Be Claim Smart Advisory

Consumer Alert

How to Be “Claim Smart”

In times of crisis or following a major disaster, many consumers may be overwhelmed and confused by the insurance claims-filing process. However, it is critical that claims be filed correctly to ensure you receive all the payments due to you. Here are some tips from the National Association of Insurance Commissioners to help you be “claim smart” and to help you avoid problems in getting your claims paid.

  1. Know Your Policy Understand what your policy says. The policy is a contract between you and your insurance company. Know what’s covered, what’s excluded and what the deductibles are.
  2. File Claims As Soon As Possible Don’t let the bills or receipts pile up. Call your agent or your company’s claims hotline as soon as possible. Your policy may require that you make the notification within a certain time frame.
  3. Provide Complete, Correct Information Be certain to give your insurance company all the information they need. Incorrect or incomplete information will only cause a delay in processing your claim.
  4. Keep Copies of all Correspondence Whenever you communicate with your insurance company, be sure to keep copies and records of all correspondence. Write down information about your telephone and in-person contacts, including the date, name and title of the person you spoke with and what was said. Also keep a record of your time and expenses.
  5. Ask Questions Ask the company for the specific language in the policy that is in question. Find out if the disagreement is because you and the insurance company interpret your policy differently.
  6. Don’t Rush into a Settlement If the first offer made by an insurance company does not meet your expectations, be prepared to negotiate to get a fair settlement. If you have any questions regarding the fairness of your settlement, seek professional advice.
  7. Auto and Homeowner Claims
  • Auto and homeowners policies may require you to make temporary repairs to protect your property from further damage. Your policy should cover the cost of these repairs, so keep all receipts. Also, maintain any damaged personal property for the adjuster to inspect. If possible, take photos or videos of the damage before making repairs.
  • Don’t make permanent repairs. An insurance company may deny a claim if you make permanent repairs before the damage is inspected.
  • If possible, determine what it will cost to repair your property before you meet with the claims adjuster.
  • Provide the claims adjuster with records of any improvements you made to your property.
  • Ask the claims adjuster for an itemized explanation of the claim settlement offer.

8.   Accident and Health Claims

  • Ask your physician to provide your insurance company with details about your treatment, medical condition and prognosis.
  • If you suspect a provider is overcharging, ask the insurance company to audit the bill and verify whether the provider used the proper billing procedure. If you still owe a large balance, your provider may submit the bill to the local medical society peer review committee to review the charges.

9.   Get More Information

  • If you believe you have been treated unfairly in getting a claim paid, please contact your state insurance department. You can link to your insurance department’s Web site by visiting www.naic.org. Click on “State Insurance Regulators Web Sites,” then click on your state.
  • The National Association of Insurance Commissioners is a voluntary organization of the chief insurance regulatory officials of the 50 states, the District of Columbia and four U.S. territories. The overriding objectives of state regulators are to protect consumers and help maintain the financial stability of the insurance industry.