1. Insurance Terms & Definitions/
  2. Insurance Terms Starting With C


What is a Claim?

In the field of insurance, the term "Claim" is central to the functioning and purpose of the industry. The definition of a 'Claim' refers to a formal request made by an insured party to their insurance company, seeking payment based on the terms of their insurance policy. The claim is essentially a demand for coverage or compensation for a loss that the insured has suffered and which is covered under their insurance policy.

Claim in More Detail

The meaning of a claim in insurance can vary based on the type of insurance and the nature of the loss. For instance, in health insurance, a claim may be a request for reimbursement of medical expenses. In auto insurance, it could be a demand for payment to cover the repairs of a vehicle after an accident. In property insurance, a claim could involve compensation for damage to a home due to events like fire, flood, or theft.
Claims are the mechanism through which an insured party avails the benefits of their insurance policy. When a loss occurs that is covered by the policy, the insured files a claim to notify their insurer. The process involves submitting proof of the loss, such as medical records, repair bills, or police reports, depending on the nature of the claim.
The insurer then evaluates the claim to determine its validity and the extent of liability under the policy terms. This assessment may involve an investigation into the circumstances of the loss, a process that can vary in complexity depending on the claim type. Once approved, the insurer will pay out the claim, either directly to the insured or to a third party (like a hospital or repair shop).
It is important to note that the filing of a claim typically follows a specific procedure outlined by the insurance policy, and failure to adhere to these procedures can result in the denial of the claim.
In summary, a ‘Claim’ in insurance is a critical concept that represents the request for payment or compensation by the insured from their insurer, following a loss that is covered under their insurance policy. It is the practical application of the insurance policy, providing financial relief to the insured in times of need. Understanding how to properly file and manage claims is essential for maximizing the benefits of an insurance policy..