Insurance Settlement Guidelines
Claims are submitted for different types of insurance policies depending on what the insurance policy is designed to cover. Once a claim has been filed, an insurer may need to investigate the circumstances before a payment is made on the claim. One type of insurance policy that an insurer may investigate before paying out a settlement is an automobile insurance policy. An insurer has certain procedures in place to determine the validity of each submitted claim.
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Claims Process
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The first step before an insurance settlement is received is to file a claim. Claims can be submitted for an injury resulting from a car accident, damage that occurs to a home or the death of a member of the family. When a claim is submitted on a automobile policy, an insurance adjuster will come out to examine the damage to the vehicle. The insurance adjuster will determine the cost to repair or replace the vehicle and in some cases offer a settlement at the accident scene.
Verifying Information
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Whenever a claim is filed for an accident, whether it involved a vehicle or while on another person's property, an insurer will want to speak with everyone involved to get all of the facts. An individual should follow basic guidelines when discussing the circumstances of an accident with an adjuster or company representative. These include remaining calm, polite and giving only limited information such as a name, address as well as a phone number and not settling the claim immediately.
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Making a Claim
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When an individual needs to file a claim with an insurer other than her own, there are steps that should be taken to request payment for injuries. The first step is to write a demand letter to the insurance company. The letter should include why the individual insured is responsible for injuries that were sustained, the specific injuries that were sustained as well as any income that was lost. If an individual has no-fault insurance their own insurance company should be contacted first.
Claim Determination
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Insurance companies can make a determination to the amount they will pay out on a claim using a variety of factors. These can include any medical care that was received by an injured person, income that was lost because of an injury, disability or any pain and discomfort as well as the loss of any family, educational or social activities or experiences. In the case of determination of a claim for life insurance an insurer may have specific guidelines that need to be followed (see Additional Resources).
Limitations
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When a claim is filed for an accident, an insurer cannot ask about the types of income or benefits that are received from other sources. This can include sick pay from an employer or health insurance benefits for medical costs. They can only use the facts about the specific claim and its causes. However, an individual may be required to reimburse the health insurer for some costs from the amount received from a claim settlement.
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