Insurance Claim: Things You Need to Know

An insurance claim is a formal request by a policyholder to an insurance company for coverage or compensation for a covered loss or policy event.

Insurance indemnity is the amount of money paid by the insurer to cover damage in the event of an insured event with the property.

The determination of insurance compensation is made on the basis of an insurance act, an emergency certificate or other document, which indicates the cause of the loss (damage) of property, provides all information about the damaged objects, and calculates the damage from the insured event. The ratio of damage and insurance compensation for property insurance is determined by the amount of the sum insured and the insurance liability system (compensation system).

If the property is insured in full actual value, the insurance indemnity will compensate for all incurred damage. If the sum insured is part of the value of the property insurance appraisal, the Insurance indemnity for most types of insurance will be the same share of the calculated damage. This is the most common system of proportional, or share, insurance compensation for damage.

Payment of insurance compensation

The procedure for insurance compensation will be as follows:

• upon the occurrence of an insured event, the beneficiary must submit a written application (insurance claim) to the insurer, as well as documents. The papers handed over must correspond to those indicated in the contract. In addition, they must provide comprehensive information about the insurance situation, the victim’s condition, etc.;
• the insurer cannot demand a list of documents not specified in the contract;
• the insurer is obliged to consider the application as soon as possible, after which a decision is made;
• in the case when there are no grounds for a refusal to pay insurance indemnity, the insurer must pay the amount for compensation for damage. The amount will be equal to that specified in the contract, or that determined by the UK law;
• the insurer is given thirty calendar days for payment of funds, or refusal to pay;
• in case of delay, the insurer undertakes to pay interest every day after the day of delay until the moment of payment.

In the event that the victim’s condition has worsened due to the same insured event, after submitting an application, the victim has the right to submit a second insurance claim to reconsider the decision and recalculate the amount paid.

Payment of insurance indemnity in case of an insured event must be fulfilled and made, despite the amounts due to be paid by other insurance companies.

When the insurer who has entered into the contract is absent from his/her place of residence, the beneficiary has the right to submit documents and a written application to another insurer operating in this region and complying with all the requirements established by the UK law. In this case, the application of the beneficiary must contain data due to which it is possible to transfer the amount of money in the requisite framework. The insurer, with whom the contract was previously concluded, will be obliged to pay the funds according to the specified details or give a reasoned refusal.

The reasons for an insurance claim refusal

The grounds for a refusal to pay insurance compensation are the following circumstances:

• Untimely notification by the insurant of the insurer about the insured event;
• The absence of an unfavorable event in the list of insured events stipulated by the validity of this insurance contract;
• Proven intentional damage to the insured property by the policy-holder;
• Proven deliberate concealment by the policyholder from the insurance company of material information that affects the possibility of an insured event;
• Failure to provide the insurer with the necessary official documents confirming the insured event.

In case of disagreement of the insured or beneficiary with the amount of compensated damage or refusal of the insurer to compensate for the damage, he or she has the right to challenge the actions of the insurance company in court.