UNDERSTANDING INSURANCE CLAIMS
You might never need to submit an insurance claim if you’re lucky. You can file a claim with your insurer if anything goes wrong and you are hurt in an unplanned accident, natural disaster, or other loss covered by your insurance policy.
If you comply with the policy’s terms and conditions, the insurance policy you purchase is a promise of support in case something goes wrong. To start the insurer’s reaction, you must submit a claim. If your claim is approved, the insurer will honor the policy by paying for necessary repairs or replacements, by paying for any necessary legal expenses, or by making a payment.
WHAT IS AN INSURANCE CLAIM?
A claim is a formal notification to the insurance company that you have sustained a loss or injury that you feel is covered by the policy and that you are asking for action. If the incident or circumstances are risks covered by the insurance, the insurer will consider your claim. You have to prove that the claim is valid, and the insurance company has to confirm that it meets the requirements of your policy.
If your claim is approved, the benefit or payout is the replacement or repair of your property or insurance money. The insurer will determine the claim’s worth and grant the proper reward outlined in your insurance policy.
TYPES OF CLAIMS
There are two ways to submit the claim: cashless or reimbursement. If you have your automobile fixed at one of our partner garages after an accident, your insurance claim is handled without needing payment. For the finest and quickest claim resolutions, it is best to find out which garages are affiliated with your insurance company. Insurance firms have partnerships with garage chains.
In this case, it is more convenient because the insurance company sends direct funds to the affiliated garage. If your automobile is fixed at a shop not affiliated with your insurance company, you will be responsible for paying the expenses.
Once this is completed, you can request that the insurance company pay for the necessary repairs. You may also submit a reimbursement claim if a third party has claimed you. Depending on the terms and conditions outlined in the policy, your insurance company may repay you if you pay the third party directly.
THE CLAIMS PROCESS
Although insurance companies work to make the claims process as simple as possible, the policyholder must go through a few procedures. Making a claim is typically straightforward and quick if you are organized and well-prepared and have all the information the insurance company needs. You must contact your insurance provider immediately after the event, mainly if the loss was caused by theft or a major accident.
To determine if you have a valid claim and if the incident is not listed on your insurance policy’s list of exclusions, you may choose to study the Product Disclosure Statement for your insurance policy. Once you file a claim, your insurer will still do this. An organized, step-by-step approach will help your claim move through much more smoothly. You may make sure you don’t skip any crucial phases by using the following suggestions.
BEFORE YOU CLAIM
SAFETY FIRST
Damaged structures can be pretty dangerous, so following the emergency services authorities’ recommendations regarding access to your home and the surrounding region is crucial. Do not attempt to enter your property if it is not secure. Above all, make sure that you and your family are always safe.
CONTACT THE POLICE
You should notify the police as soon as possible and save the incident number they provide you if you’re ever the victim of a crime like theft, vandalism, malicious acts, or any significant accident (like one that requires a tow truck or an injured person).
Give the police all the information you can about what happened, and abide by any instructions they may give you. Any significant incident will result in a police report. Request the police report number from the officer with whom you are speaking. This must be mentioned in your insurance claim.
REVIEW YOUR PRODUCT DISCLOSURE STATEMENT
To determine if you have a valid claim and if the incident is not listed on your insurance policy’s list of exclusions, you may choose to study the Product Disclosure Statement (PDS) and your policy schedule. Once you file a claim, your insurer will do this in any case. You may now find out how much excess you might have to pay.
CLAIMS HANDLING STANDARDS
The general insurance firms must fulfill or exceed the criteria for claims management outlined in the General Insurance Code of Practice. However, each insurance company has its procedures for handling claims.
The Code outlines how insurers must treat their clients, including how quickly they must process and decide on claims. The Financial Complaints Authority keeps an eye on compliance.
SETTLING CLAIMS
Insurance firms expect to evaluate all made claims as soon as possible and settle all claims that fall under the terms of their policies. The General Insurance Code requires insurance companies of Practice to reply to your claim within ten business days and let you know whether they will accept or reject it based on your provided data.
When filing a claim, you must offer sufficient evidence of the financial loss covered by the policy. This could consist of receipts, invoices, police or medical reports, and proof of ownership of the claimed things. Within ten business days of receiving your claim, the insurance company will let you know what information it wants from you if it requires more specific information before reaching a decision.
The insurance company may appoint a loss assessor, adjuster, or investigator to gather more information. If so, the insurance provider will estimate how long it will take to decide whether to approve your claim. Additionally, it will inform you about that person’s appointment within five business days and update you on the status of your claim once every 20 business days.
If your claim is complicated, the insurance provider will work with you to determine a different timetable for resolution. If the insurance provider is not looking into your claim, you have the right to view any information about you that was used to evaluate your claim. Insurance providers cannot arbitrarily refuse your requests for information and reports on your claim.
If an error is found while processing your claim, the insurance provider guarantees to make the necessary corrections immediately. If an insurance claim is rejected, the company must give written justifications for the decision and details on how it handles complaints. The insurance company will also give you copies of any reports from service providers utilized to evaluate your claim if you request them.
Because insurance companies would not be able to fulfill strict deadlines when many people are filing property claims at once, the General Insurance Code of Practice addresses insurance company reactions to an occurrence that the ICA declares a disaster. Even if you signed a release, you have the right to request a review of your claim if you believe the insurers’ assessment of your loss was incomplete or inaccurate. Your insurers have finalized your claim within one month of the catastrophe event that caused your loss. You have 12 months from the day your claim was concluded with the insurer to request a review of your claim.
THE BOTTOMLINE
It’s important to be fully ready for an accident, and the only way to do that is to have full auto insurance. Also, it’s important to know how the claims process works because, after an accident, we often get scared and forget important details.
Remember, it’s preferable to streamline your insurance company’s reimbursement procedure, so do everything you can to position yourself to submit a successful claim in the event of an unfortunate situation. As the saying goes, it is always better to be safe than sorry.
Every claim is unique, and although the claims procedure may change significantly depending on the circumstances, your adjuster will invest the time and effort necessary to settle your specific case. Sidhu Personal Injury Lawyers Calgary aims to treat each claim fairly, professionally, and meticulously as is humanly possible.
We are professional accident lawyers in Calgary, and you can always get in touch with us to receive the answers you need if you have any questions or concerns about the claims procedure.
