How Insurance Claims Work

An insurance claim is a formal request by the policyholder to the insurance carrier for payment or coverage under the terms of the policy following a loss event. The carrier reviews the claim against the policy's exclusions, conditions, and scope of loss to determine coverage.

Understanding the claim process allows you to identify where your claim currently stands and whether the carrier is following proper procedures. Delays, denials, and underpayments often occur at specific stages. Knowing these stages gives you leverage when dealing with depreciation disputes, scope disagreements, or bad faith indicators.

• Has the carrier acknowledged your claim in writing?
• Has an adjuster been assigned and an inspection completed?
• Have you received an itemized estimate?
• Does the payout match the documented scope of loss?

If your claim is at any stage and you believe the process has not been followed correctly, document everything and request a written explanation from the carrier. Consider filing a supplement if damage was missed.