Claims

When something happens that is covered by an insurance policy, such as a car accident, house fire, theft, illness or death, the policyholder or beneficiary submits a claim. The insurer then assesses whether the loss is covered and how much it should pay.

The claims process typically involves notifying the insurer promptly, providing details and evidence, such as photographs, receipts, police reports or medical records, and cooperating with any investigation. For larger claims, the insurer may send a loss adjuster to assess the damage.

For example, after a storm damages a roof, a homeowner contacts their insurer, sends photographs and repair quotes, and receives payment for the repairs minus their policy excess or deductible.

The payment may be reduced or refused if the loss falls under an exclusion, exceeds the policy limit, or if the policyholder did not disclose important information when buying the policy. Policyholders who disagree with a claims decision can usually complain to the insurer and, in many countries, escalate the dispute to an ombudsman or regulator. For insurers, claims are their largest cost, and managing them efficiently and fairly is central to their business.