Navigating the Insurance Claim Process

Whether you are dealing with the insurance claim process for your home insurance policy, or you are waiting on that check for a car accident, why does it seem like the process takes forever? No matter who you talk to if they have been through the insurance claim process they are very likely to have a horror story to go with it.

It seems no matter what type of insurance claim process you are dealing with there are always some hiccups along the way that delay payment and make life just a bit more difficult. Dealing with any insurance claim process can go a bit smoother if you follow a few simple guidelines.

The Odyssey of Insurance

Just about every insurance plan starts with an insurance quote, and here is where many people make their first mistake. Most people are budget conscious, so when it is time to get an insurance plan in place, they are looking at only one thing.

How do most Americans shop for insurance? By price. They put out their request for quotes, then pick the plan with the lowest premium, and largely ignore the fine print. Unfortunately, making that first mistake of shopping by cost alone can really leave you holding the bag if you need to enact the insurance claim process.

While you should not have to take out a loan to pay for insurance, you should be shopping for a policy that will deliver the coverage that you need, not just the lowest premium price. Like most things, the lowest price does not usually represent the best value.

Shopping for the Right Plan to Begin With

Surveys show that having the right plan in place from the start can make the insurance claim process go a lot easier. For example, let’s say that you choose an auto policy plan that includes collision coverage, you pay more for the premium, but if you need auto body repair after a single-vehicle car accident (you hit something) you will be covered.

One of the biggest frustrations for consumers is trying to get the insurance company to pay for a service that you thought you were covered for when you are not. Another good example where consumers have to do battle with the insurance claim process is when they settle for health insurance that offers little to no coverage just to save on the premium.

It is far better to be over-insured than underinsured. Combing through plans with a fine-tooth comb and becoming familiar with the terminology and really understanding the coverage is a much better way to shop for all types of insurance.

It is estimated that about 52% of homeowners are not clear on exactly what their home insurance covers. It is likely that at least as many people are unsure of what their health insurance or auto insurance covers either.

The best way to navigate the insurance claim process is to be a well-informed consumer and know exactly what the insurance company has to cover as per your policy. If you are unsure of what your plans cover, it is time to ask, before you need to file an insurance claim. For example, ask your carrier the following questions about your Medicare coverage:

  • If I need stitches can I use an urgent care center instead of a hospital emergency room? Many plans will cover an urgent care visit, many will not. It is a small thing but it is important to know.
  • What about home health care? Does the plan cover the cost of having someone come and help you recover from surgery or a long illness? How long will the plan pay for these services?
  • What is the cap on coverage? How much will the insurance company pay out if you need to start the insurance claim process for hospitalization, elective surgeries, and more?

Going into any insurance plan with your eyes wide open and having a good understanding of what coverage you have and what services are not covered is the best way of dealing with your insurance carrier.

Let’s say you need an auto insurance plan, there are questions you should ask before you hit that enter button and get coverage. Those questions include:

  • Will I be covered for rental cars should I have to wait for car repairs after an accident? What about windshield repair coverage?
  • What are my limits of liability? Limits of liability are the cap that the insurance company will pay in case of a total loss, accident, and injuries?
  • Will this plan cover my vehicle in case of theft?

Making sure that you ask the right questions before you sign up will ensure that in the event you need to start the insurance claim process you have a good understanding of what type of coverage you have. It is important that you know your coverage.

When You Have to File a Claim

The best thing you can have on your side when you have to start the insurance claim process is information. The more documentation you can provide the better off you will be. Insurance companies like when you paint a detailed picture for them and all your paperwork is in order.

If you want to avoid delays in the process be sure that you fill out every piece of information that is requested. Blank spaces left by questions unanswered can cause delays in your insurance claim processing.

Here are some other tips that you can follow when you first submit your claim:

  • Attach relevant documents. If you have any documentation about your claim be sure you submit it. It can help the adjuster to make quicker decisions if they have what they need right in front of them.
  • Go into detail. Remember when you are providing claim information that the adjuster is completely in the dark. You have to provide information in detail and this is true with all types of insurance claims. Don’t assume that the insurance company knows anything at all about your claim.
  • You have to be honest. Do not over exaggerate the situation, or veer from the truth when you are filing your claim. Just stick to the verifiable facts.

Laying out the claim for the adjuster and including all the information that you have will make it a lot easier for the insurance company to process the claim.

What If You Do Not Agree With the Decision of the Insurance Company?

Let’s say that you have crossed all your t’s and dotted all your I’s and your claim comes back denied. The first thing you need to do is to figure out why the insurance company has denied your claim. The claim may have been denied because of a simple administrative error or maybe you actually missed something on the claim form.

It is time to regroup and figure out what exactly went wrong and how you can correct it. The insurance claim process does not end with a denial. There are ways that you can contest the finding and re-submit the claim that may wind up getting you an approval.

If your claim is denied before you call the injury attorneys, call the insurance carrier and find out why they denied your claim. If you have more evidence you would like them to consider like an in car video record of the accident let them know that you will be sending that along.

Every insurance company has an appeal process in place. Follow your carrier’s guidelines for filing that appeal. It may turn around things in your favor.

Potential Reasons Your Claim Can Be Denied

You followed all the rules, you filed your claim, it can back denied, and you filed the appeal and lost on that front too. Why can the insurance company deny your claim? There are a few reasons that the insurance claim process does not work in your favor:

  • You have submitted a claim for a service that is not covered. Here is where it becomes really important that you understood your policy to begin with. If you are requesting reimbursement or approval for a service that is simply not covered in your plan, you will never win that battle.
  • You are missing some key information from your claim. Not having the requested information turned in by the date that it is requested can kill your claim in the middle of the process. It is important that you are responsive to any requests that are needed during the insurance claim process.
  • There is a misunderstanding. Claims adjusters are human too and sometimes they do not fully understand the claim. It is up to you to clear up any misconceptions about your claim. This can be especially true about health care claims or pre-approvals. Sometimes the doctors are not submitting the information and the adjuster is making decisions on only part of the information.

In many cases the insurance claim process is quick and easy, but in many cases, it is not because of a lack of information, a lack of communication, and misunderstanding.

What Can You Do To Speed Up the Insurance Claim Process?

There are a few things you can do that will help you to get through the claims process quicker. Contact your insurance company as soon as the loss occurs. The day you have the car accident or the day that the storm damages your roof is the day you should contact the insurance company.

Making a phone call early on, gets the ball rolling on your claim and can be a great time saver. Open communication with your insurance agent or directly with your carrier is important. Notifying them early on that there will be a claim for an incident can shorten the time it takes to get through the insurance claim process.

Gather all the documentation that you can find regarding the claim. For example, if you were in a car accident, get the police report number from your local authorities. The insurance company will need the police report incident number as part of your claim. If you already have it and pass it on that will be one less step in the process for the insurance company.

Do not hesitate to provide the information that the insurance company needs to process your claim. If you delay returning information that in turn will delay the insurance claim process. If you do not have the information that is being requested figure out who does and get it.

Call if there are any new developments right away. For example, if you were in a car accident and reported that you had no personal injuries, but they develop a few days later, call as soon as you can to keep the insurance company updated.

If you filed a claim for roof damage and that problem gets worse before the claim is settled, call the insurance company to let them know about the new developments. If anything changes about your claim calling the insurance company as soon as possible will ensure that they are made aware of the changes and your claim can be adjusted to reflect those changes.

Communication is The Key To Successful Claim Processing

insurance claim process

One of the best ways to communicate with the insurance company is via email. Keeping a “paper trail” of everything that you submit, and every conversation that you have is a good idea. Emailing is better than calling because you have a record of the “conversation”, and of course, you do not have to sit on hold waiting for an agent.

Open communication with your insurance carrier will also establish a relationship between you and them, and keep you updated on where you are at in the claims process. Of course, if the adjuster can easily get in touch with you to get any questions answered that will also help to offset delays in getting your check.

The insurance claim process can be simplified when you ask the right questions, are responsive, and follow the guidelines for claims processing. You can get through the process and be done before you know it.Be patient and keep in mind that millions and millions of claims are favorably settled each year for the claimants, yours can be too.

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