Claim Complaints

What to do if you're having trouble with your insurance claim

You've purchased your policy, paid your premiums and unfortunately, suffered a loss. Once a claim is reported with your insurance company, you expect to be made whole quickly…but the claim process may not go the way you anticipated. Read on for some common claim complaints and tips from the National Association of Insurance Commissioners (NAIC).

Auto Insurance

You pay your premiums each month to keep your policy active but if your vehicle is damaged and you file a claim, you still have to pay a deductible. The deductible limits for comprehensive and collision coverage are determined when you purchase a policy. Selecting a higher deductible of $1,000 might lower monthly premiums but remember you will have to pay that amount when a claim is filed. It may not make sense to start a claim with your insurer if repairs cost less than your deductible. 

Claim delays are another frequent claim complaint. If you're involved in a two car or more auto accident, your insurer and the other insurer will conduct a liability investigation. You can help by taking photos of your damage and the area where the accident took place. If there are witnesses, gather their contact information. The NAIC's WreckCheck app for iPhone and Android walks users through what to do after the accident.

If there is a dispute about what happened and in the absence of unbiased witnesses, a police report may be necessary before making a liability determination. Depending on the department, the police report could take weeks.

Homeowners Insurance

To prevent issues with reporting a claim on your homeowners insurance, determine whether your policy requires notification to your insurer within a designated timeframe after a loss. Provisions may also require that you immediately mitigate damages to protect property from further loss. For example, cover a broken window, so water can't get inside the home and cause additional damage.

If you don't have a home inventory, make one so you can provide your insurer information about what's damaged or missing. Creating a home inventory with photos should help expedite the claims process in the event of a loss. Also, take photos to document your loss and damage. Some claims can be denied due to insufficient evidence. Also ensure damages are not due to negligence. If you have sufficient proof to show you've done everything in your ability to prevent damages to your property, you'll likely have an easier time with the claims process.

Most homeowners policies will pay for additional living expenses including hotel and meal costs when you can't live in your home. Remember to keep receipts for reimbursement.

Finally, your homeowners settlement check may include your mortgage company's name, which may require extra steps with your bank to collect the payment.

Health Insurance

It's your job to verify your health care providers and facilities are in-network. In-network health care providers have contracted with your insurer to accept certain negotiated (discounted) rates. Out-of-network providers have not agreed to discounted rates. However, the complexity of the health care system and emergency situations leave many consumers with unanticipated bills.

If you've scheduled a planned procedure or office visit, verify the provider accepts your insurance. If your procedure includes an anesthesiologist or other specialty staff, try to determine if those providers are also in-network. You can also call your insurer to double-check if the facility and provider are in-network.

If you receive a surprise bill or have unresolved questions, call your state insurance department. They may be able to help find answers and determine whether there's been an error.

Life Insurance

Life insurance claims can be denied for a variety of reasons including material misrepresentation. This means if you omitted or provided false information such as your smoking habit or even employment history on your application, the insurer may deny the claim. Be honest on your applications and encourage your family members to be truthful as well.

If you think you might be the beneficiary of a life insurance policy and don't know how to begin the collection process, the NAIC's Life Insurance Policy Locator app may help, especially if you don't know the policy number or have much information about the life insurance company. You can also contact your state insurance department.

Prepare Ahead of Time

Read your policy and ask questions before a loss occurs. Know what your policy covers and talk with your agent or insurer if you need to make sure you have the right plan for appropriate coverage. Understand the covered perils in and also any exclusions in your policy. Insurance can provide peace of mind in the event of an emergency, so get smart now.

More Information

If you're having serious concerns with how the insurer is handling your claim, call your state insurance department and file a complaint. They may be ab le to assist with a resolution.

 

About the NAIC

The National Association of Insurance Commissioners (NAIC) is the U.S. standard-setting and regulatory support organization created and governed by the chief insurance regulators from the 50 states, the District of Columbia and five U.S. territories. Through the NAIC, state insurance regulators establish standards and best practices, conduct peer review, and coordinate their regulatory oversight. NAIC staff supports these efforts and represents the collective views of state regulators domestically and internationally. NAIC members, together with the central resources of the NAIC, form the national system of state-based insurance regulation in the U.S. For more information, visit www.naic.org.

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