The Claims Process

Insurance is a complicated, competitive, and highly regulated industry. It is no wonder there are so many commercials on television. Lots of money is at stake: insurance is a billion dollar industry. So how do you get the coverage you have paid for? It all begins with the insured making a claim, informing the company about a potential loss. Insurance companies employ teams of people trained to investigate and evaluate claims, called “claims adjusters.” The job of a claims adjuster is to collect information, review records (including police reports, witness statements, and medical records), and determine the extent of the insurance company’s liability. But make no mistake, adjusters are employees of an insurance company. While insurers play an important and valuable role in society, the reality is that insurance companies do not make money by paying the maximum possible amount for your claim or by paying you as quickly as possible. Insurance companies maximize their profits by minimizing their risk and payouts whenever possible. And they have the resources and motivation to do so. Most claims adjusters have dealt with thousands of accident cases and attorneys. How many have you dealt with? Due to this power imbalance many people choose to hire attorneys to represent them when it comes to serious claims that involve lots of money or accidents involving an injury, a death, or significant property damage. A lawyer can help navigate the insurance process, which can be time-consuming and frustrating, and help resolve a claim fairly and efficiently.

Keep in mind that your insurance policy is governed not only by state law, but also by the terms and conditions of the policy itself, which is considered a contract between you and the insurance company. For this reason, insurance policies can be very different and can contain exclusions for certain situations. This is why it is important to carefully review your policy and any exclusions or amendments before making a claim. You are entitled to a copy of your insurance policy and your declaration page, which will summarize the types of insurance coverage that you have. Often, the precise way you present your claim can have an effect on how the insurance company treats it. Properly presenting your claim can mean the difference between a relatively quick claim evaluation and a long, potentially contentious review and assessment. The bottom line is that your insurance coverage is only as good as the amount your insurance company will actually pay in the event of a claim.

This article is intended for informational purposes only and does not constitute legal advice or establish an attorney/client relationship.

Contributing Attorney: Sam Saks. Sam is the founder of Legal Aid of Arizona and a partner at the law firm of Guidant Law