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How Insurance Claims Work

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1. Maintain call logs - For each call, note down



- Date, time and duration of the call

- Customer service rep's *full name, rep ID, call center location

- Supervisor's name if you got transferred

- Conversation highlights

2. Always stay calm and never be rude. Be mindful of claim center reps' situation. They spend their whole day fielding tough questions from irate customers. They will certainly help you if you are nice to them; otherwise they will play by the rules hard and fast. Explain your position and ask them to help you out. Remember, they have nothing to lose and your fight is against the company, not the rep

3. Do not call during peak hours and Mondays They will not be able to spend time with you during business hours. Avoid morning hours, lunch time and Mondays.

If you have followed the above guidelines, you can deal with most of the claims. But then there are tough claims which requires a special approach.

Dealing with tough claims - How to play the game

1. Gather all details at once before you make the call - Collect all the details such as account #, model #, service contract, claim center's 800 # etc. I prefer to keep this info online so that I will have access to the details from anywhere. You can use a draft email saved copy, or Google Notepad kind of online service. Use the same notepad to add call logs each time you make the call. If time permits, collect details of similar claim denial issues - from your friends or from the experiences posted on the web

2. Pay attention to agent's greeting message - Greet the agent and note down her/his name, call center location and time in your call log immediately. Address them using their name to make them feel respected.

3. Explain the problem patiently and ask them to help you resolve it. Understood, you are frustrated and dissatisfied with the service, but stay calm and respectful. You cannot get personal and express your anger against the agent, who is not directly responsible for the situation.

4. Provide details of your sincere efforts to resolve the issue - Justify as to why you think this claim should be processed. Explain how many times you have called before and mention the name of the rep you spoke last time.

Playing Hardball - They won't listen. What Next?

5. Call some other time - Some reps are helpful, so repeated calling will help most of the times.

6. Speak to a supervisor - This won't help much, but you can give it a try. Supervisors are specialized in dealing with irate customers and will not be of much help.

7. Loyalty Threat - Tell them you have been a loyal and long time customer and you will be disappointed if they do not honor your claims

8. Contract Termination Threat - Tell them you will terminate their service if the issue is not resolved. But do not cancel the service on the same call. Call at some other time and ask them to terminate the service as the very first thing. When they ask for the reasons, explain your problem. Your case will be considered more favorably now. Do NOT terminate the contract before you have completed remaining steps here.

9. Badmouthing Threat - Warn them that you will drag them through the mud by publicizing your bad experiences. You should be willing to report the problem to news papers, TV channels, online discussion forums, blogs and finally set up a website and collect all similar experiences about that company. Check out this video - how one homeowner won his insurance claims with the help of a TV channel

10. Official Complaints with BBB - You can complain with Better Business Bureau (BBB), which will be happy to resolve the complaints and mediate between businesses and customers. BBB is not a govt. organization but it does promote integrity and business ethics in the marketplace. It will also keep public records of all complaints and companies do not want to be blacklisted there.

11. Official Complaints with State Attorney General Office - If you honestly believe that you are victimized by a business, lodge a complaint with the attorney general's office. They will launch an inquiry. Nevertheless, you can threaten your insurance company about that you will contact attorney general's office.

12. Law Suite Threat - Threaten them with personal or class action law suite. Do not use this threat unless it is really necessary. Most of the companies have their position covered legally and this may not work unless they are engaged in unlawful practices
How Insurance Claims Work
No matter what kind of claim you're making, the settlement of your insurance claim could take months, even years. Commercial claims on buildings and vehicles are often complex with reams of red tape. Domestic claims - homeowner's, life, and vehicle insurance - are less complex, but involve the often-unprepared policy holder doing battle with an insurance company that is long skilled with denying claims.

Your first weapon understands how long your claims should take. Small cases, like vehicle damage, should be taken care of right away. More than a business week is too long. Medical cases should also be handled quickly, though they may take a bit longer, up to a month or more if the case is complicated. Life insurance should be settled, also, within a month of filing provided there is no controversy surrounding the death.

Home insurance and business insurance are a little different. First, with your business, if you have business interruption insurance with the same insurer that covers your premises, you may be able get them to move faster as every day they don't pay you is another day they pay on the other policy. Regardless, in both home and business settlement will take a little longer than other policies, particularly if the damage was caused by a natural disaster that caused problems elsewhere as well. If you take pictures of everything yourself, you may be able to speed up this process; if it takes more than a couple of days for the claims adjuster to make it out to your site, you should take those pictures yourself anyway to document how much damage was done.

There are a few things you can do to speed up your claims. The first is to stay on top of it. You should know what stage your claim is in, what has been done and what remains to be done, and approximately how long it is until you can expect to hear a decision. This often entails keeping very good records as well as calling weekly or even daily to check on what's happening. The person to deal directly with is your claims adjuster.

If your adjuster does not give you good results in what you consider to be a timely manner, ask to speak to his or her supervisor. A good supervisor can get your claim expedited.

If your claim is a large one and especially if you're nervous about the possibility of the claim being denied (as in when floods cause large numbers of homes to be damaged and make it more likely for the insurers to deny claims) you might need to hire a loss assessor.

How a Loss Assessor Can Help

A loss assessor is to you the same as the claims adjuster is to the insurance company: an ally who will look at the damage done and try to come up with a fair price to cover the claim. He often has a claims adjustment background, and will be able to deal with the insurance company better than you ever could. Although a loss assessor will cost you money, the increase in your settlement he may be able to get should more than offset his cost to you, and in addition he will be able to protect your future claims with your insurance company. Whenever you have a large claim it is worth looking into a loss assessor for professional and intelligent advice.
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About Author
Both Shayri An & Derek Rogers are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.

Shayri An has sinced written about articles on various topics from Real Estate. Author is a member of HomeWarrantyReviews.com team and writes blogs and articles about. Shayri An's top article generates over 590 views. Bookmark Shayri An to your Favourites.

Derek Rogers has sinced written about articles on various topics from Leadership, Food and Drink and Computers and The Internet. Derek Rogers is a freelance writer who represents a number of UK businesses. For Insurance Claim Services and Loss Assessor Consultants, he recommends Morgan. Derek Rogers's top article generates over 74000 views. Bookmark Derek Rogers to your Favourites.
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