Understanding Insurance and How to Protect Yourself​

stethoscope over hundred dollar bills

We all need to have insurance, but we also hope we never have to use it. It can be a headache dealing with a car accident, damage to your home, health care bills, or a personal injury lawsuit, etc... You need to be familiar with the insurance claim process in order to mitigate those headaches as much as possible. Read on to learn about some key points to keep in mind as you embark on the insurance claim process.

Note: If at any point in the process you feel you need a second opinion on your claim options contact a local insurance attorney who can protect your rights under the insurance laws of your state.

The Insurance Claim Process

Preliminary Steps

The process varies depending on the type of insurance you’re dealing with, but there are some common tips to keep in mind regardless of the exact details of your situation. First off, you should examine your insurance policy so that you understand your rights and responsibilities, including:

  • If your policy covers the situation you’re dealing with
  • Timelines for filing a claim (some instruct you to file a claim within 24 hours of the relevant incident)
  • Whether you have multiple types of policies that could cover the same thing (such as an umbrella policy)
  • Deductibles that could apply to your situation 

Contact Your Insurance Company

After these preliminary steps, contact your insurance agent within the required timeframe. The insurance company will let you know what forms and information you need to submit. Document all correspondence you have with the insurance company, including the names of people with whom you speak, and keep track of the expenses you incur such as medical expenses, lost income, lost profits, etc.

Always be honest about your injuries, property damage, and other circumstances. Insurance fraud is a serious offense and can invalidate your policy and lead to both civil and criminal consequences. However, if you’re genuinely concerned that your insurance company is not fulfilling its obligations under your policy or could be acting in bad faith, consult an independent attorney to help protect your rights during the insurance claim process.

Tips For Particular Types of Insurance

Accidents and Injuries

For accident-related policies like auto, home, and liability insurance there is usually a short timeframe for filing a claim. Take pictures of the accident and retain contact information for any witnesses to the accident. In addition to filing a claim with your own insurance company, you’ll also need to determine whether you should file a third party claim with someone else’s insurance if they’re at fault for the accident.

For property damage claims, consider hiring a public insurance adjuster if you need a second opinion on the assessment and damages to estimate provided by the insurance company’s own adjuster. If you are injured, you may have to have an independent medical examination as part of the claims investigation. Never feel pressured to automatically accept a settlement offer made by the insurance company. If the offer doesn’t seem adequate, definitely consult an independent adjuster or insurance attorney for a second, independent opinion.

Health Insurance Claim Process

Usually, your health care provider can submit a claim directly to your health insurance company if they provide that service and have your insurance information. If you have to submit a claim yourself, contact the insurance company for the appropriate forms and submit those along with an itemized bill from your health care provider.

Life Insurance Claim Process

To file a life insurance claim, you’ll need to submit certified copies of the insured’s death certificate along with any forms required by the insurance company. Most states require life insurance companies to pay insurance proceeds within a certain period of time, such as 30 to 60 days.

Your Insurance Company Has Obligations During the Insurance Claim Process As Well

Each state has its own laws regulating the insurance claim process and the conduct of insurance companies in general. But across the board, insurance companies are expected to act in good faith and fair dealing. This usually includes the following:

  • Providing prompt, ongoing communication with the insured about their claim
  • Acknowledging, investigating, and either approving or denying an insurance claim within a specified amount of time
  • Effectuating prompt, fair, and equitable settlements
  • If denying an insurance claim, then providing detailed reasons why

Failure to abide other requirements by these standards and set forth in your state’s insurance laws could give you grounds to sue your insurance company for bad faith or breach of contract. If you suspect misconduct, file a complaint with your state’s insurance commissioner.

Dealing with an Insurance Claim Denial

If your insurance claim is denied, you can appeal the decision with the insurance company. Check your policy or contact the company to figure out what steps you need to take to do this. Understanding the company’s reasons for denying the claim means you could possibly provide additional information or explanations to get them to reverse their decision. An attorney can help with this process, and, if the appeals process fails, can advise you on additional options, including a lawsuit.

Protect Your Rights Throughout the Insurance Claim Process

Whether you're dealing with home, auto, health, or business insurance, filing and following through on an insurance claim can be a tedious process. If your claim has been denied, you're battling an uncooperative insurance company, or you simply need advice on your legal rights, contact a local insurance attorney who can protect your rights under the insurance laws of your state.

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