Employee Benefits

What Is an Insurance Claim?

4 min read Oct 24, 2022

An insurance claim is a formal request from the policyholder (that’s you) to their insurance company asking for payment after a covered incident. These incidents can include anything covered by your insurance policy, like a hospital stay, a natural disaster, or theft.

The payout provided by the insurance provider is meant to cover expenses associated with the covered incident. A claim payment is typically only issued to the person named on the policy (or a designated beneficiary). The types of claims depend on the situation at hand and the kind of insurance policy you have.

Types of insurance claims

Many types of insurance policies require a claim in order to pay out – we listed a few example below. Each claim type follows roughly the same claims process, but the details may vary depending on your insurance provider.

Car insurance claims

Car insurance claims can pay out in many different cases, including:

  • A collision with another vehicle, person, or property, and property damage and/or bodily harm
  • Comprehensive coverage for damage caused by an outside force (e.g., natural disaster, collision with an animal, and other no-fault instances)
  • Depending on the extent of your policy, coverage for uninsured or underinsured drivers, should they get into an accident or get a ticket

Homeowners insurance claims

Homeowners insurance claims typically cover a number of scenarios related 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) should your home become uninhabitable, and you need to stay in a hotel for a period of time

Renter’s insurance claims

Renter’s insurance claims typically cover incidents related to a rental property, such as:

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

Health insurance claims

Health insurance claims are typically handled by the doctor’s office, hospital, or clinic you visit. The only time you might be responsible for personally handling a health insurance claim is when a claim has been denied. Health insurance claims can be filed for:

  • Routine doctor’s visits
  • Emergency medical care, including sickness, injury, and mental health treatment
  • Bloodwork, x-rays, and other lab work

Life insurance claims

Life insurance claims often cover a very specific set of circumstances, all related to the policyholder’s death. In the case of the insured’s death, a payment will be made from the insurance company to a designated beneficiary.

How do insurance claims work?

Below are all of the items you’ll need to have on hand to file a claim. Regardless of the type of policy, an insurance claim will require:

  • Names of those involved
  • Date of the incident
  • Insurance policy number
  • An incident, accident, or medical report

You may also need photos if you’ve been in an accident, suffered damage to your home or property, or experienced a comprehensive, no-fault incident.

How to file an insurance claim

Once you’ve gathered everything you need, you’re ready to file the claim. Start by checking your insurance policy details to see if your incident is covered and if there is a time limit on when you can file a claim.

Following that, all that’s left is to file with your insurance company. This can usually be done in person, online, or over the phone. You will be responsible for filling out a form outlining the details of the claim and either physically mailing the paperwork or submitting it online. The insurance company will review your claim and deny or approve it, or ask for further information.

Remember that when it comes to most medical situations, the office you visit 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 claim is approved, you will receive payment from the insurance provider. The amount you receive depends on your policy, insurance company, and the extent of the incident. Payment is most often sent as a check, but can also be directly deposited into an account.

Your insurance company can also pay service providers directly—for example, the payout might go to a hospital, auto shop, or contractor.

Insurance claim FAQs

What is an insurance claims adjuster?

An insurance claims adjuster assesses the extent of the damage in the case of accidents, damage, no-fault claims, and other instances related to personal injury or property damage. They will estimate what the payout amount should be.

What does an insurance claims lawyer do?

Insurance claims lawyers protect their clients’ best interests through the process of filing an insurance claim. They can provide legal advice, argue a denied claim, negotiate the payout, and more.

What is the actual cash value?

The actual cash value (ACV) refers to the value of your property or business as determined by your insurance company. The ACV is calculated by subtracting the depreciation of your car or other covered item from the value of a replacement or the necessary repairs to said item.

How long does the insurance claim process take?

The claims process usually takes around 30 days from when you file the claim to the final resolution. However, this process can vary depending on your specific circumstances and your insurance company.

Does filing a claim increase insurance premiums?

Filing an insurance claim doesn’t automatically mean your premiums will increase; however, in some instances, they might. For example, you may see your auto insurance premiums rise after you are found to be at fault for an accident.

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This article is intended to provide general information about insurance. It does not describe any Metropolitan Life Insurance company product or feature.