How to Settle Insurance Claims

If you suffer a loss and have the correct insurance cover then you should be able to make a claim – so how to claims get settled and when might they not be paid ?

While we may not completely agree with Charles Dickens who said, in 1860, “A Life Assurance Office is at all times exposed to be practiced upon by the most crafty and cruel of the human race.”, it may sometimes seems that the insurance company holds all the cards when it comes to paying out for a claim.

From the other side of the fence,  it I certainly true that many individuals make bogus or exaggerated claims. The insurance company has to look at the full facts of the claim before deciding to pay out. The number of fraudulent insurance claims made in the UK rose to a record high in 2009, to 122,000 detected fraudulent claims, valued at £840m. In the USA one in ten (11 percent) knows someone who has inflated the value of his or her insurance claim.

Therefore it seems obvious there will be disputes between the company and claimants, even those that may be genuine.

How to make a Successful Claim

If you are in the unenviable position of having to negotiate an insurance claim there is a lot you can do to make sure that the insurance company honor your claim. When settling your insurance claim with an insurance company you will be dealing with an adjuster. Try not to be intimidated by them when discussing your claim. The following tips will help you keep a clear head during the negotiations.

Get your facts straight: Make sure you have all of the information from the accident at your fingertips.. Having all your paperwork organized is essential. This will include police reports from an accident, photographs of the damaged property, pictures of your injuries and medical bills etc. The more precise you are with dates and times the more likely the insurance company is to take you claim seriously.

Have a figure in mind: You should have done some research and calculated how much the damage or injury will cost you.  In the case of a car accident, the insurance company may want you to use a certain repair shop.  Check out the establishment and make sure you are happy to have your repairs done there, before agreeing to this.

As a guide, for medical claims the industry standard amount the settlement of pain and suffering is three times the medical bills.

Don’t be Bullied: The insurance adjuster may well try to bully you out of your claim,  intimidating you with their experience of other claims and comparing your accident damages and injuries to other incidents that they have negotiated in the past. Stand you ground, armed with the facts you have. Past claims are irrelevant. You are prepared to discuss your claim and costs only and all other claims the adjuster may have dealt with have no relevance.

Insist on a written explanation: If your claim is turned down in most states the law require written explanation of claim denials and you can insist that your insurance company provides you with a written clarification of your claim denial.

Be careful of form errors: Be very careful to the instructions closely while filling out your insurance claim form. Filing errors alone cannot be an excuse for a claim dispute unless it’s a valid one but any errors will give the company an excuse to delay and investigate further.

Make a written complaint: Always keep all documentation and be sure to have all stages of the claim in writing. If you feel that you are not being treated fairly contact the supervisor of the adjuster. Always send your mail by registered post and keep all posting details. Always make copies of all your correspondence.

Do I need Legal Advice?

If you follow a clear procedure, as outlined above, it is more than likely that you will have no problem with your claim. If you are a genuine claimant, with all the facts at your disposal the insurance company and adjuster will look upon you very favorably.

Should this not be the case, and the amount you are claiming is worth it, you can get the advice of a professional who will have experience in dealing with such claim denials. This should be the last resort of an insurance claim as it will, of course, result in greater expense.

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