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Filing Insurance Claims
consumerfilinginsclaims
Accidents happen
. . . and when they do, you may need to file an insurance claim. The common-sense
guidelines that follow can help you understand how the claim settlement process
can work for you.
Before you experience a loss . . . know your policy!
Read your policy and pay attention to the perils, property, and situations
covered in your policies, as well as dollar limitations and any exclusions.
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Find out how your policy
will reimburse you—usually either replacement cost or actual cash value.
Know the actual cash value or replacement cost of your property.
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Remember, if you have actual
cash value coverage (usually less expensive than replacement cost coverage),
your insurance adjuster will deduct the depreciation value of your property
from the cost of a new replacement item. For instance, a tire with half its
tread worn is worth about 50 percent of a new tire.
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Prepare an inventory. Worth
its weight in gold, a detailed inventory of your belongings will help assure
a speedy settlement if you file a claim. Keep the list up to date, and store
it in a safe place away from your home.
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Keep receipts, appraisal
certificates, and other documents supporting the value of possessions.
If you have a loss . . .
Homeowners Checklist
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Don't alter the condition
of your house before it is inspected by the adjuster; however, you can make
emergency repairs to prevent further damage.
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Contact your agent or company
representative as soon as possible with all information relating to your
claim.
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Follow up your call with
a written explanation of your claim.
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Keep a record of all expenses
you incur as a result of property damage, including expenses involved in
temporary repairs. Include any hotel and meal expenses, since these costs
may be covered.
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Take photos of the site
after an accident or other disaster
Car Owner's Checklist
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Get help for the injured.
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Notify the police about
the accident.
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Exchange information with
other drives involved in the accident (name, insurance, driver's license
number).
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Don't discuss fault or blame
at the scene.
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Get the names and number
of any witnesses.
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Contact your agent or broker.
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Keep a disposable camera
in your car and take photos of the accident site.
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Get estimates for repairs.
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Keep records of any expense
you incur as a result of the accident.
Determining
whether your loss is covered
If you're not sure whether your accident is covered, the best thing to do
is call your insurance representative and ask:
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Is this claim covered by
my policy?
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Will this claim likely exceed
my deductible?
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What will filing this claim
do to my future insurance costs?
Your agent will guide you as you make your decision about filing a claim.
Remember—you have the right to make a claim against someone else if his or
her carelessness results in your bodily injury or property damage. Such claims
have little or no impact on your insurance coverage.
Who will settle your claim?
Smaller claims may be settled by your insurance agent or company representative.
But in most cases, an insurance adjuster will contact you by telephone within
48 hours after you make a claim. Adjusters are claims settlement professionals,
and may work for the insurance company (staff adjuster) or work as an independent
adjuster. Staff adjusters work for insurance companies, while independent
adjusters are owners or employees of adjusting companies hired by insurance
companies to adjust claims. In either case, the adjuster represents the insurance
company. Adjusters are responsible for making sure the claim receives prompt
attention and fair settlement. They are also responsible for identifying
fraudulent claims.
What if you're contacted by a public adjuster?
Public adjusters work for policyholders rather than on behalf of an insurance
company, and are not paid by insurance companies. Public adjusters usually
ask you to sign a contract entitling them to a percentage of the total claim
(usually 10%). You may be approached by a public adjuster if your home or
other property has been badly damaged by a disaster, such as a serious fire,
hurricane, or tornado. A public adjuster may contact you before a company
adjuster, because some public adjusters monitor fire department radio channels.
Should you hire an attorney?
Usually attorneys are hired when people suffer serious injuries in auto accidents
that they believe are caused by someone else's negligence. If you hire an
attorney, you are responsible for paying any legal expenses, plus a percentage
of the settlement, depending on the terms you negotiate.
What if someone sues you?
Your insurance company will provide an attorney to represent you as long
as you have liability insurance. This coverage is nearly always included
in automobile and homeowners policies. Your insurance company covers the
costs of the insurance company attorney, and these costs are not deducted
from your liability limit in most cases. The insurance company-appointed
attorney will be completely satisfactory unless your potential liability
greatly exceeds your liability insurance limits. In that case, you may want
to involve your own personal attorney.
Settling your homeowners claim
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Be prepared to go through
the following process in settling a claim for your home.
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Your insurance company will
inspect your damaged property, per the terms of your insurance policy.
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The adjuster will probably
take photos and discuss with you the cause of the damage, property values,
your coverages, and how your claim will be handled.
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Usually, you will choose
a contractor to estimate repair costs. Be sure to use a contractor experienced
in repairing the type of damage involved. The adjuster usually can provide
you with a list of experienced repair firms.
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When estimates are available,
the adjuster and contractor will discuss how repairs will be made, what materials
will be used, and costs of repairs.
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The adjuster will advise
you of the total estimated repair costs, including the deductible.
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Extra costs necessary to
make your home comply with new building codes are not covered by the standard
homeowners policy in most states. However, in most cases you can purchase
Building Code Upgrade-Ordinance or Law coverage as an addition to your policy.
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You'll be asked to submit
an inventory of your damaged and destroyed items. The adjuster may suggest
specialty firms that can clean, repair, or salvage damaged property.
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For large claims, if you
have a mortgage payment, payment will be made to you and the mortgage company.
If you've assigned your insurance claim to a contractor, the contractor will
also be named on the settlement check.
Settling
your auto insurance claim
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Adjusters dealing with auto
accidents will focus on: the cause of the accident; injuries to all persons
covered by the policy; damage to the car; possible liability claims. An example
of liability would be a claim by the other driver in a two-car accident that
your negligence caused injuries and auto damage.
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The adjuster will thoroughly
investigate the accident: take statements from parties involved, visit the
scene of the accident, take photographs, make diagrams, search for witnesses,
and receive police reports.
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Many people believe they
are not liable if police reports indicate they did not cause an accident.
However, police reports are not legally conclusive and a driver can be found
partially at fault for causing an accident.
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The adjuster will seek to
settle the claim with you and others covered by the policy. The adjuster
may request documentation from doctors, hospitals, and employers to monitor
treatment, verify that injuries were caused by the accident, and determine
lost earnings.
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If the vehicle can be repaired,
the adjuster probably will suggest that you get estimates from auto body
repair shops.
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Depending on your insurer
and the state you live in, you may either choose what shops you receive estimates
from, or you may be directed to a list of approved auto body shops. It's
the adjuster's job to make sure repair estimates are fair and reasonable
and reflect repairs that are really needed.
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Remember that if "depreciable"
items are being replaced, such as the battery or tires, you may have to pay
part of the cost to replace a used battery with a new one.
Reaching
a settlement agreement
Reaching an agreement with your insurance adjuster about your settlement
is usually very clear cut and easy. But there may be instances where you
don't agree. If you and your adjuster have difficulty reaching agreement,
it is probably because either one or both of you need more information.
The adjuster is responsible for investigating claims as quickly as possible
and working with policyholders to resolve any disputes. Some of this resolution
may take time. As a policyholder, it's your responsibility to work with the
adjuster to provide documentation and to reach agreement on matters that
are in question.
Receiving your payment
Once repair estimates are adjusted, you will receive a check for the covered
damage, minus depreciation value and the deductible amount of your policy.
If you have a car loan, the lending institution will also be named on the
check.
If another driver is found liabile for the damages to your car, you may be
reimbursed for the amount of your deductible from the other driver's insurance.
What if you're not satisfied with the results?
Call or write to the adjuster working on your case as new developments arise.
Communication and honesty are the components that you and your adjuster will
need to team up effectively. If you aren't satisfied, call the adjuster's
supervisor or branch manager and discuss the situation. Your insurance agent
or broker can also intervene.
If the claim still can't be resolved to your satisfaction, review your policy
to see if the dispute can be settled through arbitration or mediation techniques.
Another option is to contact consumer service representatives in your state's
Department of Insurance. You can also file a complaint, which will be investigated
and ruled on by the department at no cost.
Click here for a blank accident information form. Print copies of this form
to keep in each of your automobiles and to use in exchanging information
with driver(s) of other vehicles.
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