunately, this is not always the case, and you may need an experienced loss assessor to assist with the interpretation and application of the policy wordings and coverage.
Step 5: Start Compiling Paperwork
- Every insurance claim comes with paperwork. This is unavoidable, I’m afraid!
- Be sure to take the necessary time to complete this paperwork in thorough detail and only provide accurate and true information that you are fully certain about.
Step 6: Compilation, presentation and formulation of your claim
- It is 100% up to the policyholder and/or your loss assessor to fully assess and prove your full loss to your insurance company. Therefore its vitally important that you submit a detailed and comprehensive claim that includes all areas of your claim.
- A loss assessor is an expert in the assessment, presentation, formulation and negotiation of your claim, and they are your friend in the claims process. They’ll ensure that your position is protected and will get the best possible settlement terms for your loss. This is our business; we speak the claims language, and we are the professionals.
Step 7: Wait for Insurers Loss Adjuster to Evaluate the Claim
- After you start the claims process with your insurance company, they will send a loss adjuster to your property to begin the evaluation process. This is to determine how much compensation you should receive and whether or not the incident is covered by your policy.
- The adjuster wants to ensure the damage occurred during a covered incident and see how best to protect your insurance companies position. They don’t work for you; they work for your insurance company! If possible, you, or someone that represents you, should be present for this inspection, so that your rights are protected.
- If multiple items in your home were damaged, then the loss adjuster may request an inventory of the damaged items.
Step 8: Wait for your Insurance Company to make an Offer or Deny Your Claim
After the adjuster has visited your property and analysed your claim, there are two possible outcomes:
- The insurance company will present a settlement offer
- The insurance company will deny your insurance claim
In some cases, there may be long delays, requests for more paperwork or proof of loss, or even avoidance and disregard of your claim from the insurance company.
All insurance companies have a duty to promptly respond and process insurance claims, which is regulated by the Consumer Protection Code. However, this, unfortunately, is not always what happens and you may come to the point of considering involving a loss assessor is in your best interest.
Step 9: Negotiations and Disputes
- After receiving an offer from your insurance company, you can choose to accept or deny it. Some homeowners negotiate, claiming that certain items should be covered or that certain damages should be added to the claim.
- The negotiation process can be complicated – especially if you have limited insurance experience
- Disputes during the insurance claim process are not uncommon and can quickly become complicated. There could be disputes over what is covered under the insurance policy as well as the value of the items covered. These disputes in an insurance claim can sometimes lead to mediation or arbitration.
- In other cases, your claim may be totally denied. Your insurance company might have added a clause in your contract that allows them to deny your claim in certain situations e.g. warranties, conditions, exclusions etc.
- If your insurance company has denied your claim or offered you a low settlement, then you may want to hire a loss assessor. These professionals can negotiate with your insurance company for a higher settlement. They also know far more about insurance than the average policyholder.
Step 10: You Receive Payment from your Insurance Company
If you have legitimately suffered a covered incident, then your home insurance company will send you a cheque to cover all damages and other expenses according to the terms of your insurance policy.
You will also be required to pay the excess, and this will be “deducted” from your pay-out,
Other Things To Know About The Insurance Claims Process
Insurance claims vary as different situations can arise. Some insurance claims are completed in a few days; others can take weeks, months, or even years to settle.
One final thing to note about insurance claims is that a growing number of homeowners are choosing to hire a loss assessor. A loss assessor is a regulated insurance professional dedicated to expediting your claim while securing the best possible compensation.