What Is An Insurance Claim & How Do They Work? | MetLife (2024)

An insurance claim is a formal request from the policyholderto their insurance company asking for payment after a covered incident, such as a hospital stay, a natural disaster, theft, and more.

This payment – typically issued to the person named on the policy (or a designated beneficiary – helps pay for expenses associated with the covered incident.

In this article, we’ll discuss types of insurance claims, the general process of filing a claim, and help answer several FAQs on the topic. For specific claims information, be sure to refer to your policy or contact your insurer.

Types of insurance claims

There are as many insurance claim types as there are types of insurance.A claim is a request to an insurance company to pay for a covered service or event under the current insurance policy.

1. Car insurance claims

Car insurance claims may include:

  • A collision with another vehicle, person, or property, and property damage and/or bodily harm
  • Damage caused by an outside force (like a natural disaster, collision with an animal, and other no-fault instances)
  • Damage caused by uninsured or underinsured drivers, should they cause a collision with you (depending on the extent of your policy)

2. Homeowners insurance claims

Homeowners insurance claims may include several scenarios that relate to your home:

  • Structural damage
  • Injuries to visitors while they’re in your home
  • Damage to your personal property, including theft
  • Additional living expenses (ALE) if your home becomes uninhabitable and you need to stay in an alternate residence for a period of time

3. Renter’s insurance claims

Renter’s insurance claims may include incidents related to an apartment or other property you’re renting such as:

  • Theft from your property or vehicle
  • Damage to your personal propertyInjuries to people while they’re in your rented property
  • Damage from natural disasters or other predetermined instances

4. Life insurance claims

Life insurance claims cover a very specific set of circ*mstances, all related to the policyholder’s death. In the case of the insured’s death, the insurance company makes a payment to the designated beneficiary – the person(s) selected by the policyholder to inherit the policy’s assets.

How do insurance claims work?

Filing an insurance claim typically involves a few basic steps:

1. Start by checking your insurance policy details to see if your policy covers the incident and if there’s a time limit for filing a claim.

2. Gather important information, such as:

  • The names and contact information of those involved
  • The date of the incident
  • Insurance policy numbers of those involved
  • An incident, accident, or medical report
  • Photos if you’ve been in an accident, suffered damage to your home or property, or experienced a comprehensive, no-fault incident.

3. File a claim with your insurance company if your incident requires you to do so. You'll provide the details of the claim and submit the information to your insurance company via their preferred method (e.g. mail, online or digital app). Note that for some medical insurance claims, the healthcare provider's office may file the claim directly for you.

How is an insurance claim paid?

If your insurance provider approves the claim, they’ll remit payment to you or the service provider. Payment can be in the form of a physical check, direct deposit or sent directly to the service provider (such as a hospital, auto repair shop or contractor.)

What Is An Insurance Claim & How Do They Work? | MetLife (2024)

FAQs

What Is An Insurance Claim & How Do They Work? | MetLife? ›

An insurance claim is a formal request from the policyholder to their insurance company asking for payment after a covered incident, such as a hospital stay, a natural disaster, theft, and more.

What is insurance claims and how it works? ›

An insurance claim is a formal request by a policyholder to an insurance company for coverage or compensation for a covered loss or policy event. The insurance company validates the claim and, once approved, issues payment to the insured or an approved interested party on behalf of the insured.

How do you answer insurance claim questions? ›

Below are some best practices to consider:
  1. Contact a lawyer. ...
  2. Keep in mind that despite the friendliness of the person taking your statement, that person is not your friend. ...
  3. Ask specifically that your statement not be recorded. ...
  4. Give brief answers. ...
  5. Don't volunteer information. ...
  6. Answer only the question asked.

What is insurance claim in simple words? ›

What is an insurance claim? An insurance claim is a formal request to your insurance provider for reimbursem*nt against losses covered under your insurance policy. Insurance is a financial agreement between you and your insurer. You have to pay a fixed premium.

What is insurance and how does it work? ›

Insurance is a contract between an individual or business with an insurance company to help provide financial protection and mitigate the risks associated with certain situations or events. There are various types of insurance available, including health, dental and vision, life, auto, and legal insurance.

How do claims work? ›

This step involves filling up paperwork, which includes evidence of the covered loss, and submitting it to the insurance company. The insurer will then investigate the validity of the claim. If the claim is found to be legitimate, the insurance carrier will issue the payment to the policyholder or an authorized party.

Why is insurance claim important? ›

An auto insurance claim is essentially your way of notifying your insurance provider that you'll need to use your policy to cover expenses after your car is damaged in a covered incident.

What not to say when talking to an insurance adjuster? ›

When describing an accident to an insurance adjuster, do not say anything beyond what you experienced directly. You do not want to speculate about what happened because you could accidentally blame yourself. The insurance company could then have a good excuse to reduce your compensation.

What is an insurance claim quizlet? ›

a request by a plan member, or a plan member's health care provider, for the insurance company to pay for medical services.

What is an insurance claim explanation letter? ›

An insurance claim letter is an important part of any insurance claim process. It helps the accredited insurance adjuster understand how much money you are requesting to cover the damage. At minimum the letter should include information about the accident, the policy number, the date of loss, and the amount claimed.

What is claim in one sentence? ›

Noun She makes the claim that sea levels will actually go down. He made false claims about his past job experience. You'll need to file an insurance claim to pay for the damage.

What is a claim answer? ›

A claim answers a debatable question posed by a writer, which then is proved in a paragraph or essay. For example, "Dogs make better pets than cats" is a claim that can be argued.

What is a claim and example? ›

Claims are statements about what is true or good or about what should be done or believed. Claims are potentially arguable. "A liberal arts education prepares students best" is a claim, while "I didn't like the book" is not.

How do you explain insurance for dummies? ›

Insurance is a contract, represented by a policy, in which a policyholder receives financial protection or reimbursem*nt against losses from an insurance company. The company pools clients' risks to make payments more affordable for the insured.

What does do insurance cover? ›

D&O insurance works by reimbursing defense costs, settlements, and awards resulting from claims made by shareholders, third parties, or regulators for alleged wrongful acts. It also extends coverage to the company itself if it faces litigation.

What are the four stages of an insurance claim? ›

The insurance claim life cycle has four phases: adjudication, submission, payment, and processing.

What happens to insurance after a claim? ›

So, even though it's not your fault, your insurance company will decide that you're a slightly higher risk. It might not seem fair – but insurance companies base their premiums on statistics, and if there's a link between non-fault accidents and future claims, they will reflect that in the quote you receive.

How does an insurance claim affect you? ›

Filing a claim often results in a rate hike that could be in the 20% to 40% range. The increased rates stay in effect for years, although the size and longevity of the hike can vary widely between insurers.

How do insurance companies get money to pay claims? ›

Most insurance companies generate revenue in two ways: Charging premiums in exchange for insurance coverage, then reinvesting those premiums into other interest-generating assets. Like all private businesses, insurance companies try to market effectively and minimize administrative costs.

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