The Insurance Claims Process – The Great Unknown

Insurance is something a company buys with the hope that they will never have to use it. Of course when they do have a claim, they expect the process to go smoothly. The expectation is that legitimate claims get paid, and bogus claims don’t. The majority of claims are handled without incident; but, unfortunately, we don’t hear a lot about those claims. It’s the difficult claims that get all the press because those are the claims that create the most sensationalism.

The focus of this article will be on the claim’s process, specifically, workers compensation, general liability, auto and property claims. In the interest of brevity, I’ll only elaborate on workers compensation and automobile claims. It is important to note that no two claims are exactly alike, and that each and every claim has its own set of circumstances.

The claims adjuster is the central figure in any claim. Simply stated, their job is to apply the applicable policy provisions and to make sure the claim is handled promptly and without prejudice. Claims departments are a highly specialized business unit of every insurance company. Auto claims are handled by auto adjusters, workers compensation claims are handled by workers compensation adjusters, etc.

Let’s run through a workers compensation claim. First, the insured calls in the claim and the adjuster takes all of the information. Second, the adjuster contacts the injured employee to get his/her story (on tape), and they corroborate their story with any witnesses to the accident. Thirdly, if needed, the adjuster will contact the medical provider to get an idea on the extent of injuries. Next, the adjuster will coordinate care and act as a liaison between the injured employee and the insured. Lastly, if it appears that the claim is questionable, they will do everything in their power to fight the claim. Usually, by this stage, the injured employee has hired an attorney.

In an automobile claim, you could have four different people handling the claim. Depending on the damage/injuries, you could have a front line adjuster, an appraiser, a PIP adjuster and a bodily injury adjuster. It’s the front line adjusters’ job to act as the quarterback and to coordinate the claim with all of the other adjusters. The adjusters and appraisers are highly trained in their specific area of expertise. I only mention this because, as we know, there are people out there who put in fraudulent claims. Trust me, if the claims looks as though it’s fraudulent, they will know, and the repercussions are severe.

When it comes to claims, speed is of the essence. The quicker the insurer gets the claim, the better the claim will be handled. Insurance companies want to be the first to contact the injured party (or parties). I always recommend that the insured report all claims, no matter how small or seemingly insignificant. The insured isn’t the one to make the determination as to whether the claim is legitimate or not, the insurer is. It’s important to note the policy provisions when a claim occurs. Ideally, you would have read the policy before a loss occurs, but I know that’s not always the case. Among other things, it states: “Give us prompt notice of the loss or damage.” So, not only is it wise to report claims promptly, it’s a condition in your policy to do so.

In addition to prompt reporting of claims, you must “take all reasonable steps to protect the covered property from further damage, and keep a record of your expenses necessary to protect the covered property.” For instance, if a tree falls on your building and exposes your personal property to the elements, the insurer expects you to minimize further damage by any means possible. This could include moving your property to another location, or having the building damage temporarily fixed to prevent further damage until the adjuster can make a determination of damages.

It is the adjuster’s job to set the reserve. A reserve is the probable ultimate exposure. In other words, it’s the amount the carrier expects to pay for the claim. The better the information they get, the more accurate the reserve. Reserves do change from time to time that is why it’s imperative to pay close attention to your loss runs. For the difficult claims, your agent should be scheduling (and attending) claims reviews with you and the adjuster. This gives you the opportunity to question how the claim is being handled and have the adjuster justify the reserve.

Hopefully you’ve done your best to prevent claims from happening, but we know they do occur. It’s what you do when a claim occurs that determines the final payout. It all starts with reporting all claims in a timely manner. A good agent, and insurance company, will guide you through the process, and do all they can to make sure the process goes smoothly. If they can’t, find someone who can.

Claiming Compensation For Personal Injury – Myth V Reality

Myth 1

We live in a compensation culture where people sue at the drop of a hat for even the most trivial injuries.

Reality 1

In order to make a successful claim for personal injury compensation you have to prove that you have been hurt or injured. Unless the evidence supports the claim the case has no chance of success, ever, period. Spurious damages claims may grab the headlines but they will never see the light of day in court. Anyone can claim compensation but it’s the follow-through that counts and the papers never report on the half-baked claims that never succeed.

We are only concerned here about real people who have suffered real injuries.

The fact is that many people still don’t realise that they have a right to claim compensation if they have been hurt or injured in an accident that wasn’t their fault.

We know from research carried out by the Citizens Advice Bureau that over 60% of people entitled to make a claim for compensation fail to do so. From our own experience, we find that many people who go on to become clients of the firm are unsure about making a claim for a variety of reasons. It’s our job to help accident victims and their families understand their rights and guide them through the legal process.

We understand that some people are affected by the myth of a ‘compensation culture’ and may be concerned about what family and friends will think if they make a claim. Passengers injured in a car driven by a family member or a friend can become distressed by the very thought of seeking damages and workers can be unwilling to claim against their employers.

Myth 2

People who claim compensation for personal injury are just looking for a source of extra money

Reality 2

The key issue for the injured person and their family is whether they can afford not to seek damages, particularly if they are unable to continue working or have to change jobs as a result of their accident.

In any event, the amount of money awarded is far from being a ‘lottery’ win. In the UK damages in personal injury cases are based on very precise calculations, refined over many years, which reflect the extent of the injury and the earning capacity of the victim. The process is designed with one aim in mind – to put the injured party back to where they were before the accident. Thus a twisted ankle claim will not attract a multi-million pound sum, whereas a brain-injured survivor of a road traffic accident might well receive a very large sum of money to pay for a lifetime of medical care.

Myth 3

The insurance company will look after my interests – they have already offered me a cheque.

Reality 3

Insurance companies are not registered charities. They have a statutory duty to their shareholders to maintain and enhance their levels of profitability and that means they will fight to totally repudiate or reduce the value of your claim.

It is not uncommon for accident victims to receive an offer direct from an insurance company in the immediate aftermath of their injury and before the full extent of any physical damage has been assessed ‘in full and final settlement’ of their claim. The motivation behind this offer is to reduce the insurance company’s costs by enticing accident victims with a tempting sum of money which is designed to prevent any future claim. Once this money has been accepted that’s it – claim over, regardless of any medical complications yet to be diagnosed.

Myth 4

Claiming compensation is costly and difficult.

Reality 4

Like any legal process, making a claim for compensation requires a certain level of expertise and experience. That’s what specialist personal injury lawyers are trained to do. The best lawyers will review your case totally free of charge, take on all the work and negotiate on your behalf with the insurance companies and their representatives. If they lose the case you pay nothing, if they win your case you will normally pay a pre-arranged percentage of your award.

Although the vast majority of claims settle out of court, it is vital that your case is thoroughly prepared and ready to go to court if required. Make no mistake, you need an experienced personal injury solicitor on your side who will push the insurance company’s legal team to settle your case in your favour, not someone who will sit meekly by and accept whatever is on offer. Going to court can be a bit daunting but your solicitor will be with you every step of the way to give you all the help and support you need.

Myth 5

A 100% compensation deal is better than ‘no win no fee’ if my lawyer takes a success fee.

Reality 5

Anybody can say yes to an insurance company’s initial offer. If you are on a 100% compensation deal you will get 100% of that sum, no problem, or is it? You should consider the value you place on your lawyer’s expertise and track record – check them out. The best lawyers know how to win the big awards and they are well resourced to take on the insurance industry and after all, 80% of £10,000 is considerably more than 100% of £5,000.

If you do decide to make a claim you have a bewildering choice of compensation claims ‘specialists’ lining up to help, so what do you need to consider before you lift the phone?

1. Can I claim?

If you have been hurt or injured in an accident within the last 3 years that wasn’t your fault, or if you have been diagnosed with an industrial illness or disease within the last 7 years, you are entitled to make a claim. There are special time limits applying to claims made on behalf of children.

The key phrase is: ‘entitled to make a claim’. Whether or not your claim is successful is dependent upon the strength of the evidence and the skill, experience and commitment of a specialist personal injury solicitor who will help you decide if your claim is worth pursuing in the first place.

It is vitally important to let a qualified solicitor advise on the merits of your claim. Over the years we have been able to secure substantial awards for people who thought that their actions, or lack of action (e.g. not wearing a seat belt) would drastically reduce the value of their damages or even cause their claim to be thrown out altogether. So, if you don’t want to get injured twice, get proper legal advice.

2. Who should I talk to?

There is no substitute for experience. If your injury is serious and your claim is undervalued you run a real risk of compromising your family’s financial future. Even relatively minor claims in the wrong hands can cost the accident victim several thousand pounds in ‘lost’ damages.

3. Solicitor or claims company?

It’s not quite that simple.

Many solicitors in general practice will take on personal injury cases but you have to ask yourself if they have the expertise to handle your claim. A solicitor who deals with house sales and family law matters in the morning is perhaps not the best person to be handling your personal injury claim in the afternoon.

Some specialist personal injury firms who work on behalf of accident victims (i.e. the pursuers) also work for the very insurance companies (i.e. the defenders) who are being sued by accident victims. It would be in your interest to know if the firm you are thinking about contacting is totally committed to fighting for the rights of injured people.

Despite appearances, claims companies are not firms of solicitors and they cannot pursue your claim in the Scottish courts. Claims companies operate under different guises, but they share one common characteristic – they are basically middlemen who match your claim with a solicitor from a panel. All you have done by not directly contacting a solicitor of your own choosing is added an unnecessary layer of bureaucracy and cost between you and the successful resolution of your claim.

4. Regulation

Scottish solicitors are regulated by the Law Society of Scotland. Unlike in England & Wales, there is no regulation of claims companies in Scotland.

Andy Thorogood is the Practice Development Manager at Bonnar & Company Solicitors, a leading firm of personal injury solicitors and accident compensation claim specialists with offices across Scotland.

Bonnar & Company has over 30 years’ experience of personal injury claims in Scotland and only ever works on behalf of accident victims and their families.

Navigating the Health Claim Maze

The second half of getting sick is fussing with the health insurance claims process. I have some tips to pass-on from my own health claims experiences that might help you navigate this maze. Since I also sell health insurance, my understanding of the process and structure gives me an added perspective. This is not a rant on health insurance business or healthcare – just some techniques that can be helpful.

I am way too experienced in running the Health Claim Maze. Unfortunately, I lost my older brother to cancer last year and as his friend, and later executor, had the task of helping on the insurance issues.

First the Good News

I have always gotten the right answer eventually from every health insurance company on every health claim I have dealt with. Each and every insurance company honored their insurance policy and correctly paid what was due (or had a valid reason to decline a claim). Most claims were handled correctly and timely without any intervention.

This included the Kansas Health Insurance Association (the Kansas health insurance risk pool) which paid over $500,000 for my brother’s lymphoma treatments over his two year illness. It gave him access to any treatments that were appropriate. The final cost to him, in addition to his monthly premium, was his deductible and cost sharing of $3000 for each of the two years ($6000 total).

The core value of any health insurance plan is offsetting the huge financial risk of a major illness or injury and getting you access to the treatment you need.

Choosing the Right Insurance Company

Claims service matters. Unfortunately, most folks select insurance companies based on price and not value. An important value to consider is the ease of getting help if you have a claim.

Look for an insurance company that has kept their claims call center in the United States. Nothing will make the claims process more frustrating than trying to get help on a complex health claim over a bad phone connection with someone who is talking a different version of English. Avoid any insurance company that has chosen the cheap off-shore claims helpline strategy.

Second, ask around about the claims service reputation of an insurance company. This is a good question for your insurance agent. Some insurance companies focus on making the claims process easier while others only offer only adequate service. It is worth paying more and getting the quality service.

Organization Matters

Setup a filing system to keep all claim benefit paperwork. Since the annual insurance deductible follows the calendar year, it is helpful to sort any claims “Explanation of Benefits” by the year the healthcare service was rendered. At the very least, have a box or file to toss any health insurance paperwork – keep it all. You will need this paper trail if a major health claim problem erupts.

If you are dealing with a major illness with a high volume of claims documents you will need a more advanced filing concept. For my brother, I had three files for each year: 1. Paid Claims; 2. Claims in Process; 3. Claims being appealed. I also stapled any unpaid healthcare provider invoice or appeal letter with the claims documents. Within these files, all claims paperwork was sorted by date of service. With pounds of claim’s documents generated by my brother’s illness, organization of the paperwork was very important.

The Contract / Sales Booklet

Always keep in your file the actual health insurance contract and the detailed sales booklet. The sales booklet is much more accessible and a good starting point to understanding your benefits. I purposely send the detailed booklet to each of my clients when they apply for insurance. The contract is what the health insurance company is obligated to do in exchange for your premiums and is the final word on any dispute.

Troubleshooting the Maze

Most health insurance claims are automatically (particularly if you are “in network” with your healthcare providers) and correctly handled. With any organization, even if well intended and well run (I count most health insurance companies in this category), balls are still going to get dropped and mistakes will happen. Always treat the claims representatives politely (my wife’s very wise advice) and enlist them as allies.

Here are three primary claims problems with troubleshooting techniques that I have used:

Problem #1: Claim Denied

Health claims are often denied for minor technical reasons. Don’t panic. You have work to do.

First Action: Call the Insurance Company’s claims office and ask for an explanation. Why was the claim not paid? Often it is a simple problem that can be quickly corrected.

For example: a client that had a hospitalization ($45,000 three day hospital visit due to a heart rhythm problem), but had the claim initially declined by the insurance company. A phone call to the insurance company revealed they needed a detailed bill to process the claim but the hospital had only sent a summary bill. This was quickly resolved with a second call to the hospital. A payment for the claim (less policy deductible) was quickly sent.

Second Action: Appeal the Claim. You will see on any “Explanation of Benefits” a procedure to appeal any claim that has been denied. Follow this path (normally a mailed letter). Keep a copy of everything. You need to appeal within a limited time period. I made it a policy with my brother’s claims to appeal the same day I received any Explanation of Benefits that did not pay the claim. Always send an appeal by certified mail to establish the date the appeal was made and who it was sent to. An appeal forces a higher level of assessment and typically shifts the claim to a special claims appeal review department.

Third Action: Follow up the appeal with a phone call. Normally, you will get an appeal response by mail within a specific time frame outlined in the appeals process. If you don’t receive a timely response or a response that you don’t understand, call the claims appeal office and ask for help. Request a supervisor if you don’t get an adequate answer.

Fourth Action: Ask for a copy of the contract clause that impacts the claims outcome and reread it. Have the claims representative or the supervisor explain the contract language and why the claim is ineligible for payment. You will eventually get the right answer (I always have). If the right answer is a denial, you are owned an explanation you understand.

Problem #2: Past Due Notice from Health care Provider.

This is a warning flag – something has gone astray in the claims communication or processing and you need to figure it out. Intervention will be needed.

First Action: Confirm with the healthcare provider that the claim was properly filed. Several times, I have found that the provider never got the policy information and was unable to file a claim.

Example: Both times that my brother was taken to the hospital, the ambulance service was never given any insurance policy information. The late notices alerted me to call them and provide what they need to file the claim.

Second Action: Call the insurance claims call center and confirm that they received the claim. Ask for an explanation on why claim payment has been delayed. Discuss when the claim payment will be handled.

Third Action: Repeat if necessary. If not resolved after calling the provider and health insurance claim office a second time, request the insurance company to contact the healthcare provider and resolve the communication issue directly. If this is refused, see: “Fourth Action.”

Fourth Action: The “Poor Man’s Conference Call” – my favorite technique to deal with communication barriers between healthcare providers and claims processors. Get access to two difference phone lines (I normal use a land line and my cell phone) and call both of them at the same time with a phone at each ear. Force them to dialogue with you as the conduit until the problem is resolved or until they accept your request to discuss the problem directly without you.

The “Poor Man’s Conference Call” has worked both times I had to use it. Reserve it for your stubborn communication problems when you need a “nuclear option” to force direct contact to resolve a claim problem. Because of HIPAA rules and legal risks, it is normal for healthcare providers and insurance claims processors to be reluctant to discuss any claims issues directly. Health care is a crazy world with privacy, legal barriers, office procedures and multiple layers of processors that limit cooperation and foster communication impediments.

Problem #3: Out-of-Network

The best way to avoid claims paid at the much lower “Out-of-Network” rate is to make an honest attempt to use “In-Network” vendors. If you choose to use providers that are not on the preferred list, you will pay more out-of-pocket and often have to meet a higher deductible.

Below are situations in which you are forced to use providers outside of the prefer ranks:

First Situation: Emergency Treatment. The health insurance contracts that I am familiar with and sell make an exception for any network issues if you are unable to choose a preferred provider due to bonified medical emergency. Your claim will likely be processed initially based on the “Out-of-Network” rates and then you will need to appeal for claim payment based on the emergency treatment exception and request adjustment to an “In-Network” settlement.

Second Situation: No Ability to Select an In-Network Provider. I have appealed and been successful based on the argument that there was no opportunity to select a preferred provider.

Example: My brother was transported by an ambulance service that was summoned by calling 9-1-1. He had no control over which ambulance was dispatched. The ambulance service was not a preferred provider and the initial claim was figured based on “Out-of-Network” rates which left a substantial balance. After an appeal, this balance was paid by the insurance company.

Another example: You select an “In-network” facility but are assigned an “out-of-network” doctor or provider. My brother’s pathology sample was sent to a lab that was not a preferred provider. He had no control of the transaction and no ability to select who got his lab work. I again was successful on appeal.

Third Situation: No network provider available. Any health insurance contract that I am familiar with has an exception for any network issues if no preferred provider is reasonably available. You may have a basis to appeal if you can show that no provider on the network will take you or that none of the preferred providers are within a reasonable travel range.

Example: My brother’s doctor that specialized in infections was not a preferred provider. All of the claims from this provider were initially process as “Out-of-Network.” I was able to prove that no “Infections Doctor” that was on the preferred provider list was available to treat my brother within 30 miles. An appeal, based on network provider availability, was then successful and the claim adjusted.

Summary

While most health insurance claims are processed correctly, you still need to be prepared for the few that aren’t. Always follow-up with phone calls, ask for help and appeal an unfavorable outcome, if necessary. Be polite and enlist the claims representatives to be your allies. Remember, you deserve explanations that you can understand and help resolving any claims processing problems. I hope my organizational and troubleshooting tips are helpful.

4 Key Questions You Should Ask Before Bringing Your Road Traffic Accident Claim

Being involved in a road traffic accident is likely to be a traumatic experience, even if you walk away relatively unscathed physically the shock of such an event can leave you with psychological wounds that require treatment to heal properly.

Suffering an injury, either physical, physiological or both, can have a devastating effect on your life. Your injury could prevent you from working, either short term or long term, it could make hobbies you once enjoyed impossible, and it could have a negative effect on your relationships with friends and loved ones causing them to either become damaged or break down completely.

There is no way to estimate to effects that a road traffic accident can have on you, and while bringing a claim won’t change the fact that the accident has happened and you are living with the consequences, it can make those consequences easier to manage. Bringing a claim can help you support yourself financially while you get back on your feet, it can bring you closure on a traumatic part of your life, and it can help you find (and afford) treatment options that you were previously unaware of.

However, a claim is not something that should be started lightly; you should carefully consider the pros and cons of bringing a claim, as well as your likelihood of success.

If you are confident you would like to bring a claim then it can be difficult to know where to start, how do you get the ball rolling? Should you go it alone or get a solicitor? What should you be considering before starting a claim?

This article demonstrates four of the key questions you should be asking before you begin your claim to help you make the right decision for you.

Number one: Who was at fault for your accident?

To successfully bring a claim, you must prove three elements. That the Defendant ( the person you want to claim against) owed you a duty of care, that they breached that duty, and that their breach caused you an injury.

If the Defendant was another road user, e.g. a driver or cyclist then they will owe you a duty of care, you will not need to establish this as it is accepted under the law that all road users owe each other a duty of care.

You must next prove that the Defendant breached that duty of care. This means you must prove that it was the Defendant’s fault the accident happened. The easiest way to do this is either by collecting the police accident report (if the police attended the accident they would have produced a report which establishes who they believe was at fault), through dash cam footage, through CCTV footage if it is available or through witness statements.

If the accident was not the Defendants fault, then you will not be able to claim against them. Despite what a lot of adverts say having an accident is not enough to bring a claim, it must be someone else’s fault. It cannot be a genuine accident where no one was at fault, and it cannot have been your fault for you to successfully claim against a Defendant the accident must have been caused by them, at least in part. If there is more than one person at fault, e.g., both you and the Defendant are partly to blame, then you can still bring a claim but any compensation received will be diminished based on the percentage you are found to be at fault.

e.g., if the accident is 80% the Defendants fault and 20% your fault and the case settles for £10,000.00, then you will only receive 80% of £10,00000 as you were partly (20%) to blame.

Number Two: Do you want to bring a claim yourself or go through a solicitor?

If you bring your claim via a solicitor, then you will gain the advantage of having a seasoned legal professional or a team of legal professionals on your side who will run your claim from start to finish. A lot of solicitors will take a road traffic accident claim on a No Win No Fee basis; this means if you are unsuccessful you will not have to pay legal costs. Although you could still be liable for disbursements, disbursements being anything the firm has had to buy to move your case forward, e.g. copies of your medical records, and a medical report. If you win, you will have to use a percentage of your compensation to pay your solicitors. The legal costs in cases like this will be limited to usually 25% of your compensation.

If you bring the claim yourself, then you will have to do all the work yourself, and you will likely be going up against the Defendant’s insurers legal team which can be daunting. You will also have to pay any disbursements out of your pocket as and when they arise and then possibly be reimbursed for them later if you win.

However, if you are successful, you will keep 100% of your compensation.

Number Three: Do you use your insurer’s solicitors or find one yourself?

If you have car insurance, then you may be covered for legal claims and your insurer may run the claim for you using their own in house legal team. This can reduce stress for you as it means everything is taken care of for you and you do not usually have to worry about paying any disbursements if your claim is unsuccessful. However, you will never meet your legal team unless you go to court. All contact is likely to be done by email and over the telephone; you may not have a single claim handler but a team which could mean you talk to a different person each time you phone, although this depends on the company.

If you choose your solicitors, you can pick a firm local to you so you can physically go in and see someone. You can build a relationship with that person and deal with them throughout the process. You can physically drop in when you have questions and or documents you wish to provide.

Neither of these options is more qualified than the other, and it is your decision based on your preferences on how you wish to proceed.

Number Four: What funding options are available?

Most claims involving Road Traffic Accidents can be dealt with by a No Win No Fee Agreement, where should your case be unsuccessful, you will not have to pay any legal fees, but if you are successful, a portion of your compensation will go to the solicitor in legal fees.

You may be able to bring your claim using an existing insurance policy. Your Certificate of Insurance or Policy Schedule will usually state if your car insurance includes a legal expenses policy.

Using your existing insurance policy to bring your claim has an obvious financial advantage, being that it removes the risk from you regarding the need to pay for disbursements. The insurance company will cover your legal fees for your claim if you lose your case. Some insurers will not charge you the 25% if you are successful, but some will, make sure you clarify this with them before agreeing to let them run your claim.

If you are a member of the Trade Union or other similar organisation, they may cover the cost of your claim and may have their solicitors whom they can instruct on your behalf.

Lastly, you can self-fund a claim either by paying a solicitor privately or by running the claim yourself. If you decide to pay a solicitor privately, they then will submit monthly invoices to you, which you will then have to pay. It is likely they will also ask for a sum on account of work and disbursements.

If you decide to run your claim yourself, you will be required to pay the costs of the case as it progresses. This means paying the solicitor fees and disbursements that arise when they arise. You should discuss hourly rates and how many hours worth of work your case will involve with your solicitor. Keep in mind this is the most expensive way to run this type of case, and it will not be cheap. You could end up paying out more in legal fees than you receive in compensation.

BONUS QUESTION!

Was a friend with you in the car? Can you claim together?

While it won’t necessarily help or hinder your claim, having a friend to claim with can provide you with a unique support network. It will also give you someone to discuss matters with to help you recall events and give a voice to your concerns and thoughts.

In conclusion, deciding to bring a claim is never an easy decision or one that should be made lightly. It should be given much thought, and you should consider whether or not you have a valid legal claim, how you will fund your claim, and how you will progress your claim. If you are unsure about any of these elements a lot of solicitors offer a free advice session. Many firms will use a free advice session to assess whether or not you have a claim.

Bringing a claim yourself? Check out the below link for a step by step guide to bringing you own Road Traffic Accident claim.

Insurance Claims – Notify the Insurance Company!

Seems sort of obvious, doesn’t it? But, there are different ways to notify the company that you’ve had a loss. And when you notify the insurance company can make a big difference in how your claim is handled.

The first place to look for information is on your policy. Many policies will have a telephone number listed for reporting a claim. However, I’ve seen policies that require the policyholder to notify the company in writing. So, make sure that the method of reporting your claim is acceptable to the insurance company. Likely, your agent has his name and telephone number on the policy. If so, call him and report the loss also.

Sometimes, an agent will have settlement authority to handle small losses, such as homeowner’s losses under $2,000.00. In that kind of instance, the agent could handle the claim for you. I’ve found this situation to be rare, though. Occasionally, captive agents (agents that work for only one company, like Allstate, Nationwide or Liberty Mutual) will have a small amount of settlement authority.

The first thing you should remember is that the agent is licensed by the Department of Insurance in his state to be an agent. There is a separate license for claims adjusters. It’s actually a violation of insurance regulations for an agent to do claims adjusting. It’s not his job to handle your claim, but to assist you in buying the coverage that’s right for you. Agents can be very helpful by making calls on your behalf if you’re having problems in your claim. They can be helpful in finding out key names and phone numbers for insurance company personnel that are handling your claim. If the agent has a large number of policyholders with that company, and his clientele represents a large amount of premium to that insurance company, it can be very helpful to have the agent call on your behalf when you’re having problems.

After all, it’s all about customer service, and keeping the promises made in the insurance policy.

Sometimes, the agent or an office secretary/customer service representative will fill out a claim form (called an ACORD form), and submit the claim form to the insurance company on your behalf. In this age of the Internet, frequently the claim form is electronic, and the agent will submit the electronic form by computer.

If the agent notifies the company on your behalf, and uses some type of form, ask the agent to send you a copy of the completed form. Then, you’ll be certain that the claim was submitted, and the date the claim was submitted.

Many times, however, the agent will have to refer you to the claims department of the insurance company. Your policy may have a telephone number for the claims department listed on the policy, and instructions how to make a claim.

Your policy requires you to notify the insurance company “in a timely manner” after you’ve had a claim. What is timely? It varies policy to policy. But each state has statutes of limitation that limit the amount of time after a claim occurrence that a claim can be made. Check with your state’s Department of Insurance to determine the statute of limitation where you live…or where the loss occurred. You’ll find a list of all of the Insurance Departments of all 50 U.S. states and their phone numbers in the Appendix, and at the website address shown below.

For example: you live in Minnesota, and own a retirement home in Florida. The Florida house gets hit by a hurricane. The statutes for Florida would apply.

WARNING: If you wait more than a month after your loss to notify the insurance company, they will be instantly suspicious. In those cases, you should expect to receive one of two forms from the insurance company before they begin their investigation of the loss:

Non-Waiver Agreement. This basically states that the insurance company is going to do a thorough investigation of the claim, but that their investigation does not commit them to pay the claim. It states that they do not waive any of their rights under the policy, and that the insured does not waive any of his rights by cooperating with the investigation. The insurance company wants the insured to sign this form. However, if the Insured refuses to sign the form, the insurance company will send him a….

Reservation of Rights letter. This states basically the same thing as a Non-Waiver Agreement, but the Insured does not have to sign it.

Don’t forget to write in your claim journal the date, time, who you spoke with, the phone number you called, and what was said when you reported your claim. That information could be very valuable later if you have problems with your claim.

Most likely, you’ll receive a claim number from the company when you report the loss. Write the claim number in your journal!!! Don’t expect the insurance company to quickly send you a form that has the claim number on it. Sometimes, it may be many days before the claims department sends you any correspondence, and you will likely need to speak with them before then.

WARNING: What about a situation in which someone else is at fault, and you’re making a claim against the other person’s insurance company? This could happen in an auto accident, or if someone causes damage to your house, or your contents. EVEN IN THIS SITUATION, you must notify your own insurance company that you’re involved in a claim.

The reason is that third party claims don’t always turn out well for you, the claimant. Sometimes, the other person’s insurance company denies liability or denies coverage. Sometimes, the other person’s insurance company drags the process out. Sometimes, the other person’s insurance company makes a settlement offer far below the fair value of the claim. Months may pass, and you have suffered a financial loss that is not getting paid.

What if you, or someone in your family, is injured in the claim…and the other guy’s insurance company won’t accept liability?

Those things might occur weeks or months after a loss. In many cases, you can short-cut that process and make a claim against your own insurance policy to repair the damages. Then your insurance company will do something called “Subrogation.” That is, they will pay your claim, and then contact the other person’s insurance company and demand reimbursement, including your deductible.

So, if you don’t report your claim right away, the policy might allow that insurance company to deny your claim based upon late reporting.

Besides, your policy REQUIRES you to notify the insurance company “promptly” after you have a loss of covered property. That requirement is there no matter who is at fault for the damages.

Don’t get caught in this technicality! Don’t lose your right to collect what you deserve when you notify the insurance company.

Now, I’d like to offer you two special reports at no cost. One is “5 Things To Do When Shopping For Car Insurance,” and the other is “5 Things To Avoid When Shopping For Car Insurance.” Each one is a $9.95 value, but free to you when you sign up for my newsletter at the website address below.