What Is An Insurance Claim & How Do They Work? | MetLife (2024)

An insurance claim is a formal request from the policyholderto their insurance company asking for payment after a covered incident, such as a hospital stay, a natural disaster, theft, and more.

This payment – typically issued to the person named on the policy (or a designated beneficiary – helps pay for expenses associated with the covered incident.

In this article, we’ll discuss types of insurance claims, the general process of filing a claim, and help answer several FAQs on the topic. For specific claims information, be sure to refer to your policy or contact your insurer.

Types of insurance claims

There are as many insurance claim types as there are types of insurance.A claim is a request to an insurance company to pay for a covered service or event under the current insurance policy.

1. Car insurance claims

Car insurance claims may include:

  • A collision with another vehicle, person, or property, and property damage and/or bodily harm
  • Damage caused by an outside force (like a natural disaster, collision with an animal, and other no-fault instances)
  • Damage caused by uninsured or underinsured drivers, should they cause a collision with you (depending on the extent of your policy)

2. Homeowners insurance claims

Homeowners insurance claims may include several scenarios that relate to your home:

  • Structural damage
  • Injuries to visitors while they’re in your home
  • Damage to your personal property, including theft
  • Additional living expenses (ALE) if your home becomes uninhabitable and you need to stay in an alternate residence for a period of time

3. Renter’s insurance claims

Renter’s insurance claims may include incidents related to an apartment or other property you’re renting such as:

  • Theft from your property or vehicle
  • Damage to your personal propertyInjuries to people while they’re in your rented property
  • Damage from natural disasters or other predetermined instances

4. Life insurance claims

Life insurance claims cover a very specific set of circ*mstances, all related to the policyholder’s death. In the case of the insured’s death, the insurance company makes a payment to the designated beneficiary – the person(s) selected by the policyholder to inherit the policy’s assets.

How do insurance claims work?

Filing an insurance claim typically involves a few basic steps:

1. Start by checking your insurance policy details to see if your policy covers the incident and if there’s a time limit for filing a claim.

2. Gather important information, such as:

  • The names and contact information of those involved
  • The date of the incident
  • Insurance policy numbers of those involved
  • An incident, accident, or medical report
  • Photos if you’ve been in an accident, suffered damage to your home or property, or experienced a comprehensive, no-fault incident.

3. File a claim with your insurance company if your incident requires you to do so. You'll provide the details of the claim and submit the information to your insurance company via their preferred method (e.g. mail, online or digital app). Note that for some medical insurance claims, the healthcare provider's office may file the claim directly for you.

How is an insurance claim paid?

If your insurance provider approves the claim, they’ll remit payment to you or the service provider. Payment can be in the form of a physical check, direct deposit or sent directly to the service provider (such as a hospital, auto repair shop or contractor.)

What Is An Insurance Claim & How Do They Work? | MetLife (2024)

FAQs

What is insurance claims and how it works? ›

An insurance claim is a formal request by a policyholder to an insurance company for coverage or compensation for a covered loss or policy event. The insurance company validates the claim and, once approved, issues payment to the insured or an approved interested party on behalf of the insured.

How do you answer insurance claim questions? ›

Below are some best practices to consider:
  1. Contact a lawyer. ...
  2. Keep in mind that despite the friendliness of the person taking your statement, that person is not your friend. ...
  3. Ask specifically that your statement not be recorded. ...
  4. Give brief answers. ...
  5. Don't volunteer information. ...
  6. Answer only the question asked.

What is insurance claim in simple words? ›

An insurance claim is a formal request from the policyholder to their insurance company asking for payment after a covered incident, such as a hospital stay, a natural disaster, theft, and more.

What is insurance and how does it work? ›

Insurance is a contract between an individual or business with an insurance company to help provide financial protection and mitigate the risks associated with certain situations or events. There are various types of insurance available, including health, dental and vision, life, auto, and legal insurance.

What is claim and how does it work? ›

• A claim is the main argument of an essay. It is the most important part of an academic paper. • A claim defines the paper's goals, direction, and scope. It is supported by evidence. • A claim must be argumentative.

How does claims made insurance work? ›

What is a claims-made policy? With a claims-made policy, your coverage only kicks in when you file a claim during the policy period. As long as an insurable event happened after the policy's retroactive date, your insurer should provide coverage. A claims-made policy covers claims filed while your insurance is active.

What is the claim process? ›

Step-by-step procedure to file a claim

The first step of claim process is to contact your insurer and intimate about the claim. Fill your claim form and attach the relevant documents. A surveyor conducts damage evaluation. Acceptance of your claim. Get the claim amount.

What is an insurance claim quizlet? ›

a request by a plan member, or a plan member's health care provider, for the insurance company to pay for medical services.

What is an insurance claim explanation letter? ›

An insurance claim letter is an important part of any insurance claim process. It helps the accredited insurance adjuster understand how much money you are requesting to cover the damage. At minimum the letter should include information about the accident, the policy number, the date of loss, and the amount claimed.

What is a claim in easy words? ›

A claim is when you express your right to something that belongs to you, like your medical records or the deed to your home. When you make a claim or claim something, you're demanding it or saying it's true.

What is a claim exactly? ›

A claim is a set of operative facts creating a right enforceable in court. The term claim is generally synonymous with the phrase cause of action, though some contexts prefer to use one of the terms over the other.

What is a claim answer? ›

A claim answers a debatable question posed by a writer, which then is proved in a paragraph or essay. For example, "Dogs make better pets than cats" is a claim that can be argued.

How do you explain insurance for dummies? ›

Key Takeaways

Insurance is a contract (policy) in which an insurer indemnifies another against losses from specific contingencies or perils. There are many types of insurance policies. Life, health, homeowners, and auto are among the most common forms of insurance.

What is insurance in your own words? ›

Insurance is a way to manage your risk. When you buy insurance, you purchase protection against unexpected financial losses. The insurance company pays you or someone you choose if something bad happens to you. If you have no insurance and an accident happens, you may be responsible for all related costs.

How does insurance work at work? ›

Your employer may offer a choice of group health plans to eligible workers and cover part of the premium (monthly cost). The employer often pays most of the premium and the employee pays the rest.

What are the four stages of an insurance claim? ›

The insurance claim life cycle has four phases: adjudication, submission, payment, and processing.

How are claims paid out? ›

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.

What happens when someone makes a claim on your insurance? ›

What happens if someone claims on my insurance? If both you and the other driver agree that the accident was your fault, then your insurance provider will simply handle the claim and pay out. You shouldn't have to do anything once you've reported the accident.

What is the function of claims in insurance? ›

The first goal of the claims function is to satisfy the insurer's obligations to the policyholder as set forth in the insurance contract. In a property insur- ance policy, the insurer's promise is to pay for direct physical loss to covered property by a covered cause of loss.

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