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Insurance Claim Process

Learn about the insurance claim process

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Everything You Need to Know About Making an Insurance Claim

At some stage during our life, most of us will need to make an insurance claim or be involved in an insurance settlement. This is the business end of your insurance policy — the part everyone hates.

This is where the insurance company assesses your insurance claim and determines whether or not they will pay out as per the conditions specified in your insurance policy. It is extremely important that you are honest and accurate in your statements for all insurance claims. If you misrepresent the truth in any way, this is considered fraud and your claim will automatically become void, leaving you without recourse or reimbursement for your loss.

The purpose of this article is to provide you with help for making an insurance claim and to educate you about the claim process. You will learn the important parts of an insurance claim form, how to get help, how to make a claim, how to get a positive  settlement and how the Insurance Council of New Zealand can help you with your claim.

Frequently Asked Questions When Making an Insurance Claim

 

What is an insurance claim?

An insurance claim is when you seek the benefits provided by the insurance company due to an occurrence covered by the policy. The claim is then filed with a representative of the insurance underwriting company. The insurance claim goes through the proper filing procedure, and then a claims evaluator reviews your policy and conducts a thorough investigation into the damage or loss of your property. Not all insurance claims are paid out. Fraudulent claims in the industry costs New Zealanders $62 million annually. That’s around $62 per household. To qualify for an insurance claim, the policy must be active or fully paid.

What information should you give when making an insurance claim?

The application form asks personal questions that should be answered truthfully. Omitting any information can cause denial of your insurance claim, so be sure to include every detail. It is important to be honest. Insurance investigators are very good at finding discrepancies. Some insurance claims investigators come from law enforcement or investigation backgrounds and have years of experience identifying inconsistencies in stories. They know what questions to ask and are aware of common lies. If you are honest in your claim, you should not have a problem receiving your settlement.

When purchasing your insurance policy, be careful to disclose all information. Once you’ve had a policy voided due to non-disclosure, it will be difficult for you to obtain insurance again.

When can a home insurance claim be denied?

A home insurance claim may not be granted if it is proven that the damage to the home was done intentionally or through fraudulent means. The company may or may not approve the claim after they have assessed the circumstances and reviewed the policy. A home insurance claim may also be denied if the damage or incident was not specified in your home insurance policy.

What information should be presented for a fire insurance claim?

A fire claim should be supported with documents proving ownership of the home. If the documents have been lost in the fire, other supporting documents will be required. A home appraisal, mortgage documents or purchase records from the real estate agent will be required. It is advised to report the damage immediately even if you lack the necessary documents in order to start the fire insurance claim process right away.

If you are faced with any insurance claim problem, you can take the issue to the Insurance Ombudsman to help resolve the issue free of charge. See the next sections for more information about the Insurance Ombudsman.

Where can I get help for insurance claims and insurance claim settlements?

Contacting the local authorized agent is the first step. You can also go back to the insurance broker or insurance agent you bought the insurance policy from. You will need to complete an insurance claim form. Be sure it is filled out properly. When reported to the insurance company, the company will immediately dispatch its insurance claim adjusters to investigate the damage to the property. Usually, the insurance provider you bought the policy from will have a contact center or help line. This is a good place to start. Most Insurance companies also have a website where you can download, complete and submit an insurance claim form.

The Insurance Ombudsman

With the number of insurance policies written in New Zealand, there will likely be the occasional insurance claim problem. The insurance company has to protect itself from fraudulent claims and may, at some point, deny a claim in error. Conversely, the consumer has a right to fair dealings as well. This is why the Insurance Ombudsman was created. Any disputes handled by the office of the Insurance Ombudsman are reviewed thoroughly and without prejudice toward either party. If you are not satisfied with the decision of the Ombudsman, you can still take the matter to court. Note that insurance companies are bound to the decisions of the Ombudsman.

The New Zealand Insurance and Savings Ombudsman

The New Zealand Insurance and Savings Ombudsman (ISO) is a free independent service. This is where you lodge your complaint or receive assistance when there are unsolved issues regarding your claim. The office resolves insurance claim disputes without charge to the consumer. The office deals with problematic claims regarding house, contents, travel, auto and income protection insurance claims.

The Insurance Council of New Zealand

The Insurance Council of New Zealand, also known as the Insurance Council of NZ, represents NZ fire and general insurers. During disputes or legislations, the Insurance Council of NZ works to protect the interests of the insurance companies without prejudice to the insured consumers.

How do I make an insurance claim?

  • You must provide your insurer with a full and accurate account of what happened. If applicable, be sure to supply photos or diagrams.
  • Keep a record of when and whom you spoke to in regards to your insurance claim. Ask for a reference number of the conversation. This will make it easier for them to retrieve your information if it needs to be reviewed for anything promised or said to you during your conversations. View our insurance tools section to find helpful insurance tools.
  • Keep a file of all information regarding your insurance claim and throw nothing away, including the damaged property, until your insurance claim has been approved. You may need it to prove your claim.
  • If you are unhappy with the insurance adjustor ‘s assessment regarding your insurance claim, you may want to hire an independent insurance expert.

What If my insurance claim is denied?

This is an unfortunate position to be in. If you find yourself facing this situation, consider the following tips:

  • Contact someone of higher authority in the insurance company to explain your dissatisfaction.
  • Determine whether the insurance assessor had all the facts and properly understood your claim. Look at all the reasons why your claim was denied. Was there or is there information you forgot to supply?
  • You can always make a formal complaint to your insurance company. Find out their procedure and supply them with a copy of all documentation, photos and expert advice you may have received. Ensure that your complaint is made in writing.
  • The New Zealand Insurance Ombudsman has been set up to help consumers with insurance claim disputes. It is free of charge. They will assess your claim and decide whether the denial of your insurance claim is justified. You can find the contact details for the Insurance Ombudsman and other insurance resources here.
  • Search our insurance tools section. You will find free templates that will assist you when buying insurance or when making an insurance claim.

Steps to Take When Requesting Insurance Claim Assistance

If you need help making an insurance claim, contact the local insurance agent affiliated with your insurance company immediately. It may help to be aware of the following:

  • Regardless of the type of insurance claim, be ready to deal with the process.
  • Ensure that your insurance application was and still has accurate. It’s better to contact your insurance company with updated information before an accident happens.
  • When your insurance policy comes up for renewal, make sure that the details are still correct and disclose anything that may affect an insurance claim in the future.
  • Cooperate with the insurance claims adjusters that represent your insurance company; they are there to assess the damage to prevent contractors from charging exorbitant fees for repairs.
  • If the insurance company withholds payment on some grounds, ask the Ombudsman to look into the case.
  • To avoid problems when it comes to insurance claims, always keep receipts, photos and serial numbers of your most valuable insured possessions.
  • Know your insurance policy inside out. Know what dollar and value amounts your items are insured for. Contact and communicate with your insurance provider if you feel some of these values or details are outdated or incorrect.
  • Keep records of any communication you have with your insurance company. You can download free insurance tools from the insurance tools section.

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