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How Does the Insurance Claims Process Work?

Mar 21, 2022 | Insurance Dispute


The insurance claims process is quite complicated and sadly set up to mitigate expenses for the insurance company. On the surface, your role appears quite simple. You’ll follow these steps.

  1. Open a claim with the insurance company documenting what happened, when, and why.
  2. Answer questions from the adjuster and facilitate having damaged property inspected.
  3. Seek medical care for ailments and document treatment with a medical professional to ensure a full recovery.
  4. Submit receipts and evidence for repayment of accident-related expenses.
  5. Receive reimbursement and move on with your life.

Tragically, these steps are not as simple as they could or should be. That’s because the insurance company is looking for every opportunity to reduce or limit your claim.

You have to be very careful what you say and do throughout the process to protect your rights and your ability to recover damages. That’s why it can be very helpful to have an attorney represent you throughout the process to protect your rights and explain what’s really happening.

Role of the Insurance Company

Insurance companies have set up the claims process to protect their finances and their best interests. Although you or the policyholder have been paying for the service awaiting the day you would need the coverage, the insurance company is not there to be your friend.

From the moment a claim comes in, the insurance company starts gathering information about it to either reduce or deny the claim. That’s the challenging reality of the job that insurance adjusters are tasked with.

Computer algorithms play a role as well in evaluating your claim. The claims that they don’t deny, they’ll gather information to reduce the claim.

We once talked to an insurance adjuster who said that their training told them that every claim has a component of fraud in it and their job is to find that fraud. If the insurance adjuster is looking at your claim in that way, it puts you, the victim, on the defense.

The Biggest Mistake Victims Make During the Insurance Claims Process

The idea that every insurance claim includes an element of fraud is bogus. Most people want to work with the insurance company, get their property fixed and their medical bills paid, and move on with their lives.

And because of that desire to work with the insurance company and move on with life, they often make the biggest mistake of working through an insurance claim.

They agree to a recorded statement with the insurance company without legal counsel.

Recorded statements are designed to help the insurance company learn information so they can pay you less in your claim. Talking to them only hurts you.

You are not obligated to talk to the insurance company. Instead, you can and should give them basic information in writing or through your attorney. Having your attorney represent you is the best way to protect yourself, but if you prefer to work through it yourself, providing written information can help you ensure you don’t say the wrong thing.

Reaching a Fair Claim Payment With the Insurance Company

Once you’ve opened a claim, you start another game with the insurance company. Instead of calculating your costs and giving you the money you deserve based on the evidence you’ve provided, the insurance company tries to offer you lower amounts to see what you’ll accept.

The whole system from start to finish is stacked against the individual filing the claim. That’s why we urge accident victims to talk to our team about their car accidents, slip and falls, defective products, workers’ compensation claims, etc. before talking to the insurance company.

We’re passionate about ensuring you don’t get taken advantage of during the insurance claims process and we want to be here for you during this time.

Schedule your free consultation with Stewart & Stewart now to ensure your insurance claim process goes well.

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