Making an Insurance Claim
"An insurance claim is the actual application for benefits provided by an insurance company. Policy holders must first file an insurance claim before any money can be disbursed to the hospital or repair shop or other contracted service. The insurance company may or may not approve the claim, based on their own assessment of the circumstances."
Nobody really wants to make a claim, but at the end of the day, this is what your insurance is really all about: claiming for damage to your car; claiming for a water leak in your home; claiming for a cancelled flight. Your insurance should put you back in the financial position you were in before the incident occurred; however, in reality this does not always happen. You may for example have an excess, which you have to pay before the rest of a claim can be settled; or you may expect to be paid more (or less!) for a car that has been written off; always make sure you have checked the value of the car you are insuring. The insurance company will only pay what the assessor says the car is worth at the time of the accident, and this may not match what the car is worth to you. We will always advise you of the current market value when you insure a car with us.
In general, the claim will be processed by us and we will liaise directly with the insurance company to ensure your claim is settled quickly and efficiently. Once an insurance claim is opened, the insurance company may send out an investigator called an adjustor or assessor (a perito in Spanish). The insurance adjustor's job is to objectively evaluate the insurance claim and determine if the repair estimates are reasonable. This is to prevent possible fraud by contractors who may inflate their bills for additional compensation. Insurance companies tend to accept the adjustor or assessor's evaluation as the final word on the insurance claim.
Some insurance claims may not be recognized by the insurance company for any number of reasons. If a claimant's premiums have not been paid in full, the policy itself may not be active. Another insurance company may have already agreed to pay for the damages listed in the claim. This happens quite often in automobile accidents where one party is held responsible. Another reason an insurance claim may be rejected is a failure to fall under covered conditions.
Most insurance policies spell out specific areas which qualify for benefits, so you should always read the policy conditions carefully to ensure the cover is right for you.