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Claims in insurance. Insurance claims meaning.

Claims in insurance

Insurance claims include many types ranging from medical bills, property damage, car accident injuries, and life insurance death benefits.

Insurance claims meaning

A claim is a policyholder’s request to an insurance company for payment, asking for coverage or compensation for a covered loss. These claims are typically for medical bills or to repair damaged property.

For example, if a fire has damaged a homeowner’s house, they will file a claim that involves asking their insurance providers to pay for any repairs.

This guide will cover the types of insurance claims, how they work, and how they’re processed.

Table of contents

  • Types of insurance claims
  • How do insurance claims work?
  • Processing insurance claims

Types of insurance claims

Just like there are many insurance types to suit different needs, there are many types of insurance claims.

The type of claim you need to file depends on the incident you are involved in and what your insurance policies cover.

Some of these insurance claims must be filed with your insurance provider, whereas others must be filed with another party’s insurer.

Keep reading to find out about the different claims in insurance.

First-party insurance claims

Filing an insurance claim under your own policy is known as a first-party claim. The insured individual files these kinds of claims against the insurance company. These types of claims must usually be filed immediately after the incident.

Claims for injuries and accidents are the most common types of insurance claims, with home and auto insurance being used the most.

General claims

General insurance claims cover many accidents and are often used by businesses.

For example, general claims can involve business claims like business interruption, worker’s compensation, data breaches, or professional liability.

Car insurance claims

Car insurance typically covers damage or injury when you are at fault in an accident. However, if your auto insurance policy includes collision coverage, you can usually file a collision claim for injuries and damages, regardless of who was at fault.

Car insurance claims can pay out in various cases, including:

  • A vehicle collision, property damage, or bodily harm to another person.
  • Damage caused by an outside force (e.g., an animal, falling objects, or a natural disaster) with comprehensive coverage.
  • Coverage for uninsured or underinsured drivers (with comprehensive coverage).

Types of claims under a car insurance policy can include collision coverage, vandalism, robbery, physical injuries, property damage, uninsured driver coverage, and liability.

Homeowners insurance claims

Homeowners insurance covers your personal property, the structure of your home, and your liability for visitor injuries.

You can file a claim under your home insurance policy for covered damages, such as a pipe bursting in your kitchen or an extreme weather event damaging your property’s exterior.

Homeowner insurance claims typically cover the following:

  • Structural property damage.
  • Visitor injuries of people who visit your home.
  • Damage to and loss of your personal property, including theft.
  • Additional living expenses (ALE) if your home becomes uninhabitable and you need costs for temporary accommodation.

Renters insurance claims

Renters insurance pays out claims for incidents related to your rental property. Rental insurance covers the theft, or damage to personal property, personal liability for damage or injury, and additional living expenses for temporary relocation.

Claims under a renters policy are similar to homeowner’s insurance claims, as they are subject to specific perils.

Renter’s insurance claims typically cover the following, such as:

  • Damage sustained to your personal property.
  • Property loss from the theft of your home or vehicle.
  • Damage caused by natural disasters or related incidents.
  • People’s injuries while they are renting or visiting your rental property.

Third-party insurance claims

A third-party claim involves filing a claim under someone else’s insurance provider. This type of claim is filed by someone other than the policyholder.

For example, you might file a third-party claim against someone else’s auto insurance company if you are in a car accident.

Third-party claims are more common among car and home insurance policies.

Third-party car insurance claims

If the accident you were involved in was the other person’s fault and they fail to make a claim, you might need to do so with their insurance company.

You can also file a third-party claim if you were injured as a passenger or bystander.

Third-party home insurance claims

You should file a third-party claim if you get injured when visiting someone’s home.

Homeowners’ and renters’ insurance policies usually cover visitor injuries if the homeowner or renter does not maintain the property or warn the visitor of any perils.

Other types of insurance claims

Although the process of filing insurance claims is similar across different types, there are several significant differences.

Life insurance claims

Unlike other types of claims, you don’t file a life insurance claim as an insured. This kind of claim is a contract between another insured party and the insurance company.

The insurance provider will pay the sum assured in the policy contract to the beneficiary who filed the claim after the insured individual’s death.

Health insurance claims

You must submit your own claim to receive benefits for most insurance types, but your healthcare provider usually submits a health insurance claim directly to the insurance company.

You might have to copay, and the claim will determine your debts.

Health insurance claims can typically be filed for the following:

  • X-rays, bloodwork, and lab work.
  • Routine check-ups and doctor’s visits.
  • Emergencies, including accidents, injuries, sickness, and mental health.

Natural disaster insurance claim

Not all homeowner policies cover natural disasters.

Other insurance claims include those for natural disasters, floods, earthquakes, boating accidents, pets, and agricultural issues.

How do insurance claims work?

No matter what type of claim you need to file, there are typically three steps.

  1. You must report the incident to the insurance company.
  2. You wait for the insurance company to appoint a claims adjuster to evaluate the damage.
  3. The insurance company then decides on the settlement amount or rejects the claim.

No matter the policy type, you are required to provide the following information during an insurance claim process:

  • The date of the incident.
  • Names of those involved in the incident.
  • Your insurance policy number.
  • Any relevant information, such as an accident, incident, or medical report.
  • You should also provide photos of damages or injuries as proof.

Processing insurance claims

What should you expect in the process of filing an insurance claim?

Filing an insurance claim doesn’t have to be a complicated process. While there’s no expected result, there is a process to follow. However, the claim handling process depends on your policy.

Here are the general steps of filing insurance claims and what to expect in the process.

1. Contact your insurance company

You should inform your insurance company about the incident immediately after, even if you’re not sure your policy covers it. It’s also essential to communicate with your insurance agent even though you might not want to file a claim.

You should remember that there are limits regarding the time you can file a claim. Different kinds of claims have different timeframes, so discuss this with your provider when you contact them.

As well as informing your insurers, you might need to contact the relevant authorities, depending on what damage or loss you’ve suffered.

2. Gather your proof and information

After you’ve contacted your insurance company and filed a claim, they may need you to fill out a form or give a statement. Your insurance provider must determine what happened and whether your policy covers the damages or loss.

At this point, you may need to send the insurance company photographic proof you gathered of the incident. It’s important to document as much evidence as you can.

3. Meet with the adjuster

At this stage, most insurance companies send an adjuster or contractor to assess your reported damages. You might need to share the contact details of relevant witnesses and parties, so be prepared that they may ask you for the necessary information.

This stage may also involve having repairs done if you’ve filed an auto insurance claim.

In a home claim, the adjuster will visit your property to inspect the damages. They will ask you questions to determine how much it’ll cost to repair the damage.

The adjuster may ask you to make a statement about the incident in a liability claim, and they may need to verify with the injured party.

4. Pay your deductible

The last stage of the process typically involves paying your deductible, as your claim won’t be approved if your damage amount is lower than your deductible.

In the event of an auto accident claim, if your damages are designated a total loss, the cost of your deductible is typically deducted from the amount of money issued as a payout.

Your policy deductible may not apply to the payment if your claim is part of a liability case.

The deductible usually varies based on the type of damage you’ve incurred for a property damage claim.

5. The payment process

If you filed a property damage claim, you would receive payment once a settlement amount has been agreed upon.

You likely won’t receive a lump sum check if you have a mortgage. You will receive the money in stages while repairs are made.

If you file a claim for personal property loss, your provider will reimburse you for the actual cash value or the cost to replace the stolen items so you can replace them.

Key takeaways

There are many types of claims in insurance to suit different needs. The type of claim you need to file depends on the incident, your policies, and what they cover.

Insurance claims can involve medical bills, property damage, car accident injuries, and life insurance death benefits.

Some claims must be filed with your insurance provider, whereas others must be filed with another party’s insurer.

No matter what type of claim you need to file, there are a few steps to take to start the process.

No matter the policy type, you must provide details about the incident and usually have to provide photographic evidence.

Check your insurance policy details to determine if there is a time limit for filing your claim and if you suffered a covered loss or damage.

A healthcare professional will file the claim for you in most medical situations.

You should ask your insurance provider to determine if your incident is covered if you are unsure.

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