CLAIMS PROCESS
Welcome, I am Ashlynne. I am one of the owners of VP Custom Insurance Solutions. My goal in writing this blog is to guide you in learning what insurance is. Answering those questions that no one seems to take the time to answer. To pull the curtain aside and let you peek into the workings of an agent. Now let’s get back to what you came here for.
Uh Oh, you had a fire in your home or business. Now what do you do? This is a scary moment for anyone. Realizing that all you have and worked for is turning to ash before your eyes. No one can really relate to you unless they have been through it too. You hear the horror stories of how insurance companies refuse to payout on the claim or took longer than necessary to get the money to people. Honestly, this is actually quite rare and if you have an insurance agent, like VP Custom Insurance Solutions, than you have an alley that can help you. I am going to walk you through what a claim is, how you can report it, what the carrier’s process is, and your options that you have available to you if your claim is denied.
When anyone hears the word “claim” it instantly puts anxiety into the air. Society has put horror around the claims process and the what if’s. The rare occasions of bad service on a claim broadcasted to the world as if they are the normal. It has caused all of us to shrink at the word and shy away from it. Claim is a bad word that should not be uttered unless needed. In my experience, most of the discomfort comes from not knowing what a claim is, if the claim is covered, and what the process is for the carrier. I want to provide you with the tools to be prepared when a claim happens and make it through the process with as much ease as possible.
What is a Claim?
Let’s break this down. A claim is essentially a formal request to your insurance carrier to provide you with reimbursement of a covered loss. Your insurance policy is a financial agreement between you and your carrier to help with losses that are a financial burden to you, like the loss of a home. Most of us do not have $300,000+ to rebuild our homes and purchase more furniture and put our lives back together. This is where insurance comes in. It is a two party contract between the policyholder (you) and the insurance carrier. You submit your claim request to the carrier asking for them to hold up their end of the contract. As long as the loss is covered by your policy (contract), then the carrier will compensate you for your loss. Something to remember is that your policy is not there to cover the normal wear and tear and upkeep of your property. It is there for the big losses that happen unexpectedly. You are paying to cover the “IF” and the company is there to make sure you are able to replace, recover, or fix what has been lost. In the case of liability, they are there to help pay for the negligence so that you are not paying it out of pocket. One thing to remember is that most policies have deductibles. If the loss is not above the deductible, the carrier will not cover it.
“Insurance is like marriage. You pay, pay, pay, and you never get anything back.”
How to report a claim
We went over what a claim is, but how do you get it to the carrier? Each company is different but essentially they all have the same methods. The first thing to do is call the appropriate authorities if needed, such as for a theft or accident. Make sure to get a copy of the report for your records and to give to your carrier. The next step is documentation. In this case there is no such thing as too much information. It is better to have more information than is needed, then not enough. You will want to collect photos, names & phone numbers, reports, a description of the damage, items stolen, etc. Then take a look at your policy. Most policies have pages at the front or back that tell you how to report your claim and may even include a claim form. If there is a form, go ahead and fill it out. Next you are going to want to contact your carrier and/or agent. If have access to go directly to the carrier, I suggest you do even if you have an agent. Reason being is that I find it cuts out the middle person (agent) and allows for the claim to progress more smoothly and quickly. If you have to go to your agent, your agent should be collecting all necessary information from you and passing it to the carrier. Once established, the carrier will assign a claims adjuster who will contact you. A claims adjuster is an employee of the carrier whose sole job is to collect information through investigation and the policy holder, review the policy and make the call on if the claim will be covered and for how much. When it comes to filing a claim, I suggest you file your claim as soon as possible. Depending on the type of claim, you have anywhere from 30 days to 3 years to file a claim, but in best practice, I would argue the “sooner the better” method.
What is the process after submitting a claim?
You have submitted your claim and feel like you are just waiting on pins and needles for a response. If you have done your homework and provided as much information and documentation as possible, the claim process on the carrier’s end should run quickly. If they have to dig up most the information themselves then the process is understandably longer. When the carrier receives your claim it is put into a queue to be handled. A claims adjuster is then assigned to that claim. This can be same day or if there is a lot of volume being handled, it may take a couple days or so. Once a claims adjuster is assigned, they are going to review the information they have and then give you a call or email to go over any additional details and provide you with a claims #. Keep this number in a safe place, you can use it to check on your claim or provide it to customer service for them to pull up the information. Once the adjuster has finished their investigation and they have concluded that the loss exceeds your deductible, they will evaluate the amount of money to be paid out based on current costs and other variables, such as depreciation. Once that has been finalized, a check will be sent to you and/or your lender to compensate the loss.
What if my claim is denied?
There is always the possibility that a claim will get denied for several reasons. If the loss is not above the deductible, the type of loss is not covered, or it is found to be another parties fault. The one that worries us most is the loss not being covered. The possibility of being stuck trying to fix the damage on your own. In cases like this, it is hard to overcome but not impossible if you believe you have a case. You have the right to appeal a claims decision and get the chance to prove why the adjuster made the wrong decision. The key word is “prove”. You will need to have on hand the information that shows why your claim should be approved. It can be bids showing the work is more than the deductible, paperwork showing proof of ownership, and any other documentation you are able to come up with.
Having an insurance agent, like VP Custom Insurance Solutions, can help you through this process and provide you with assistance. Make sure you understand your policy and what you have agreed to. We are always here to help you with your policy and your needs. Contact us today and ask us about how we can help guide you.