Claim Advice

How Does The Insurance Claims Process Work?

At some stage in your life, you will probably have to make an insurance claim. Whether you were in a car accident, or you hurt yourself on private property, or in any other situation where something has gone wrong, your insurance is there to protect you in the event of an accident. However, the insurance claims process can be quite complex, and there can be many steps involved in this process. If you are needing to make an insurance claim, read on to find out more about how the insurance claims process works.

Making insurance claims to your own insurance company:

  • Check your insurance policy
    Before making an insurance claim, you should always firstly check your insurance policy to ensure that the claim you are making is covered by the insurer.
  • Notify your insurance company of the insurance claim
    Once you have established that the claim is covered by your insurance policy, you should contact your insurer directly to let them know you wish to make a claim. From there, your insurer can direct you to any forms you will need to complete. The standard insurance claims process forms will usually ask you to provide details about the accident, any damages you have suffered as a result, and any supporting evidence you can provide.
  • Assessment of your insurance claim
    Once you have submitted your claim, the insurance company will assess the claim based on your story of events and your supporting documents, such as medical records. This assessment can take awhile as the insurer needs to establish that your claim is genuine.


  • Assessment of damage by a third party
    During the assessment period, the insurance company may engage a specialist to help assess your situation. For example, the insurer may wish to have their own doctor assess your injuries, or have their own mechanic supply a quote for the damage to your car. While you might have already submitted your own records or quotes, having a third party involved is to ensure that all evidence is unbiased and accurate.
  • Further information
    The insurance company may find that the information you have supplied is insufficient or unclear, and it is common for an insurer to contact you for clarification or ask you to supply more information.
  • A decision is made on your insurance claim
    Only after the insurance company has completed their assessment on your accident, will a decision be made on whether to accept or reject your insurance claim. Depending on the complexity of your case, it can take between weeks and months for this decision to be made.
    A claim may be denied if your policy clearly stipulates it does not cover your certain claim, which is why it is important to ensure that your claim will be covered before entering into this whole process. A claim may also be rejected if the insurance company has found that you failed to give accurate and complete information – for example, you lied about being at fault for the accident, or did not disclose a pre-existing medical condition when you applied for the insurance policy.
    If your claim is successful, you may receive compensation for things such as property repair expenses, medical expenses, lost earnings or earning capacity and loss of enjoyment of life.


If you were not at fault for the accident

There may be cases where you were not at fault for an accident at all – for example, if another car drives through a red light and has then crashed into your car, the fault clearly lies with the other driver. The general rule is that whoever is at fault will be responsible for paying for any damage caused.

If you were not at fault for the accident, you should consider not claiming on your insurance policy, and instead directly pursuing the party at fault for compensation.

  • Letter of Demand
    The first step in claiming compensation from the person at fault is to send a letter of demand to the person, and their insurance company. Your letter can include any expenses you have incurred which you will need to be compensated for.
  • Legal action
    If the person’s insurance company refuses your claim, or fails to reply, you should consider taking legal action.


For more information about a claim for compensation, contact Schreuder Partners today.

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