How Do Insurance Claims Work?

How Do Insurance Claims Work?

May 11, 2022
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The process of filing a claim is an important topic of discussion when it comes to insurance. Filing a claim brings your insurance experience full circle; the coverage that you have been maintaining is now being put to use for your protection. At its simplest, a claim is a request for your insurance company to pay for something that is within the coverage of your policy.

Many policyholders wait until an incident strikes, only to realize that they are not fully sure how or when to submit their claim. We always recommend speaking with your insurance team at the point of establishing your policy to understand how to file your claim.

Submitting A Claim

Commercial clients are assigned to Senior Claim Administrators aligned with each producer. The account management team will provide you with your dedicated claims administrator, who monitors the claim and obtains updates from the carrier throughout the life of the claim.

We understand the direct relationship our clients have with their producers. When contact is made with the Senior Claims Administrator, they are your exclusive contact within the agency for the claim. However, the producer is notified immediately when a large loss occurs or there is a need for their involvement throughout the process.

At the request of the client or producer, the claims division is able to provide clients with claim reviews twice a year to assist in risk management, frequency, & the status and/or outcome of any claim filed.

The claims administrators work closely with the producers and their account team to provide the best client experience.

When a claim occurs, you should contact your assigned Senior Claim Administrator to file all business claims with the insurance company except Workers Compensation losses.

Workers Compensation carriers request all first reports of injuries to be submitted by the employer to gather all information including the employees’ personal information to ensure privacy per the HIPPA guidelines.

Once the claim is filed with the insurance carrier by the Senior Administrator, they determine the potential severity of the claim. If the claim is minor and has no complex concerns, it is transferred internally to our fast-track administrator who monitors these losses through conclusion.

Bottom line: no claim is too small for our agency’s oversight.

The claim administrators will periodically follow up with the insurance carriers on all known reported claims to monitor developments and outcomes. This ensures the claim is proactively handled, minimizing any delayed outcomes that may adversely affect you.    

When Should You File a Claim?

If you are unsure whether an event could qualify as a potentially covered claim, the claim administrators will assist the account managers and producers in the review of coverages. The claim administrators will also provide guidance to the insurance team.

Keep in mind that Blue Ridge Risk Partners is not able to confirm or deny coverage on behalf of the insurance carrier. Any guidance provided is only to determine if a claim should be submitted for review of coverage by the carrier. 

As a rule of thumb, you should traditionally file a claim if...

  • someone is injured.

  • you experience a total loss (e.g., a completely totaled car).

  • you are unsure of who is at fault.

When in doubt, a claim should always be submitted to avoid any conditions in the policy that may count as late notice and potential prejudice within the investigation.

Blue Ridge Risk Partners is a top 75 independent insurance agency in the United States. With 21 offices throughout Maryland, Pennsylvania, and West Virginia and access to hundreds of carriers, we are able to meet your unique insurance needs.