Filing An Accident Insurance Claim: 3 Basic Steps

When you experience a loss due to an accident, you will need to make an accident insurance claim. This process ensures that benefits payable to you will be paid in a timely manner once the loss has occurred. There are procedures for filing an accident insurance claim that must be followed. State insurance law mandates these steps as mandatory uniform policy provisions, for your protection as a policy owner.

Step 1: Filing a Notice of Claim

The first requirement when a loss occurs is to file a notice of claim with the insurer. This notice may be either written or done over the phone and, as required by the insurance laws of most states, must be filed within 20 days after the loss has occurred.

The notice of claim lets the insurer know of the existence of a claim and allows them to prepare to investigate and handle the claim in an efficient and expedient manner.

Step 2: Receiving the Claim Form

Once the notice of claim has been received by the insurer, they are required (again under the insurance laws of the state) to provide the insured with a claim form. This document can be electronic or physical. The document details the nature of the loss incurred by the insured and the information necessary to process the claim.

Under law, the insurer is given 15 days in which to provide the insured with the claim form once notice of claim has been made and received by the insurer. Failure on part of the insurer to properly provide the insured with a claim form could constitute an unfair claims practice, which violates state insurance laws.

Step 3: Submitting the Claim with Proof of Loss

After the claim form has been received by the insured, it can be completed and returned to the insurer for processing. The form is submitted typically with a proof of loss, which in most cases is a hospital bill or in the case of accidental death under an Accidental Death & Dismemberment policy, the death certificate.

The proof of loss must be sent by the insured to the insurer under law within 90 days of the loss’s occurrence. The exception to this requirement is if the nature of the accident were to leave the individual incapacity, for example, in a coma. In such a case, the insured is given up to 1 year to provide proof of loss to the insurer.

Conclusion

The process for making claims is specifically outlined in the insurance laws of the state in which the accident insurance plan was sold. This process also appears in the policy as mandatory uniform policy provisions and is designed to protect the interests of the insured against unscrupulous practices by the insurer.
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