Insurance is something a company buys with the hope that they will never have to use it. Of course when they do have a claim, they expect the process to go smoothly. The expectation is that legitimate claims get paid, and bogus claims don't. The majority of claims are handled without incident; but, unfortunately, we don't hear a lot about those claims. It's the difficult claims that get all the press because those are the claims that create the most sensationalism.
The focus of this article will be on the claim's process, specifically, workers compensation, general liability, auto and property claims. In the interest of brevity, I'll only elaborate on workers compensation and automobile claims. It is important to note that no two claims are exactly alike, and that each and every claim has its own set of circumstances.
The claims adjuster is the central figure in any claim. Simply stated, their job is to apply the applicable policy provisions and to make sure the claim is handled promptly and without prejudice. Claims departments are a highly specialized business unit of every insurance company. Auto claims are handled by auto adjusters, workers compensation claims are handled by workers compensation adjusters, etc.
Let's run through a workers compensation claim. First, the insured calls in the claim and the adjuster takes all of the information. Second, the adjuster contacts the injured employee to get his/her story (on tape), and they corroborate their story with any witnesses to the accident. Thirdly, if needed, the adjuster will contact the medical provider to get an idea on the extent of injuries. Next, the adjuster will coordinate care and act as a liaison between the injured employee and the insured. Lastly, if it appears that the claim is questionable, they will do everything in their power to fight the claim. Usually, by this stage, the injured employee has hired an attorney.
In an automobile claim, you could have four different people handling the claim. Depending on the damage/injuries, you could have a front line adjuster, an appraiser, a PIP adjuster and a bodily injury adjuster. It's the front line adjusters' job to act as the quarterback and to coordinate the claim with all of the other adjusters. The adjusters and appraisers are highly trained in their specific area of expertise. I only mention this because, as we know, there are people out there who put in fraudulent claims. Trust me, if the claims looks as though it's fraudulent, they will know, and the repercussions are severe.
When it comes to claims, speed is of the essence. The quicker the insurer gets the claim, the better the claim will be handled. Insurance companies want to be the first to contact the injured party (or parties). I always recommend that the insured report all claims, no matter how small or seemingly insignificant. The insured isn't the one to make the determination as to whether the claim is legitimate or not, the insurer is. It's important to note the policy provisions when a claim occurs. Ideally, you would have read the policy before a loss occurs, but I know that's not always the case. Among other things, it states: "Give us prompt notice of the loss or damage." So, not only is it wise to report claims promptly, it's a condition in your policy to do so.