Understanding the Claim Payout Process | Department of Insurance, SC (2024)

Understanding the Claim Payout Process | Department of Insurance, SC (1)Insurance exists to help out with expenses after a disaster strikes. You may be one of many policyholders who want to know how quickly you can expect to receive your payout after you’ve filed a claim. And while processing times do vary from company to company and are dependent on the type of claim, Insurance Information Institute (III)has provided a good overview of what you can expect.

The initial payment isn’t final

In most instances, an adjuster will inspect the damage to your home and offer you a certain sum of money for repairs, based on the terms and limits of your homeowner's policy. The first check you get from your insurance company is often an advance against the total settlement amount, not the final payment. If you’re offered an on-the-spot settlement, you can accept the check right away. Later, if you find other damage, you can reopen the claim and file for an additional amount. Check your policy to know how long you have to reopen claims.

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You may receive multiple checks

When both the structure of your home and your personal belongings are damaged, you generally receive two separate checks from your insurance company, one for each category of damage. If your home is uninhabitable, you’ll also receive a check for the additional living expenses (ALE) you incur if you can’t live in your home while it is being repaired. If you have flood insurance and experienced flood damage, that means a separate check as well.

Your lender or management company might have control over your payment

If you have a mortgage on your house, the check for repairs will generally be made out to both you and the mortgage lender. As a condition of granting a mortgage, lenders usually require that they are named in the homeowner's policy and that they are a party to any insurance payments related to the structure. Similarly, if you live in a coop or condominium, your management company may have required that the building’s financial entity be named as co-insured. This is so the lender (and/or, in the case of a coop or condo, the overall building), who has a financial interest in your property, can ensure that the necessary repairs are made. When a financial backer is co-insured, they will have to endorse the claims payment check before you can cash it. Depending on the circ*mstances, lenders may also put the money in an escrow account and pay for the repairs as the work is completed. Show the mortgage lender your contractor’s bid and let the lender know how much the contractor wants up front to start the job. Your mortgage company may want to inspect the finished job before releasing the funds for payment to the contractor. If your home has been destroyed, the amount of the settlement and who gets it is driven by your policy type, its specific limits, and the terms of your mortgage. For example, part of the insurance proceeds may be used to pay off the balance due on the mortgage. And, how the remaining proceeds are spent depends on your own decisions, such as if you want to rebuild on the same lot, in a different location, or not rebuild at all. These decisions are also driven by state law.

Your insurance company may pay your contractor directly

Some contractors may ask you to sign a “direction to pay” form that allows your insurance company to pay the firm directly. This form is a legal document, so you should read it carefully to be sure you are not also assigning your entire claim over to the contractor. When in doubt, call your insurance professional before you sign. Assigning your entire insurance claim to a third party takes you out of the process and gives control of your claim to the contractor. When work is completed to restore your property, make certain the job has been completed to your satisfaction before you let your insurer make the final payment to the contractor.

Your ALE check should be made out to you

Your check for additional living expenses (ALE) has nothing to do with repairs to your home. So, ensure that this check is made out to you alone and not your lender. The ALE check covers your expenses for hotels, car rental, meals out, and other expenses you may incur while your home is being fixed.

Your personal belongings will be calculated on cash value, first

You’ll have to submit a list of your damaged belongings to your insurance company (having a home inventorywill make this a lot easier*). Even if you have a replacement value policy, the first check you receive from your insurer will be based on the cash value of the items, which is the depreciated amount based on the age of the item. Why do insurance companies do this? It is to match the remaining claim payment to the exact replacement cost. If you decide not to replace an item, you’ll be paid the actual cash value (depreciated) amount for it.

To get replacement value for your items, you must actually replace them

To get fully reimbursed for damaged items, most insurance companies will require you to purchase replacements. Your company will ask for copies of receipts as proof of purchase, then pay the difference between the cash value you initially received and the full cost of the replacement with an item of similar size and quality. You’ll generally have several months from the date of the cash value payment to purchase replacements; consult with your agent regarding the time frame.

In the case of a total loss, where the entire house and its contents are damaged beyond repair, insurers generally pay the policy limits, according to the laws in your state. That means you can receive a check for what the home and contents were insured for at the time of the disaster.

We couldn’t have said any of this better than III did. The SCDOI gives credit to III for the information in this blog post.

Please click their link at the beginning to visit the original post and to access some excellent links.

Understanding the Claim Payout Process | Department of Insurance, SC (2024)

FAQs

What are the steps in the settlement of a claim? ›

Your insurance claim, step-by-step
  1. Connect with your broker. Your broker is your primary contact when it comes to your insurance policy – they should understand your situation and how to proceed. ...
  2. Claim investigation begins. ...
  3. Your policy is reviewed. ...
  4. Damage evaluation is conducted. ...
  5. Payment is arranged.

What are the steps the insurance claims process? ›

Six Steps in Making an Insurance Claim
  • Step One: Contact Your Agent Immediately. ...
  • Step Two: Carefully Document Your Losses. ...
  • Step Three: Protect Your Property from Further Damage or Theft. ...
  • Step Four: Working with Adjustor. ...
  • Step Five: Settling Your Claim. ...
  • Step Six: Repairing Your Home.

How long does an insurance company have to settle a claim in SC? ›

Insurance companies in South Carolina do not have a specific amount of time in which they must settle an insurance claim. Instead, state law requires them to settle claims with “reasonable promptness”.

What happens during the settlement step of the payment process? ›

The settlement period largely consists of clearing - the time between authorization and settlement where details are verified and the banks agree to debit and credit the accounts of each party. This communication is conducted through a payment network, which facilitates the exchange of transaction data.

How long does it take for insurance claim settlement? ›

The time limit set for the claim settlement process by the IRDAI is within 30 days of raising the claim. Most insurance companies settle the claims within 10 days. Read on to know everything about the claim settlement process.

What is the last step in the claim settlement process? ›

Now the claims settlement process arrives at its final stage: settling the claims payment. Armed with data from claim investigation stages, each insurance agency puts forth its demand of payment liabilities. Sometimes, if the figures and facts match, the settlement is made quickly and without hiccups.

What are the three most common mistakes on a claim that will cause denials? ›

Here, we discuss the first five most common medical coding and billing mistakes that cause claim denials so you can avoid them in your business:
  • Claim is not specific enough. ...
  • Claim is missing information. ...
  • Claim not filed on time (aka: Timely Filing)

What must happen in order for an insurance company to make a payout? ›

The insurance company must verify the claim. The insured party must file a claim. The insurance policy must be in place. The insured party must experience a covered loss.

What is settlement and its process? ›

Payment settlement involves collecting the funds for the amount recorded for an order. For example, when using credit cards, the settlement process specifically involves contacting the payment system and collecting the required amount of funds against the credit card.

What is the settlement method of insurance? ›

An insurance settlement is the payment that an insurance company offers to a customer in response to a claim. The settlement is the final amount paid to the customer, after their claim has been adjusted (and assuming their claim is covered by their policy).

What is the final step in a claim investigation? ›

At the end of the investigation, an insurer can either reject or accept the insurance claim. Then, an insurance adjuster tables the initial settlement amount.

Do I have to pay medical bills out of my settlement in South Carolina? ›

If money is recovered by way of settlement or trial, those proceeds will first be used to pay back your medical bills. In some instances, hospitals and other care providers will reduce your bill to assist us in reaching a fair settlement.

What is the average settlement for a car accident in South Carolina? ›

What Is the Average Settlement for a South Carolina Car Accident? While each car accident claim is different, the average settlement amount ranges from $10,000 to $41,000,000. This depends on the type of injuries you sustain from your accident.

What happens if insurance doesn't want to settle? ›

When an insurance company refuses to settle, it may be liable for the full amount of the excess judgment after trial, notwithstanding the lower policy limits. This duty of good faith aligns the insurance company's incentives with those of its insured.

What are the 5 steps to the medical claim process? ›

The Five Vital Steps in Getting a Medical Claim Paid
  • Patient Demographics. Getting up-to-date patient and insurance information is essential to getting claims paid. ...
  • Charge Entry. ...
  • Payment Posting. ...
  • Working the Accounts Receivables. ...
  • Sending Monthly Patient Statements.
Mar 22, 2023

What is the first step in any claims settlement process? ›

The first step in the claims settlement process is to inform the insurer about the incident.

What is the settlement phase of a lawsuit? ›

A Settlement is an agreement that can sometimes be made between the Plaintiff and the Defendant without having to go to trial, or before a lawsuit is filed. Once the settlement demand is drafted, it will be delivered, in the form of a letter from Chain | Cohn | Clark, to the defendant's insurance company.

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