Homeowners Insurance

HOW DOES AN INSURANCE CLAIM WORK?

Claims are pretty common in the insurance world. Come and understand what this means and how to proceed in this situation.

Anyone who has contracted or is considering hiring some insurance needs to know what a claim is.

This term is quite common in the insurance universe and is present in life insurance, automobiles, real estate, cards, and personal items.

However, although it is expected, many people are still not sure what it means. With that in mind, we prepared this content to address some of the main doubts surrounding insurance claims. Check out!

What is sinister?

The SUSEP (Private Insurance Superintendence) booklet defines a claim as “the occurrence of the covered risk during the period of validity of the insurance plan.”

The term refers to when an event causes damage to an appropriately insured asset.

In other words, a claim is an accident, unforeseen event, or unexpected situation that can occur at any time and that is specified in the policy as something that, if it happens, will result in the payment of compensation.

Therefore, an accident not listed in the insurance contract is not considered a claim.

For this reason, it is extremely important to read the entire contract and clear all your doubts with the insurance company or broker to understand the coverage and claims that will provide indemnity or compensation.

How does the claims process work?

 

The claim can be full, as in the case of auto insurance, when a vehicle is stolen, and the insurance company must pay the total amount of compensation or partial.

In addition, the accident can occur with the insured’s property or that of third parties, always depending on the coverage contracted in the policy.

When contacting the insurance company to report the accident, it takes action to verify all that happened and the policy in order to confirm the veracity of the event to proceed with the payment of the indemnity.

Examples of insurance claims

Here are some of the prominent examples of insurance claims:

Car Insurance Claim

 

In auto insurance, several situations can configure a claim, depending on the coverage.

For example, when the insurance policy is for theft or theft and the vehicle is stolen or stolen, this crime is characterized as a claim.

Likewise, in cases where the insurance covers a collision and the vehicle is involved in an accident, this collision is also considered a claim under this policy.

Credit Life Insurance Claim

Because of an accident, a self-employed professional can no longer work to pay a particular debt and has taken out credit life insurance for it, it can be considered a claim under this policy.

Life Insurance Claim

Several situations can be considered a claim in life insurance. The main ones are:

  • death from natural causes;
  • partial or accidental disability;
  • total disability due to the accident;
  • serious illness;
  • per diem for temporary incapacity;
  • funeral assistance;
  • among others.

Regarding life insurance, we can list three fundamental events that are considered claims: death, accident with disability (permanent or partial), and illness.

Home Insurance Claim 

In residential insurance, it is characterized by accident: damage to the insured property due to fire, theft, explosion, or lightning strike, among others – always following the coverage indicated in the contract.

What to do in case of an accident?

In the event of claims, the insurer must indemnify the insured against the losses resulting from the claim, always in accordance with the coverage provided for in the product policy.

However, before that, it is interesting that the insured is aware of the procedure that he must follow to activate the insurer and ensure that the entire process takes place in the best possible way.

Consequently, here is a brief overview of what to do in case of an accident:

Check if anyone is injured.

 After a collision, it is essential to check whether anyone is injured and if so, you must ensure that they are under the necessary medical care.

Protect the damaged good

Always seek to protect the damaged property by trying to minimize the risk of further accidents or aggravation of damages. Most of the time, the assets are inspected by the insurance company and need to be preserved.

Call the insurer

Afterward, it is necessary to contact the insurer directly or through your insurance broker to check the coverage of the contracted policy and report the claim.

Here, you must inform all the details of how and when the accident happened, damages or losses generated, people or property involved, and responsible for the accident, among other information.

Damage assessment

It is the insurer’s duty to collect documents and statements from the client in order to understand what actually happened and the proportion and cause of the accident.

Insurer rating

After collecting all the information and carrying out the first investigation, the insurer evaluates what happened in order to verify if there is coverage for that situation.

In addition, other documents may be requested, according to the general conditions of your policy or certificate. Thus, the process of analyzing the coverage and surveying the losses caused by the event can be forwarded.

Payment or not of compensation

After carrying out a thorough assessment and finalizing the process, the insurer finally reaches a conclusion on whether or not the event can be covered by the policy.

Claim closure

After the insurer makes the decision, the indemnity is paid, or the claim process is closed without indemnification to the insured.

What documents are required to file the claim?

In the event of any type of accident, it is recommended to contact the insurance company as soon as possible to start the process as soon as possible.

Once this is done, the insurance company will list all the documents necessary for analyzing the event.

This documentation varies according to the property that was damaged. However, there are some common documents that are often required for different insurance coverages. They are RG and CPF, medical records, police reports, and, in case of car accidents, driver’s license and vehicle documentation.

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