FAQ Claims (2024)

FAQs

How to answer insurance claim questions? ›

Be cautious about the information you provide to the insurance adjuster. Only share details directly relevant to the crash and your claim. Avoid discussing your personal life, schedule, or anything unrelated to the incident. Oversharing can give the adjuster information they will use to minimize your claim.

Once you file a third claim, there is a chance that the insurer will drop you. As unexpected as it might be, car insurance companies can drop you as they see fit. Typically, an insurer will send a dropped policyholder notification that their policy will be terminated early at the end of the next month.

Do Not Admit Fault. You do not want to say anything to an insurance adjuster that could be taken as an admission of fault. To recover compensation, you'll need to show that someone else was responsible for your injuries.

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.

A statement that respond to/answers the question using words from the question. Provide EVIDENCE to support your claim. The evidence should relate to the answer and include facts/text evidence that will convince someone that your claim is correct.

Stick to the facts and only provide the information requested. If the adjuster attempts to discover information about your work or salary or wants to know where you work, avoid answering these questions by just saying that you cannot confirm that at that time.

Why Do Insurers Drag Their Feet in Handling Your Claim? Since insurance companies take the money they receive from premiums and invest it, the longer they keep those funds, the more interest they earn. This gives them a significant incentive to delay paying out on claims as long as possible.

Overall, nearly 15% of all claims submitted to payers for reimbursem*nt were initially denied. Medicare Advantage and Medicaid managed care plans denied claims at higher-than-average rates of 15.7% and 16.7%, respectively.

Too many insurance claims

If you file claims often your insurer may view you as a greater risk, which may lead them to non-renewing your policy. Insurers may not drop a customer after their first one or two incidents. The first step is often to increase your car insurance rate.

How do you negotiate with a claims adjuster? ›

To be strong and effective, a claim should be debatable, focused, and specific. In other words, it ought to be something that can be argued with reasons and evidence, and it ought to be narrow enough to properly support or prove in the space and format available.

Remember this motto: Stick to the basic facts. Don't add opinions such as who's at fault, what triggered the crash, or what the damages might be. More importantly, don't lie or even embellish the facts, as this can compromise your insurance claim and become grounds for serious legal trouble.

It could increase your premiums

When determining your premiums, insurance companies consider your likelihood of filing a future claim — which could cost them money. The higher your perceived risk, the more likely you are to pay more in premiums. Your claims history tends to play a direct role.

Be brief. Answer the allegations in the complaint with one or two sentences. Again remember that the statements you make in your answer can be used as admissions against you. Your response to the allegations in the complaint may admit part of the statement in the specific paragraph and deny part.

I am writing to request a review of your denial of the claim for treatment or services provided by name of provider on date provided. The reason for denial was listed as (reason listed for denial), but I have reviewed my policy and believe treatment or service should be covered.

Stick to what you know for sure and be clear and concise in your answers. If you do not know the answer to a question, say so, rather than guessing or making assumptions. “I can't be sure, but I'll bet the other driver was on the phone” is classic speculation that is best left out of a statement.