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Protect Yourself When Filing an Insurance Claim

By May 14, 2022March 30th, 2023No Comments
If you want to be sure you are getting everything you deserve in relation to your claim, there are four important steps you should take to protect yourself:
1.    Read your policy very carefully, both when buying the insurance and when making the claim.You buy insurance to get peace of mind, but you can’t truly know you’re covered until you know what’s in your policy.  When looking for a policy, be sure to go over the policy’s terms.  If you don’t understand the terms, ask your agent for a better explanation.  Often, you will not get a copy of your actual policy until after you’ve already signed up, but most policies allow you to read it on receipt and cancel for a full refund within a fixed (often very short) period of time.  If the policy’s terms will not work for your situation, keep shopping!
After you’ve decided to keep the policy, and after a potential claim arises, it is time to review your policy again.  You want to be fully equipped to discuss your claim with your adjuster.  You also want to have your policy with you for reference while you talk to anyone from the insurance company.  It can be hard to remember exactly what circumstances are covered, in what amounts, and when exclusions apply.  It is better to be able to refer to the actual policy than to rely on incomplete, or inaccurate, explanations from the insurance company.

2.    Be very careful when filling out your policy application (when you first buy the policy) and your claim application (when you make a claim on the policy).

One of the first places insurance companies look when they want to deny a claim is information supplied by you.  Reasons for a claim denial can pop up anywhere. For example, if there are omissions on your policy application, such as undisclosed medical issues, your insurance company may claim that this makes you uninsurable, and will simply refund your premiums rather than pay a valid claim.  Another problem could arise if the information you give is inaccurate.  If you give the wrong dates or incorrectly identify your doctors, the insurance company may come to the conclusion that the entire application is falsified.  The best way to avoid these problems is step three, keeping good records.

3.    Keep good records.

Chances are, you aren’t buying that many insurance policies or making that many claims.  The insurance company, on the other hand, deals with issues similar to yours all day, every day.  In order for them to function, they must (or should) keep detailed, accurate records of their communications with you.  If it turns out later on that their records weren’t quite as accurate or detailed as you would like, you want to be able to prove your side of the story.  To do this, you should put all your communications with the insurance company in writing.  Start with your initial application—any explanations of coverage or representations regarding the policy need to be written down.  Make a note of who you spoke with, and the time and date.  Make a note of when you received your copy of the policy, and keep a complete copy of it somewhere safe.

When you make a claim, the same level of record-keeping applies.  Keep a detailed journal of when you called, who you spoke to, whether you left a message or the substance of your conversation, and any other details you can recall.  One great way to make sure you and the insurance company are on the same page is to write a letter to the person you spoke with detailing the contents of your discussion, and your understanding of what needs to be done next, either by you or by them.  Having your own set of records helps you hold your own in the he-said-she-said battles that insurance companies often rely on to deny claims or delay payment.

4.    Do not give up.

When you abandon your claim, the insurance company wins.  Many times, an insurance company will deny your claim initially, or make the claim application so complicated that filing a claim doesn’t seem worth the effort, because they hope that you won’t stick with the claim long enough to get to the payment stage.  This approach is contrary to the entire reason behind insurance: to give you peace of mind.  If your claim is denied, or if you don’t understand the claim process, ask the insurance company what you should do to appeal or further pursue your claim.

This information is not intended to provide legal advice, and no legal or business decision should be based on its content. No representation is made that the quality of legal services to be performed is greater than the quality of legal services performed by other lawyers. Read full disclaimer.