What is a claim and how do I file it?
An insurance claim is the actual application for benefits provided by an insurance company. Policy holders must first file an insurance claim before any money can be disbursed to repair shops or other contracted services. The insurance company may or may not approve the claim, based on their own assessment of the circumstances.
Individuals who take out home, life, health, or automobile insurance policies must maintain regular payments called premiums to the insurance company. Premiums are then used to build the assets of the company, cover the company's expenses and pay the claims of individuals who suffer a covered loss.
In general, the insurance claim is filed with a local representative of the insurance company. With most insurance companies this can be done by contacting your local agent, through the phone or over the internet. After an insurance claim is filed, the insurance company may send out an investigator called an adjustor or appraiser. It is important to remember that a local agent is not licensed by the Texas Department of Insurance to perform the duties of an adjuster. The insurance adjustor's job is to objectively evaluate the insurance claim and determine if the repair estimates are reasonable. This is to prevent possible fraud by contractors who may inflate their bills for additional compensation. Insurance companies tend to accept the adjustor or appraiser's evaluation as the final word on the insurance claim.
Sometimes the policy holder may not want to file an actual insurance claim if the damage is minor or another party has agreed to pay out-of-pocket for their mistake. Additionally, some insurance claims may not be recognized by the insurance company for any number of reasons. If a claimant's premiums have not been paid in full, the policy itself may not be active. Another reason an insurance claim may be rejected is a failure to fall under covered conditions. All insurance policies have certain terms, limitations and exclusions that apply. Reference your insurance policy for specific details regarding your coverage.