Behind the Scenes of the Insurance Claims Process

Have you ever wondered why the insurance claim process sometimes is quick and in other cases, it seems like it takes forever to get that check? You are not alone. There are a lot of people that do not understand the insurance claims process.

Many people do not actually understand the insurance process at all. Over 50% of homeowners do not really understand their homeowner’s coverage and have never read their policy. A better understanding of the insurance claims process can be very enlightening and help you to make informed choices moving forward.

The Top Three Coverages

Most people have three types of insurance policies that they are dealing with. Homeowners, automotive, and medical insurance. Each of these policies provides different types of coverages and the insurance claims process can be a bit different.

We will examine all three types of insurance, review the typical insurance claims process, and provide tips on how you can get the most out of your plans.

If you own a home than you should have a homeowner’s insurance policy in place. Homeowners insurance provides coverage that can range from a roof repair in case of storm damage to helping you pay for residential drywall service should your basement flood.

Even if you are in the early stages of building a house you want to be sure that you have not only a high-quality fire sprinkler system design, but also insurance coverage to help protect the project. Without coverage, you can wind up shelling out far more money than you need to.

Homeowners insurance provides important protection so that you do not have to worry about taking a private loan to pay for necessary repairs. Standard homeowners policies typically cover:

  • The dwelling itself (your home)
  • Personal possession located in the home
  • Other structures on the property. Liability from injury on your property.

Your home is covered, your personal possessions located in the home are protected, and other structures on your property like a shed or garage are also usually covered.

Perils that your property is covered for usually include theft, fire, hail damage, storm damage, some water damage (usually not from a slow leak that has been not repaired is not covered). The best way to understand what is excluded from coverage is to read your policy or at the least speak to an insurance agent that can explain exactly what you are covered against.

Taking a few steps to ensure that you have the best coverage for your property can really make a difference if you ever need to initiate the insurance claim process. For example, if you have made some upgrades to your home or have unique possessions like rare art, take pictures, record serial numbers, and provide the information to the insurance company.

Working together with your insurance agent will help you to get the protection your property needs. Remember that most homeowner policies are pretty general unless you request specific coverage for your collections and or special property features, you will not have that coverage.

A lot of frustration can be avoided when it comes to insurance claim processing for homeowner’s insurance if you start off on the right foot with the insurance company. Taking the extra time that it takes to provide lists of goods with serial numbers, and include any other valuables, can keep you from experiencing losses. Most simply put, your insurance company does not know what you have in your home unless you tell them.

Navigating the Insurance Claims Process For A Homeowner’s Policy Claim

One of the best ways to make sure your claim moves through the insurance claims process smoothly is to keep open communication with your insurance agent. Provide all the documentation that is requested. Make yourself available if the adjuster needs to come and do a home inspection.

It may take some patience on your part especially in the case of a natural disaster where there are thousands of claims coming in from the same area. Typically, the process is pretty quick. As long as it is a covered peril, your insurance claim will move quickly.

Automotive insurance is a must-have to drive in any state in the US. Of course, there is a wide range of plans that are available. Choosing a plan that just delivers the liability limits that your state requires may be the best option if you are driving around in a used car that you did not pay much for. You can save money on your premiums by going with the mandatory limits of liability.

On the other hand if you buy a new Toyota or any other new vehicle you likely will have to have a more comprehensive plan, especially if it is financed. An insurance agent can explain in detail the differences between general liability and more comprehensive plans and how they will affect you.

Many people do not really understand their coverage. They make their monthly premium payment and do not really think about their auto insurance coverage until something happens. It is always better to get familiar with your coverage before you need to deal with filing a claim.

There are some standard parts to every automotive policy that include:

  • The premium
  • The deductible
  • Limits of liability

The premium is what you pay for coverage, the deductible is what you have to pay before the insurance will cover the losses, the limits of liability is how much your policy is worth. The premium can usually be paid in payments.

The premium and the deductible go hand in hand. If you opt for a low deductible, then you will pay a higher premium and vice versa. Of course, choosing a higher deductible will reduce the cost of the premium but you will also have to pay that amount of money if you are in an accident to get repairs done.

Finding the right coverage with the right premium and the right deductible to meet your budget can be a bit of a balancing act but it is possible. An insurance agent can help.

Understanding Your Auto Policy

If you choose the limited liability plans to be in sync with what your state requires you should know that those plans protect you from being sued after an auto accident but don’t cover your property damage or your medical bills.

Limited liability means that if you are in a car accident and it is your fault, your auto damage is not covered, and you will have to pay out of pocket for the repairs. Again, if you have an older vehicle that you would not miss too much if you had to replace it after an accident, then limited liability may be the way to go.

Comprehensive coverage is coverage that will provide coverage against fire, theft, and collision. Many plans also throw in added value services when you comprehensive coverage like towing services, roadside assistance, rental car coverage, and more.

Many people prefer the peace of mind that comprehensive coverage has to offer. The best way to decide if you have the right coverage is to review your policy and speak to your insurance agent about any changes that you want to make or to get clarity about your coverage.

Navigating the Insurance Claims Process For Your Automotive Claim

There are a few things that you need to do to manage the insurance claims process. You will need to report the issue to the insurance agent ASAP, provide police reports if there are any and work with the insurance adjuster to get the claim processed.

You never want to pay for the repairs to your car before you file the claim. You also want to be sure that you take pictures of any damage to your vehicle as soon as possible. A claim for theft will require a police report so call the police first and make sure you get the report number.

Communicating with the insurance agent and keeping a good document trail can help to move the claim along. Providing as much information as you can, will help to speed up the process.

The third most common insurance is health insurance. Of the three insurance claim process, health insurance is typically the quickest and the easiest to navigate. Again, it is vital that you understand what your coverage is.

Read through your plan materials and jot down any questions that you have. Call the insurance company to get your questions answered. One of the biggest issues that people experience with the insurance claim process for health insurance is that they do not understand their coverage and then get frustrated when they find that their recent appointment was for a service that was not covered.

Avoiding some of the pitfalls of navigating the insurance claims process for health insurance starts with really understanding a few things about your plan including:

  • What type of plan do you have? Is it an HMO? A PPO? Or something different?
  • What is your deductible? What is your cost share? What is your co-pay?
  • What are the covered services?

Start out with learning what type of plan coverage you have. Each category of plans has different coverage limits, different restrictions, and different costs associated with getting care. You can avoid any surprises with the insurance claim process by understanding your plan.

For example with one plan, you may be highly restricted to only network providers, with another type of plan you may be able to get urgent care for your medical emergency outside the network. Yes, it can be confusing, but it is necessary to understand your plan.

This can be very confusing for a lot of people but deductibles, cost shares, and co-pays are not the same. One of the frustrations with the insurance claim process is understanding your financial responsibility. They all require you to pay money out of your pocket for health care but they all serve a different function.

Deductibles are what you pay BEFORE your health insurance ever kicks in and starts to pay medical bills. Cost-share is your percentage of what you pay out of pocket and can include your deductible and co-pays, but does not include the premium. The co-pay is a set fee that you pay the doctor or another medical provider for a service.

The premium is what you pay for the plan. In many cases, employers share the cost of the premium for their employees through a group health insurance plan. In other cases, like if you are self-employed those premium costs are your responsibility.

In-Network, Out of Network

Most plans have an in-network option and an out of network option, although some only provide coverage for in-network care. An in-network medical provider has an agreement with the health insurance company to provide services to members. An out of network provider is not affiliated with the health insurance company but may offer to manage the claims process for you.

The insurance claim process is easier if you use in-network care providers because they will do the work for you. If you must, and your insurance company allows, you can file claims for reimbursement for any bills that you paid on your own.

The insurance claim process can be time-consuming if you have to file a claim for each doctor’s visit on your own. It is highly recommended to use in-network doctors. If you do choose to file your claim on your own make sure you fill out the claim form completely and provide any documentation that is required to help your claim go smoothly.

Moving through the insurance claim process successfully really comes down to two things. Understand your coverage and keep the channels of communication open with your insurance carrier. If you have questions about your policy be sure to ask them. If you think that you need different coverage act on that feeling before you have to file a claim. You want to be able to avoid paying for that roof repair out of pocket if possible.

An insurance agent can be your best ally in finding the right plans and navigating the insurance claim process if you ever need to.

Leave a Reply

Follow by Email