Insurance claim

An insurance claim is a formal request by a policyholder to an insurer for compensation under the terms of their policy. Policyholders submit claims after losses such as car accidents, home fires, or medical emergencies.

Insurers require documentation including police reports, repair estimates, or medical bills to process auto, homeowners, or health claims. US insurers like State Farm and Allstate typically process auto claims in 7–15 days if documents are complete.

Adjusters investigate property claims by inspecting damage and reviewing repair invoices from contractors like Servpro and Belfor. Most insurance companies offer online portals and mobile apps for submitting digital claims with photos and receipts attached.

Health insurance claims can be submitted electronically by providers using standard forms like the CMS-1500; data from America’s Health Insurance Plans (AHIP) shows 94% of claims in 2021 were submitted this way. Denied claims usually result from incomplete information, late filing, or excluded damages, according to NAIC statistics.

Reopened claims are possible if new evidence emerges, such as revised medical diagnoses or additional repair costs, according to documentation from YourInsurance.info. Filing multiple claims within short periods often leads to premium increases; for example, LexisNexis found premiums rise up to 20% after two home insurance claims within five years.

Insurers settle approved claims either through direct deposit or mailed checks; most states require payment within 30 days by law. Claim status can be tracked via customer service hotlines or dashboards on carrier websites such as Geico.Com and Progressive.Com.