Description of the Life Cycle of an Insurance Claim

by Wanda Thibodeaux ; Updated July 27, 2017
Most types of insurance have the same basic claims life cycle.

Insurance protects you against loss or injury due to accidents, acts of nature, theft and vandalism. Regardless of the kind of insurance you have or what company you use, the basic procedure for filing a claim is similar. Knowing the "life cycle" of a claim may help you get what you need from your coverage.

Basic Cycle

Typically, you begin the insurance life cycle when you contact your insurance company and file the claim paperwork. The second step in the cycle is when you document your loss. A claims adjuster comes out to your home or business to verify your loss and assess the dollar damage. The adjuster takes this information back to the insurance company, which then adjusts and fully processes the claim.The company contacts you with an offer, and you accept or reject that offer. If you reject it, you may have to go to court to get what is fair for your situation. Once your claim is settled, you can make full repairs, if needed.

Duration

Most insurance claims take a few weeks to process, if they are not complicated, according to the FreeAdvice website. However, complex claims may take longer, especially if you end up having to take your insurance company to court. You may be able to speed the process along by keeping excellent documentation of everything related to the claim, such as receipts for replacement materials or goods and letters from the insurance company.

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Expert Input

A simple insurance claim usually involves only you and your insurance company.However, depending on your circumstances, you also may need to pull in vendors or contractors for quotes or even an attorney to complete the claim cycle. With auto accidents, Police officers will need to file an accident report. Life insurance claims may involve creditors, trustees and real estate tax agents. Your doctor, clinic or hospital may need to be involved for health insurance claims.

Obligations

Through the claim process, you and the insurance company both have obligations under the contract. This means you and the insurance company must operate under "duties of loyalty" and "duties of care," according to Tamar Frankel, author of "Fiduciary Law." As the policy holder, you have the responsibility to initiate the claim and respond cooperatively to any reasonable requests for information from the insurance company, says Corey Harris, attorney with the Merlin Law Group. The insurance company must process your claim in a timely fashion and under the same procedures as all other clients.

Complications

Not all insurance claims proceed through the claims process smoothly. In some cases like health or disability claims, the insurance company may accuse you of malingering. As explained by the Wrong Diagnosis website, malingering is exaggeration done for non-psychological reasons, a type of fraud usually intended to garner financial gain. You may need testimony from witnesses or a physician to prove your claim is accurate or that there is a medical reason for your complaints. Conflicting testimony or reports also may hinder the claims cycle, as can lack of proficiency on the part of the insurance agent. Medical status also may prevent moving forward with a claim. For example, you may be unable to continue negotiation with your insurance company if you need a serious medical procedure.

About the Author

Wanda Thibodeaux is a freelance writer and editor based in Eagan, Minn. She has been published in both print and Web publications and has written on everything from fly fishing to parenting. She currently works through her business website, Takingdictation.com, which functions globally and welcomes new clients.

Photo Credits

  • Coche accidentado image by quicolopez from Fotolia.com
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