Employee Benefits
What Is an Insurance Claim?
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.
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. Pet insurance, disability insurance, dental insurance, and vision insurance all require you to submit a claim before a payout will be issued. Note that each claim type follows roughly the same claims process, but the details may vary depending on your insurance provider. Let’s jump into five specific insurance claim types as examples.
1. Car insurance claims
Car insurance claims may cover a variety of circumstances, including:
- 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 cover a number of scenarios that relate to your home, which can include:
- 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 cover incidents related to an apartment or other property you’re renting such as:
- Theft from your property or vehicle
- Damage to your personal property Injuries to people while they’re in your rented property
- Damage from natural disasters or other predetermined instances
4. Health insurance claims
A doctor’s office, hospital, or clinic you visit typically handles health insurance claims. However, you might be responsible for personally handling a health insurance claim if your insurance provider denies it. Health insurance claims typically help cover:
- Routine doctor’s visits
- Emergency medical care, including sickness, injury, and mental health treatment
- Bloodwork, x-rays, and other lab work
- Surgery
- Hospitalization
5. Life insurance claims
Life insurance claims cover a very specific set of circumstances, 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.
Finally, you’ll need to file a claim with your insurance company. You’ll fill out a form outlining the details of the claim and then physically mail the completed paperwork back to the insurance company or submit it online.
Note that for most medical insurance claims, the medical provider’s office will most likely file the claim for you — you won’t have to contact your insurance provider.
How is an insurance claim paid?
If your insurance provider approves the claim, they’ll send you a payment. The amount you’ll receive depends on your policy, insurance company, and the extent of the incident. Payment is most often sent to you as a check, but it can also be directly deposited into an account. Your insurance company may also pay service providers (such as a hospital, auto repair shop, or contractor) directly.
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This article is intended to provide general information about insurance. It does not describe any MeLife product or feature.