Claims Process
The sequence of steps a policyholder follows to request and receive payment for a covered loss.
What is Claims Process?
The insurance claims process is the formal procedure through which a policyholder notifies their insurer of a loss and requests reimbursement or direct payment under the terms of their policy. The process typically involves: notifying the insurer promptly after the loss, documenting damages or injuries, submitting a proof-of-loss form, cooperating with the assigned claims adjuster, and receiving a settlement or denial decision. Timelines and requirements vary by policy type and insurer, but most states require insurers to acknowledge claims within 10 to 15 business days.
Example
A homeowner's basement floods after a burst pipe. They call their insurer the same day, photograph all damaged items, complete a proof-of-loss form, meet with the assigned adjuster, and receive a settlement check within three weeks. Their $1,000 deductible is subtracted from the $18,000 claim, yielding a net payment of $17,000.
Source: National Association of Insurance Commissioners — Filing a Claim