What Is an Insurance Claims And How Does It Work

An insurance claim is a formal notification to an insurance company, asking for a payment based on the terms of the insurance policy or contract. Insurance companies provide various protections to their clients in case of financial losses or damages in exchange of regular monthly payments, known as premiums. In return, they are entitled to compensate their customers by covering the losses as mentioned in the insurance policy. The insurance claim process is a relatively straightforward one, but when applied, can lead to various complexities for the insured (person who is covered under the policy) and the insurer (the person or entity providing coverage).


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    How insurance claims work

    Life is full of risks and in order to manage those risks, people tend to protect themselves by obtaining insurance coverage which allows them to transfer their financial losses to another party in exchange for a premium.

    The losses can arise from unforeseen circumstances such as fire, theft, flood, medical condition etc. In order to limit those losses people buy insurance which is a legally binding contract. The contract describes the nature of the insurance (auto, home etc) and the responsibilities, limitations and obligations of the insurance company.

    When a person suffers losses which have been defined in the policy, he/she is entitled to file for claim, which documents the loss in detail and the subsequent worth attached to it. In return, the person will be reimbursed or will be provided coverage for the maximum amount of the policy.

    However, in order to ensure that the process pans out smoothly, the victim or the insured person must assist the insurance company by providing details of the incident and must prove that the damage was not caused due to his or her own negligence. The company then evaluates the damage by comparing previous cases and assigns a value to that claim. If an ambiguity exists, and the claim is not provided, the insured person is entitled for settlement or may defend himself or herself via a court trial.

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    The insurance policy can be obtained by an individual or can be in the form of a pool insurance where large companies purchase insurance policies on behalf of the whole organization. An insurance policy may be available for all sorts of potential risk situations.

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