Insurance is designed to protect against risks (unlikely events) such as damage to property or loss of property and loss of life or poor health. In the event of such risks, a person can file a claim with his or her insurance company so as to receive compensation (Jawadekar, 2004). The various specifics of the claim may vary depending on the insurance provider or the type of insurance taken such as health or life insurance or homeowner’s insurance. Making an insurance claim can be a very simple and less stressful process especially if all details are gotten correctly. In making a claim, information would be needed by the insurance company for them to ascertain whether to offer compensation or not. Making a claim involves a step by step process that ensures the insurance provider offers compensation. This paper would discuss the claim submission process, give reasons as to why a claim may be rejected and thereafter discuss the steps to be taken to check the status of the claim.
The claim submission process first begins with keeping a good record of all the necessary documents that would be needed in the case of making a claim (Miller, Clinton & Powell, 1989). This would mean keeping a good record of the receipts of the insured items and the insurance documents. A proper record of these documents guarantees that a claim would be made without any hitches. With the necessary documents, next would be reporting the claim to the relevant authorities (police) before engaging in any other activity. If a person is claiming for something that has been stolen, vandalized or damaged, he or she should report it to the police first. Reporting increase the chances that the claim would be settled quickly without others claiming that they are surprised with the information you are providing. It should be noted that many insurance policies have limits for the reporting of damaged or stolen goods to the police and hence reporting should be done immediately.
After reporting to the authorities, the subsequent step is to check your insurance policy. This process ensures that you confirm whether you are covered for the events that have just occurred and also whether there is a process that needs to be followed. Checking of the policy ensures that you are covered for the claim you will be reporting. Some risks may need quick action like for instance the case of the bursting of pipes. It is important to check the policy document to see whether the insurance provider would provide a workman to fix it or you use your local plumber. Many a times, the insurance provider makes local arrangements for you. Any action taken should be in accordance with the requirements of the policy you have taken (Jawadekar, 2004).
The next step in making a claim would be finding all the necessary documentation. The documents that would be needed include your policy document, the relevant receipts for the damaged goods or stolen goods and the reference numbers (such as police reports if you filed one). Having all these documents in place would ensure that the claim process runs smoothly without any hitches. After finding the necessary documents, it is most important to get all the facts right. A person should be clear about all the things that happened so that he or she can tell the story factually and consistently without any form of exaggeration or missing details. A claimant is required to have all the necessary information related to the claim. The important information to note includes the time and dates of the events, the details of everyone involved (such as the other party in the event of a car crash, or the workman who fixed the burst pipe), information on exactly what happened and what you are claiming for (how much money you expect to be compensated). These information should be presented truthfully and accurately to ensure the speeding up of the process of claim settlement (Jawadekar, 2004).
Armed with the necessary documents and information related to the claim, the next step would be to call the insurance company’s helpline. In case one used an insurance broker to purchase the policy, the broker should be called to assist in making the claim. The brokers might offer advice or support, or work with the insurance company to make sure you successfully submit your claim and get compensated. Calling the insurance company’s helpline enables the making of the claim itself. The insurance company’s helpline is usually found on the policy document or the company’s website. A claimant should be prepared to give all the details and information related to the claim worked upon on the previous steps. Different insurance companies have different methods of making claims with others preferring the making of claims online. After making a call or submitting the claim online and depending on the type of claim, the insurance company would advise on the next steps to be taken. For life and health insurance, the insurance companies have specific rules on how to make claims such as visiting a general practitioner (GP), requesting a GP to refer you to a doctor and contacting the health insurance provider to get approval for private treatment.
If a claim goes through without any glitches, a claimant would receive full compensation from the insurance company. A number of factors may be responsible for a claim not being approved for compensation. First, if a claim was not filed as soon as possible, the claim may be rejected by the insurance company. A given insurance policy may have a time limit for making a claim and if this time limit is exceed, the claim would be rejected. It is very important for a claimant to file for a claim as soon as possible to ensure that it is approved by the insurance company. Provision of shoddy or unclear details in the claim may also lead to the rejection of the claim. The easier a claimant makes things for the insurance company, the easier the claim would be processed and approved. If a claim does not have the specific details of the events that transpired or the details of the goods in question, there is a high likelihood that the claim would be rejected by the insurance company.
Exaggeration or the provision of false information may also lead to a rejection of the claim. If a claimant falsely represents the data related to the events or the goods damaged or stolen, there is a high likelihood that the claim would be rejected. Many claimants also have the tendency of overplaying the value of the claim which may lead to the insurance companies rejecting it. Many insurance companies are used to seeing claims that do not stack up. A claimant should stick to the relevant facts. Asking for too much than the actual value of the goods or property may lead to the invalidation of the claim. Another key reason that may lead to rejection of the claim is the lack of documentation of the damage. The lack of accurate documentations such as the taking of photos and videos of the damaged property may invalidate the claim. Documentation should take place as soon as the damage occurs. Lists of the items lost or damaged should be generated as soon as possible. The more solid evidence a claim has the easier and quicker an insurance company would accept the claim. Lastly, the lack of documentation of the claim process may also lead to a rejection of the claim. The lack of information or letters sent to the insurance company may lead to an invalidation of the claim (Miller, Clinton & Powell, 1989)
After making a claim, a person is usually issued with a claim number that enables tracking of the progress of the claim. A claimant should locate the claim number that was assigned when the claim was filed. Contacting the claim department via the telephone or online means ensures that one is up to date with the status of the claim. The claimant should provide the representatives with the claim number so as he/she can be able to check the progress of the claim. Some companies have online portals that make it easier for customers to track the status of the claims. A customer should always contact the claims supervisor in the case he or she cannot be able to see the status of his/her claim.
Jawadekar. (2004). Management Information Systems. Gardner Books. Print.
Miller, C. E., & Powell, L. G. (1989). How insurance companies settle cases. Santa Ana, CA: James Pub. Group.