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A claim is a formal application to the insurance company asking for compensation to be paid for an insured loss. Policyholders purchase insurance policies to protect themselves and their property against financial losses caused by unforeseen circumstances. Insurance companies insure policyholders for the risks that might cause financial loss in return for payment known as premium. When an insured event occurs the policyholder can file a claim. When the event is minor or when payment has been received by the one who caused the loss the policyholder might not file one.

Adjusters, appraisers, examiners and investigators

The claim is filed by a local personal representative or agent who acts on behalf of the insurer. Insurance company forms may be used or standard forms. They are presented to the claims department where record clerks are employed. The adjuster investigates the claim to ensure it has been covered in the policy. He has the knowledge and experience of handling this work. He negotiates for settlement and determines how much is to be paid. Claimants may engage the services of independent adjusters to negotiate the best possible settlement for them. The insurance company may hire independent appraisers as freelancers to work in their best interest.

Appraisers are usually hired in automobile insurance to estimate or value the cost of auto repairs in agreement with the repair shop. An appraiser is a professional who has the expertise of valuing damaged automobiles determining the cost of repairs. If it is a total loss, he determines the salvage value. He fills insurance forms and prepares reports which may be downloaded from the laptop computer while in the field. The cost or value is calculated by insurance software.

Insurance claims may be complex because they involve a third party who may not accept liability readily. The adjuster who works with the claimant and witnesses visits the site taking photographs. He consults the police and takes statements. He checks hospital records and doctor reports. He works with the examiners who determine whether the claim is correctly filled. Examiners verify the validity of the claim from the policy files. They check whether the information is correct and approve, deny the claim or pass it to investigators for a thorough review. When adjusters or examiners suspect fraud or overstated damages they pass the claim to investigators who conduct further investigations. Insurance companies hire investigators in fraudulent cases.

How to file a claim
Contact your local representative or broker immediately by phone, fax, email or letter and explain what happened where and when. Fill the forms as soon as possible before the deadline. The information should be complete and accurate with supporting documents. Do not exaggerate because it might be rejected. Include receipts for expenses, photographs, audio, video, drawings and reports such as medical and written police reports. Look for witnesses who will back you up. Most claims which are not complex are handled promptly and the adjuster will call you to negotiate payment and send you a check.

Last modified onTuesday, 02 April 2013 15:57
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