Read This Before You File a Claim | McClain Insurance Services (2024)

Things You Should Know BEFORE You Submit Your Claim

Dear Most Valued Client,

You’re probably reading this because you recently had a car accident or suffered some other kind of loss to one of your vehicles, your home or your business.

And you’re wondering …

  • Should I submit a claim to my insurance company or not?
  • Will there be any negative consequences?
  • Will my price go up? By how much?
  • Can my policy be canceled … and what happens then?

Those are very important questions. And while every situation is different, I’d like to provide you some inside information to help guide you to your answers. But, admittedly, you can’t get a specific answer to your specific situation in this report.

Why not? Two reasons.

First, there are many factors that determine the true impact of a claim on your policy. For instance …

  • Each kind of insurance is subject to specific state laws and regulations – especially involving cancellation,
  • Each insurance company has its own internal rules and practices,
  • And your personal claims history and circ*mstances will trigger those rules and practices differently than, say, your neighbor’s.

Second, once you have the facts and know what the impact will be, the decision to submit the claim or not is truly personal. What’s right for your neighbor isn’t necessarily right for you. Given the same facts you each might make a different decision.

The bottom line is this …

If you’re concerned about the potential impact of submitting your claim, contact us and discuss your situation! (This is just one of the many benefits of doing business with me and my dedicated team instead of some faceless 800 number somewhere.)

We’re here to advise and counsel you … to explain how your insurance really works. We’ll give you the facts BEFORE you submit your claim and help you make the best decision – for you.

Now … here are the more important factors that come into play. But first …

Isn’t This What My Insurance Is For?

Yes … insurance is for paying claims.

You elect the protection options and limits you want. You pay your premium. Your insurance company pays your covered claims.

That’s the deal.

Then why all this talk about the “consequences” of claims? Why can claims increase my price or even get my policy canceled? That’s what insurance is for!

That’s absolutely true. It’s just not the whole story.

I don’t want to turn this report into an insurance manual, and you don’t want that, either! But this is a common question I get from clients, so I want to explain it to you here … very simply.

Insurance, and the price you pay for it, is based on risk – the risk of a loss occurring. High risk of loss means higher prices are necessary to pay for those increased losses. And low risk of loss means lower prices. Make sense?

Now, what determines the level of risk? Lots of things. But claims experience is one of the most important.
Statistics show that people who have a claim are more likely to have another claim. So, when compared to someone with no past claims, someone with claims on their record represents a higher risk of loss to the insurance company.

And you already know what a higher risk of loss means. Yep…higher prices.

Therefore, when you have a claim you now represent higher risk of future loss to your insurance company. And sometimes that increase in risk will be met with an increase in price.

This allows the company to keep prices lower for people who represent lower risk.

The Size of Your Loss

If it’s not obvious, this discussion about whether or not to submit your claim really only comes into play with small losses … losses that come close to your deductible.

Clearly, if you have a $20,000 car wreck…or $50,000 of damage to your home…or $35,000 of inventory stolen from your store, it’s highly unlikely that you would even consider not submitting that claim. That IS what you buy insurance for!

On the other hand, small losses can sometimes hurt worse by submitting them. The consequences of submitting the claim may outweigh the money you receive from the company.

Sometimes it just makes sense to pay your loss yourself and avoid the consequences of submitting a claim.

Your Deductible

Your deductible has a direct impact on whether you should submit your claim or not.

A quick review … Your deductible is the amount you pay out-of-pocket toward the amount of your loss. The insurance company then pays the balance.

For example, let’s say you suffer $3,000 of damage to your home under a covered claim. And let’s say your deductible is $1,000. In this case you pay $1,000, and your insurance company pays the remaining $2,000.
Clearly, if the amount of your loss is less than your deductible there’s no point to submitting your claim. You’re going to pay it all anyway, so why report it?

For example, if your deductible is $1,000 and your suffer $800 in damages, then your insurance company isn’t going to pay anything. The amount of damage is less than your deductible. You’re responsible for the first $1,000, so you’re responsible for the full $800 in this case.

But here’s where it gets a little tricky.

What if the loss is just a little bit more than your deductible amount? What if your deductible is $1,000 and the damage is, say, $1,200?

In this case, your damages are only $200 more than your deductible. Therefore, you’ll receive only $200 from the company. Is it worth getting $200 to suffer the consequences of submitting the claim?

It depends. It depends on what those consequences are!

Depending on the type of loss and your personal situation, this claim may cause an increase in your rates, possibly a significant increase. It may cause your policy to be non-renewed.

You may find – once you know the exact situation for your personal circ*mstances – that it’s less costly for you to pay the additional $200 out-of-pocket and keep the claim off your policy.

The point is … unless you know what the impact will truly be you can’t make a good decision. So, if you’re not sure, get the facts.

Did Someone Get Hurt?

Many incidents involve only property damage. For example, maybe the wind blows some shingles off your roof. Or perhaps you back into a pole in a parking lot.

The point is nobody’s hurt. There are no injuries.

When your loss involves property damage only, it sometimes makes sense to take care of it yourself and avoid the consequences that come with submitting the claim. You pay for the damage and it’s over.
However, when someone’s injured it’s never a good idea to keep that to yourself. Why?

Because no matter how minor the injury may be, the injured party can come back and sue you many months or even years later.

If that happens and you didn’t report the claim when it occurred, your insurance company can legally refuse to defend you in the lawsuit and deny any payment, as well.

Your policy requires you to report your claims promptly so the company can control the claim. If you don’t, they can deny coverage.

In the case of a small property loss, nobody’s ever going to come back and sue you. But when someone’s injured you never know. Defending yourself in court is expensive – even if you win – so don’t take a risk when someone’s injured. Always report those claims.

Company Rules and Practices

Regardless of what TV commercials try to tell you, every insurance company is different. They all have their own rules, practices and rate plans. And they all treat claims differently, too.

Some companies have a price for just about everybody. That means that no matter how bad your claims record gets they’ll keep you insured. Of course, your price will go up and up to match your claims experience!

On the other hand, some companies don’t have a price for everyone. When your claims record gets too bad, they’ll non-renew your policy (within the circ*mstances allowed by law). When that happens you’ll be forced to get insurance elsewhere, and it’s likely you’ll pay a significantly higher price with a new company.

State Laws

State insurance laws protect you, the consumer. Among other topics, those laws define the circ*mstances under which a policy can be canceled or non-renewed. Depending on the type of insurance, these laws can provide you a lot of protection or very little.

For example, personal auto insurance is generally well protected under the law. An insurance company can’t cancel or non-renew a policy simply because they don’t want to insure you any longer. The law states the conditions under which cancellation is allowed.

However, other lines of insurance – like business insurance, for example – have fewer such defined cancellation criteria. In many cases, the insurance company can non-renew your policy just because they don’t want to keep your risk on their books.

I can’t emphasize this enough … there are no clear-cut guidelines for making this decision. State laws, company rules and practices, the size of your loss, your deductible and your personal claims history and experience all mix together to create your unique circ*mstances.

If you’re wondering whether or not it makes any sense to submit your claim, give me and my team a call FIRST. Get the facts for your specific situation. And then make an informed decision.

Read This Before You File a Claim | McClain Insurance Services (2024)

FAQs

How to answer insurance claim questions? ›

Below are some best practices to consider:
  1. Contact a lawyer. ...
  2. Keep in mind that despite the friendliness of the person taking your statement, that person is not your friend. ...
  3. Ask specifically that your statement not be recorded. ...
  4. Give brief answers. ...
  5. Don't volunteer information. ...
  6. Answer only the question asked.

What to do before making a claim? ›

10 Things to Consider Before Filing an Insurance Claim
  1. File Quickly. It's best not to wait to file a claim. ...
  2. Show Your Knowledge. ...
  3. Be Diligent. ...
  4. Find Experts to Help. ...
  5. Make a List. ...
  6. Work With Insurance Adjusters. ...
  7. Document Insurance Adjuster Interactions. ...
  8. Report and Document Damages.

What is the first step in filing an insurance claim? ›

Step One: Contact Your Agent Immediately

Give your name, address, policy number, and the date and time of your loss. Make sure to tell your insurance agent where you can be reached, especially if you are unable to stay in your home. Follow up the call with a letter detailing the problem. Keep a copy of the letter.

What not to say when filing a claim? ›

Admitting Fault, Even Partial Fault.

Even if you think you may be partly at fault for the accident, do not discuss this with an adjuster. Avoid any language that could be construed as apologetic or blameful. Admitting any level of fault can eliminate or reduce the compensation that may be available.

What should I say in an insurance claim? ›

However, it is paramount you only state the facts and do not speculate. Avoid any discussion of fault or injuries. If they ask you directly what happened, you can tell them you would prefer to give a written statement.

What is insurance best answer? ›

Insurance is a contract, represented by a policy, in which a policyholder receives financial protection or reimbursem*nt against losses from an insurance company.

What are 3 important things to do when you file a claim? ›

How to File an Insurance Claim
  • Step 1: Call the Police if Necessary. If a crime was committed, someone was hurt in an accident, or there is significant damage, don't just stand there. ...
  • Step 2: Document Everything and Exchange Information. ...
  • Step 3: Contact Your Insurance Company. ...
  • Step 4: Filing Your Insurance Claim.
Mar 18, 2024

What are the 5 steps to file a claim? ›

Your insurance claim, step-by-step
  1. Connect with your broker. Your broker is your primary contact when it comes to your insurance policy – they should understand your situation and how to proceed. ...
  2. Claim investigation begins. ...
  3. Your policy is reviewed. ...
  4. Damage evaluation is conducted. ...
  5. Payment is arranged.

What is a claim checklist? ›

It functions as a to-do list, giving you an overview of the tasks required for each claim, along with labels, the due date, the assigned person and the action required.

What insurance company denies the most claims? ›

Claim denial rates by insurance company
CompanyClaim denials
UnitedHealthcare32%
Anthem23%
Aetna20%
CareSource20%
1 more row
Apr 24, 2024

What is the claim process? ›

The first step of claim process is to contact your insurer and intimate about the claim. Fill your claim form and attach the relevant documents. A surveyor conducts damage evaluation. Acceptance of your claim. Get the claim amount.

What are the three most common mistakes on a claim that will cause denials? ›

Here, we discuss the first five most common medical coding and billing mistakes that cause claim denials so you can avoid them in your business:
  • Claim is not specific enough. ...
  • Claim is missing information. ...
  • Claim not filed on time (aka: Timely Filing)

How do you write a strong claim sentence? ›

An effective claim is sharply focused and limited enough to be covered in the prescribed length of the essay. A claim must also answer the question: So what? Why/how does this issue matter to readers? What does it mean to make an argument about a text?

How to argue with an insurance adjuster? ›

If you disagree with the insurance adjuster, it's crucial to gather supporting documents and consider consulting a car accident lawyer to help you navigate the claims process and ensure you receive the fair settlement you deserve.

How do you answer an insurance adjuster question? ›

You may provide the most basic details such as your name and contact info, the location and date of the crash, and what car you were driving. Other than that, politely decline to give more details. You have the right to refuse to answer the adjuster's questions or to consult with a car accident lawyer first.

How do I argue an insurance claim? ›

Steps to Appeal a Health Insurance Claim Denial
  1. Step 1: Find Out Why Your Claim Was Denied. ...
  2. Step 2: Call Your Insurance Provider. ...
  3. Step 3: Call Your Doctor's Office. ...
  4. Step 4: Collect the Right Paperwork. ...
  5. Step 5: Submit an Internal Appeal. ...
  6. Step 6: Wait For An Answer. ...
  7. Step 7: Submit an External Review. ...
  8. Review Your Plan Coverage.

How do you write a response to a claim? ›

Answering the Claims for Relief

On a separate page or pages, write a short and plain statement of the answer to the allegations in the complaint. Number the paragraphs. The answer should correspond to each paragraph in the complaint, with paragraph 1 of the answer corresponding to paragraph 1 of the complaint, etc.

How do you explain an insurance claim? ›

An insurance claim is a formal request from the policyholder to their insurance company asking for payment after a covered incident, such as a hospital stay, a natural disaster, theft, and more.

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