What is an insurance claim? Understand this concept better!
Do you know what an insurance claim is? This concept may seem simple, but it brings some important specifications to your policy.
In this case, understanding what this concept is and how it works is essential to have greater security when activating your policy.
Furthermore, it allows you to have greater control over your coverage, and know what to do in unforeseen moments.
For this reason, it is essential to learn what an insurance claim is, learn more about what are covered events and when they can generate compensation.
Check out this and other information in the special content we have prepared, and answer any questions you may have on the subject!
What is an insurance claim?
An insurance loss is an unexpected situation, which is covered by the policy. In other words, it is an accident or unforeseen event from which you and your family are protected.
Officially, the Private Insurance Superintendence (Susep) describes this concept as an “occurrence of the covered risk, during the period of validity of the plan”.
So, if something happens and you have life insurance that covers that event, it is a claim.
However, it is important to note that not all unanticipated events are classed in this manner, as it is determined by the insurer’s unique features and the kind of insurance.
For example, a fire is an unexpected occurrence that can cause serious financial and material losses.
However, if your contract does not have coverage for fires, this event will not be a claim for your insurer or insurtech .
Therefore, in addition to understanding what an insurance claim is, it is essential to understand the excluded risks and specific characteristics of their protection.
How crucial is it to know what an insurance claim is?
Understanding what an insurance claim is is essential for you to make informed decisions and know how to deal with unforeseen events.
After all, not all events will be covered by your policy, and knowing more about this concept allows you to identify a situation where your contract may be supported.
Consequently, it makes it possible to guarantee financial protection for your family when they truly need it.
And by understanding what an insurance claim is, you will also be able to identify the coverage you really need on a daily basis, personalizing your policy so that it meets your profile.
Although it is a simple concept, many people may have doubts about how it works, and fail to control the situation with confidence.
For this reason, it is essential to know more about this term and its characteristics, so as not to risk harming your compensation and the support you can offer your dependents.
How does a claims process work?
The claim process begins by identifying what happened and classifying the damage, which can be complete or partial.
A partial occurrence indicates that only part of the material or property was damaged, such as a vehicle accident. Generally, repair costs are less than 75% of the original value.
Meanwhile, a comprehensive claim occurs when the asset is completely damaged, such as theft or total loss.
This classification helps insurtech understand the best way to deal with what happened, through full compensation or proportional compensation for the loss.
After identifying the event, the insured informs the company responsible for the policy and data collection begins, where the company evaluates the situation and possible causes.
This way, you will be able to prepare reports with the results, and indicate whether there is the possibility of continuing with the compensation.
The entire verification process is carried out by the insurance company, and the holder must simply inform about what happened, provide the requested documents and wait for the analysis.
What are the main types of insurance claims?
To understand what an insurance claim is, it is also worth checking the main types of events and policies . See below:
Automotive accident
Automotive accidents can occur in different models and sizes of vehicles, involving damage to the car.
The losses can be partial, such as an accident that dents the bodywork, or complete, where there is a theft, for example, and the entire car is taken.
Furthermore, incidents due to external causes, such as rain on the road, for example, can also be classified as a loss, if the insurance has this coverage.
Life insurance claim
On the other hand, if you want to better understand what an insurance claim is, you may have doubts about this concept in a life policy.
This is because losses tend to be subjective, and not material. In the case of simpler contracts , without extra coverage, the main event is the death of the holder.
However, death can be natural or by accident, for example. Each reason generates a different claim, and, depending on the policy, becomes a covered or excluded risk.
Furthermore, if the insurance has other coverage, such as disability , it may also include occurrences such as permanent disability and diagnosis of a serious illness , which qualify as a claim and enable compensation.
Home insurance claim
For properties, residential insurance claims also tend to address situations that compromise the owner’s assets and assets.
The main events covered by a policy like this are robberies and thefts, and natural events, such as lightning strikes and fires.
However, each contract has its own clauses, and may vary depending on what you request.
Credit life insurance claim
Furthermore, credit life insurance also considers some more common claims, especially accidents or the death of the holder.
This way, your income will be compromised, making it impossible to pay the debt and making compensation necessary to cover outstanding issues.
Loss of employment is also an event that may be part of the risk covered under this modality.
What is the difference between the insurance claim and the premium?
The loss is an unexpected event covered by your life insurance, while the premium represents the monthly contribution amount that the holder must pay to keep the coverage active.
When an accident occurs, you notify your insurance company or insurtech, so that they can take action and release the compensation.
However, this only occurs if your policy is active and has no outstanding issues. In other words, if you have all your premiums paid.
This value is agreed upon when contracting, based on the choice of coverage , insured capital and number of beneficiaries you choose to include.
What to do in the event of a life insurance claim?
After you understand what an insurance claim is, the next step is to know what to do if anything unexpected happens. However, the methods are easy, and you may get control of the issue by taking a few measures. See in detail:
1. Contact the insurance company
As soon as the incident occurs, the first step to take is to contact the broker or insurtech responsible for your life insurance.
This way, she will be able to follow the necessary procedures to help you or your family after an unforeseen event.
Therefore, inform about the accident and provide the necessary data, such as the policy number, the name of the main insured and the details of the event.
2. Wait for the damage to be assessed
Then, the broker will request documents proving the accident to send to the insurance company and the insurance company will verify the data and documents.
This may include police reports, medical reports, death certificates, if necessary, and forensic reports.
It is important to gather this information and provide it to the insurance company as quickly as possible to speed up the analysis.
Once you inform the company responsible about the accident, simply wait for the results of the investigation.
3. Wait for the insurance company’s assessment
With the investigation and reports, the insurance company will carry out an assessment to determine whether the loss is eligible for compensation.
For this reason, it is essential to know what an insurance claim is, to ensure that the incident is covered by your policy and offers financial support to your loved ones.
This analysis may also include other elements in addition to the documents sent, such as investigation into the cause of the event, the validity of the policy and whether there are exclusion clauses, for example.
4. Policy consideration
If the insurer or insurtech concludes that the loss is covered and meets all conditions, the compensation will be made available to its beneficiaries.
In this case, the person responsible will contact you to inform you of the approval, indicating the next steps for payment.
If there are problems with the documents or the investigation, the deadline is interrupted and the company will contact you to request more data or talk about ineligibility.
5. Closing the claim
Once approval and payment of compensation has taken place, the claim analysis process will be completed. Furthermore, beneficiaries must receive the amount established in the policy, through the indicated channel.
In this case, be sure to confirm all details of closing the claim with the insurance company to ensure that all steps have been completed correctly.