Insurance Claim
An insurance claim is a formal appeal made by a policyholder to their insurance provider, seeking coverage or compensation for a loss or event covered under their policy. The company will review and either approve or deny the request. If the claim is approved, the insurer will provide payment to the policyholder or an authorized party on behalf of the policyholder.
Insurance claims encompass many situations, from life insurance death benefits to routine and comprehensive medical examinations. Occasionally, a third party may file a claim on behalf of the insured individual. However, in most instances, only those named on the policy are eligible to receive claim payments.
Key Points
- An insurance claim involves a policyholder formally requesting coverage or compensation from their insurance company for a covered loss or policy event.
- The insurance company reviews and validates the claim, and if approved, provides payment to the policyholder or an authorized party on their behalf.
- In property-casualty insurance, like car or home insurance, filing a claim can result in increased future premiums.
How an Insurance Claim Functions
A paid insurance claim compensates a policyholder for financial losses. Individuals or groups pay premiums in exchange for the benefits outlined in an contract between the insured and the insurance company. The most common types of claims cover expenses for medical services, physical damage, loss of life, liability associated with owning property (such as homeowners, landlords, and renters , and liability for operating vehicles.
Impact of Claims on Property and Casualty Insurance
For property and casualty insurance policies, the frequency of filed claims directly influences the cost of coverage typically paid through premiums. Regardless of the accident’s extent or fault, more claims can lead to higher rates. If a policyholder files too many claims, the company might even refuse to renew the coverage.
Factors Affecting Rate Increases After Filing a Claim
If you file a claim for damage that you caused, your rates will almost certainly increase. Conversely, if you are not at fault, your rates might not be affected. For instance, if your parked car is hit from behind or your house’s siding is blown off during a storm, these events are clearly beyond the policyholder’s control and may not result in a rate hike.
Additional Factors Influencing Rate Increases
However, other factors can lead to higher rates, even if the recent claim was for damage you didn’t cause. These include the number of previous claims you’ve filed, the number of speeding tickets you’ve received, the frequency of natural disasters in your area (such as earthquakes, hurricanes, and floods), and even a low credit rating.
Varied Impact of Claims on Insurance Rates
Insurance rate increases can vary significantly based on the type of claim. Claims for dog bites, slip-and-fall injuries, water damage, and mould can signal future liability to insurers and often negatively impact rates and coverage continuation. Interestingly, speeding tickets might not lead to a rate hike, especially for a first offence. Similarly, a minor car accident or a small homeowner’s claim may not result in increased premiums.
Special Considerations
Understanding Rate Hike Variability
There are no universal rules for rate increases; what one company might overlook, another might penalize. Since any claim can potentially affect your rates, it’s crucial to understand your policy. Knowing if your first accident is forgiven or if a previous claim won’t affect you after a certain period allows you to make informed decisions about filing claims, aware of their potential impact on your rates.
Discussing Policies with Your Agent
It’s crucial to discuss your insurance company’s policies with your agent well before you need to file a claim. Be aware that some agents are required to report potential claims to the company, even if you decide not to file. Therefore, it’s wise to inquire about your insurer’s consultation policies ahead of time, rather than waiting until you need to file a claim.
How Do I Initiate an Insurance Claim?
To start an claim for damages covered by your policy, contact your insurer via phone or online. Once initiated, the insurer will gather the necessary details and may request evidence like photos or documentation. An adjuster might also be sent to assess the claim’s validity through interviews and evaluations.
Why Does Filing a Claim Increase Insurance Premiums?
Impact of Filing Claims on Insurance Premiums
Filing a claim can sometimes lead to increased premiums in the future, although not always. Some insurers may forgive the first accident, for instance. Increased rates following a claim typically reflect the insurer perceiving a higher risk and adjusting costs accordingly. If you can demonstrate that a claim was filed where you were not at fault, you may be able to contest such increases. However, filing multiple claims in a short period could lead the insurer to decide not to renew your policy, regardless of fault.
Related Terms
Understanding Uninsured Motorist Coverage (UM): Operation and Requirements
How Uninsured Motorist (UM) Coverage Works
Uninsured motorist (UM) coverage is designed to compensate a policyholder for damages resulting from an accident involving a driver who lacks or is involved in a hit-and-run incident.more
