How insurance claims work

“I have striven not to laugh at human actions,
Not to weep at them, nor to hate them,
But to understand them.”

— Baruch Spinoza

Insurance companies process claims with hesitation, reluctance, and tenacity.

But more to the point. Insurance companies follow their own claim manuals when they process claims. The following generalization of the claims process is accurate for most claims.

The Who

When you call an insurance company to report the claim you’ll speak with a claims adjuster. Claims adjusters have settlement authority to give a low settlement offer.

Claims adjusters answer to claims supervisors. Supervisors possess higher settlement authority, and may allow a claims adjuster to offer a higher settlement amount.

Sometimes there are claims specialists, who focus on one type of claim or more serious claims. Depending on your type of claim, you may speak to one of them.

Claims managers oversee claims adjusters, supervisors, and specialists. They have the highest settlement authority.

If you file suit, you’ll likely deal with staff counsel, attorneys who work for and defend the insurance company.

The What

When you first call the insurance company to make the claim, an initial claim report is made. Either the claims adjuster you speak to will handle the claim, or they will assign it to another adjuster. After the report is made, the adjuster will give you a claims number and will determine whether there’s insurance coverage.

Investigation happens next. You may be asked to give a recorded statement (I tell my clients never to give recorded statements). Or you may be asked to allow an insurance employee to inspect your home.

At that point, the insurance company will give you two bad choices: 1) they will deny the claim and ask you to go away; or 2) they will give you an extremely low settlement offer. Reject both choices and hire an attorney.

Questions? Contact Me for a free consultation.

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