July 18, 2024

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WHAT IS AN INSURANCE CLAIM AND HOW DOES IT WORK?

Claims are quite common in the world of insurance. Come and understand what this means and how to proceed in this situation.

Claims are quite common in the world of insurance. Come and understand what this means and how to proceed in this situation.

Anyone who has contracted or is considering the possibility of contracting some type of insurance needs to know, first of all, what is a claim.

This term is quite common in the insurance universe and is present in life insurance , automobiles, real estate, cards, personal items, among others.

However, although it is common, many people are still not sure what it means. With that in mind, we have prepared this content to address some of the main questions involving insurance claims. Check out!

What is a claim? 

The booklet by SUSEP (Superintendence of Private Insurance) defines a claim as “the occurrence of the covered risk, during the term of the insurance plan”.

In other words, we can say that it is when an event occurs that causes damage or damage to an asset that is duly insured.

That is, the claim is an accident, unforeseen event or unexpected situation that can occur at any time and that is specified in the policy as something that, if it happens, there will be payment of compensation.

Therefore, an accident that is not listed in the insurance contract is not considered a claim.

For this reason, it is extremely important to read the entire contract and clarify all your doubts with the insurer or broker to understand the coverage and claims that will provide indemnity or compensation.

How does the claims process work?

The claim can be full, as in the case of car insurance, when a vehicle is stolen and the insurer must pay the full amount of compensation, or partial, when there is an accident and the car is damaged.

In addition, the claim may occur with the insured’s own property or that of third parties, always depending on the coverage contracted in the policy.

When contacting the insurer to report the claim, it takes action to verify everything that happened and the policy, in order to confirm the veracity of the event to proceed with the payment of the indemnity.

Examples of insurance claims

Below are some of the main examples of insurance claims:

Car insurance claim

In auto insurance, there are several situations that can configure a claim, depending, of course, on the coverage.

For example, when the insurance policy is for robbery or theft and the vehicle is stolen or stolen, this crime is characterized as an accident.

Likewise, in cases where the insurance covers collision and the vehicle is involved in an accident, this crash is also considered a claim under this policy.

Credit life insurance claim

When a liberal professional, due to an accident, is no longer able to work to pay a certain debt and has contracted credit life insurance for it, it can be considered a claim in this policy.

Life insurance claim

There are several situations that can be considered a claim in life insurance. The main ones are:

  • death by natural cause;
  • partial disability or accident;
  • total disability due to accident;
  • serious illness;
  • per diem due to temporary disability;
  • funeral assistance;
  • among others.

That is, when it comes to life insurance, we can basically list three fundamental events that are considered sinister: death, accident with disability (permanent or partial) and illness.

Home insurance claim

In home insurance, it is characterized by a claim: occurrence of damage to the insured property due to fire, theft, explosion, lightning, among others – always in accordance with the coverage indicated in the contract.

What to do in case of an accident?

In case of claims, the insurer has the obligation to indemnify the insured with the losses arising from the claim, always in accordance with the coverage provided in the product policy.

However, before that, it is interesting that the insured person is aware of the procedure he must follow to trigger the insurer and ensure that the whole process takes place in the best possible way.

Therefore, here is a short summary of how to proceed in the event of an accident:

Check if anyone is injured

After a collision, it is essential to check whether there are any injured people and, if so, you must ensure that they are under the necessary medical care.

Protect the damaged property

Always seek to protect the damaged property to try to minimize the risk of further accidents or worsening damage. Most of the time, the assets are inspected by the insurer and need to be preserved.

Activate the insurer

Afterwards, it is necessary to contact the insurer directly or through your insurance broker to check the coverage of the contracted policy and report the claim.

Here, you must inform all the details of how and when the accident happened, damages or losses generated, people or goods involved, responsible for the accident, among other information.

damage assessment

It is the insurer’s duty to collect the client’s documents and testimonials in order to understand what actually happened and the proportion and cause of the accident.

insurance company assessment

After collecting all the information and carrying out the first investigation, the insurer assesses what happened in order to verify if there is coverage for that situation.

Furthermore, other documents may be requested, in accordance with the general conditions of your policy or certificate. Thus, the process of analysis of coverage and survey of losses caused by the incident can be forwarded.

Payment or not of compensation

After carrying out a thorough assessment and finalizing the process, the insurer finally comes to the conclusion whether or not the event can be covered by the policy.

Claim closure

After the insurer makes the decision, the payment of the indemnity is made or the claim process is considered closed without indemnification to the insured.

What documents are required to file a claim?

If any type of accident happens, it is recommended to contact the insurer as soon as possible to file the process as soon as possible. 

Once this is done, the insurer will provide a list of all documents necessary for analysis of the event.

This documentation varies according to the good that was damaged. However, there are some common documents that are often required for different insurance coverages. They are: RG and CPF, medical records, incident report and, in case of car accidents, CNH and vehicle documentation.

How to choose the best insurance company?

Choosing a good insurer is an extremely important point to ensure the necessary security and peace of mind in the event of an accident.

Therefore, it is essential to look for solutions that meet your profile, in addition to checking the reputation of the insurer.

In addition, after understanding what a claim is, the contractor should also pay attention to the details of the contract, to ensure that the biggest points of concern are covered by the policy.