What Happens after I File an Insurance Claim?

Filing an insurance claim after an accident or theft can be a stressful experience. Insurance customers often want to know what is going on with their claim and when they will receive reimbursement. After an insurance claim is filed, an insurer typically will assign a claims representative to the case. For auto, life and home insurance cases, the insurer verifies — either through visual inspection or legal reports — that the loss did take place, determines the value of the loss and either sends a check to the insured party or denies the claim. Health insurance claims are more complicated and usually involve some negotiation between the insurer and the healthcare provider involved before claims are paid.

Calling an automotive insurer to report an accident is often a person's first experience with insurance claims. The claims representative will ask a series of questions about the accident and gather information from the involved parties and law enforcement. The insurance company may send a claims adjuster to the customer's home or workplace to inspect the damaged vehicle and determine an estimate for repairs. In other instances, the insurer may ask the customer to go to an approved repair shop for an estimate. The insurance company will then write a check — minus the customer's deductible — to fix the vehicle and, depending on which party was at fault, either pay for damage to other involved vehicles or collect money from other drivers or their insurance companies.

For most homeowner's claims, an insurance adjuster visits the customer's home and inspects damage done by fire or severe weather. He will then estimate repair costs and the likely time frame required to make the home livable again. Depending on the type of policy, an insurance company may pay for housing while the residence is being restored and arrange for the home to be repaired and cleaned. Claims of theft are typically scrutinized for evidence of fraud, particularly if a customer has made theft claims in the past.

Most healthcare claims are handled by the insurer and healthcare provider. In some instances, there may be two or more companies involved with the insurance claim if the patient has purchased supplemental insurance. Depending on the healthcare services provided, the patient may only be responsible for a co-pay at the time of the office visit. In more complicated cases involving hospital stays or extensive diagnostic tests, it may take some time for the care provider to collect from the health insurance companies. Eventually, the patient will be billed by the healthcare provider for any services the insurer did not cover.

A life insurance claim is usually fairly straight forward. Once a beneficiary files a claim and a copy of the death certificate, the insurance company will verify that the policy is paid up and the death certificate is genuine. In some cases, the insurance agency may investigate the death to make sure the beneficiaries are not defrauding the company, particularly if the circumstances of the death were unusual or the policy was recently purchased.