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How does the insurance claims process work?

A sample form used for insurance claims

Whether you are injured in a car accident or you get hurt at work, likely you’ll need to deal with the insurance claims process. Whether you’re dealing with your insurance, your employer’s or the party that caused your injury, dealing with the insurance claims process is not easy or fun.

What Are Insurance Claims?

Insurance claims are forms of formal documentation from an insurance policyholder to the insurance carrier/company, putting forth the issue that needs resolution by the carrier. Insurance claims can list the injuries to your person, damage to a car in the case of a car accident, etc. 

Two of the most common insurance claims that people file after being injured are car accident claims and health insurance claims.

Steps for Filing an Insurance Claim

There are a few standard steps in filing an insurance claim in almost any case where you’ve been injured. 

  1. Notify your employer or responsible party – it’s important that all parties are notified that a claim will be raised, so there can be no confusion or disagreement about when the injury occurred or when it was first raised.
  2. Consult with an attorney – as we said, insurance claims are neither easy nor fun. Having an attorney on your side can help you navigate the process and will ensure that you have an advocate looking out for your best interest- especially if you were seriously injured.
  3. With the assistance of your attorney, gather and provide evidence – photos, medical records, and documentation are all important to gather when you are filing insurance claims. 
  4. Write a demand letter – a demand letter is a key part of the insurance claims process. If you are working with an attorney, they will handle this for you. A demand letter is a formal complaint acknowledging the issue and asking for payment. 

Insurance Claims Approval Process

After you file your insurance claim, the process can vary depending on the type and extent of the claim, the type of insurance coverage, and the insurance carrier.

It’s important to examine and understand your insurance policy to know if what you are outlining in the claim will be fully or partially covered. An attorney can help review your policy and guide you on the likelihood of coverage.

Factors that will be weighed when determining if your insurance claim will be processed include:

  • Whether or not your policy covers the injury or issue (and whether you have multiple policies or types of insurance that could be affected)
  • Timing of when you filed
  • The complexity of the claim (this can affect timeline)
  • Whether you have deductibles as part of your policy

The Role of the Insurance Company in the Claims Process

During the process of filing insurance claims, your insurance company, or that of your employer, will play a major role – though, it can be confusing to understand what you should and shouldn’t expect from your carrier. 

Though things about the process will vary depending on the type of claim and carrier, there are a few things you should expect:

  • Prompt and ongoing communication
  • Acknowledgment and investigation of the claim (though the level of investigation will vary) within a reasonable amount of time
  • Fair explanation of the approval or denial decision

How an Attorney Can Help with Insurance Claims

Though your insurance carrier should meet those expectations, it’s not guaranteed that the process will be easy to navigate. It’s always a good idea to consult with an attorney if you are filing an insurance claim that involves a personal injury, major property damage, or a work-related injury. 

The attorneys at Georgelis, Larsen & Sabatino Injury Law Firm, P.C. have years and years of experience working directly with insurance companies to ensure the proper processing of insurance claims. Call for a free consultation today at 1-800-HURT-NOW


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