We hope it never happens, but when you suffer a loss, you’ll have to file a claim to receive payment from your insurer. Here’s how the process works, and how to handle it to your best advantage.
- Notify Authorities
Your first priority is always to prevent further injury and to protect life and health. If someone is injured, call for an ambulance if needed or perform first aid. If your loss involved theft, robbery or an auto accident, notify the police—your insurer will want a copy of the police report. If a fire occurs, ask your local fire department to inspect it, even if you put it out yourself, to prevent smoldering embers from reigniting later.
- Document What HappenedWhenever a loss occurs, the insurer will require information to determine what exactly happened and if your insurance covers it. As soon as possible after an accident or loss, make a written report. If you were involved or witnessed the incident, write down what you saw. If you were not present, find out if there were any witnesses and, as soon as possible, interview them. Make sure your report includes pertinent details, such as date, time of day, location, conditions that could have contributed to the accident or loss, involved persons and witnesses and contact information for them. If you don’t have time to make a written report immediately, you can use video to document the incident.
Photos also help document what happened. If the incident involved an injury, take photos of the surrounding area, including any conditions (wet floors, loose carpeting, missing safety equipment) that could have contributed to it. In the case of property damage, photos can help establish the value of any damaged property.
- Prevent Further DamageIf a repairable condition contributed to an accident, such as a broken stair tread or burned out light, fix it as soon as possible to prevent future accidents. Likewise, your business property policy probably contains a provision that requires you to prevent further property damage when a loss occurs—such as boarding up broken windows. However, don’t make any permanent repairs until your adjuster says it’s okay. He or she might need to see the location in its near-original condition to properly evaluate your claim.
- Report the Loss to the Insurance CompanyThe insured has duties under the insurance policy. Most liability policies include a reporting provision, which requires insureds to report a possible loss (property damage or injury to a third party) as soon as practically possible. Even if you think the loss won’t be covered, report it to your insurer. You can call your agent or broker during business hours, or if the loss occurs after regular business hours, contact your insurer on its 24-hour telephone number or website. Have your policy number and your report ready when you call. If you speak with someone other than your insurance agent or broker, note the name of the representative you spoke with, the time you reported the claim and the claim number assigned to the case.
- Be Prepared to Work with a Variety of PeopleIf you experienced a substantial property loss, the insurer might assign an adjuster to your case. An adjuster might be an employee of the insurer or an independent contractor.
Adjusters plan and schedule the work required to process a claim. They might, for example, handle the claim filed after an automobile accident or after a storm damages insured property.
Adjusters will take a look at your coverage: Was your policy in force when the claim occurred? Do any exclusions or limitations apply? What are your policy limits and deductibles?
The adjuster will also investigate your claim by interviewing the claimant and witnesses, consulting police and hospital records and inspecting property damage to determine the extent of the liability or property damage. Adjusters may consult with other professionals, such as accountants, architects, construction workers, engineers, lawyers, and physicians, who can offer a more expert evaluation of a claim. The information gathered—including photographs and statements, either written, audio, or on video tape—is set down in a report that is then used to evaluate the associated claim.
When the adjuster’s report concludes a policyholder’s claim is legitimate, the claim is turned over to the claims adjuster, who negotiates with the insured, or injured party in a liability case, to settle the claim. When claims are contested, adjusters will work with attorneys and expert witnesses to defend the insurer’s position.
- Be Satisfied Before Accepting a Claims CheckIf your claims adjuster offers a settlement, be satisfied with the amount before signing a full release of all claims. If you’re not satisfied with the amount of the settlement, be sure the claim remains open—if you sign a release of all claims, you will not be able to collect additional payments later.
- Use Your Agent as a ResourceIf you have questions or concerns at any point of the claims process, don’t hesitate to call your agent or broker. He or she will be able to provide you with claim forms and help guide you through the claims process.