Every insurance carrier has its own way of handling a claim. When you signed your policy, you received important information about it. That may have been a while ago, and not every situation merits a claim.

If you’re not sure when to make an insurance claim, you’re not alone. Understanding your policy and the process can help, but your Rathbun Insurance team is your biggest ally.

Deciding whether to file a claim

Before you call your insurance carrier direct claims line, call your agent. Remember, the Rathbun Insurance team isn’t employed by the insurance company that holds your policy. 

Your Rathbun Insurance producer and service staff's employer is Rathbun Insurance , which is a separate entity from the insurance carrier. Independent producers at Rathbun Insurance work in your best interests. Their knowledge is an asset when you’re faced with a claim.

A word on whether to file a claim

It makes sense to file a claim when there’s significant damage or liability involved, such as wind damage from a tornado or a dog bite.

Deciding whether to submit a claim gets tricky when the damage is minor or no liability is involved. For example, let’s say you have a small kitchen fire that causes cosmetic damage to the wall. The cost of repairing it is $2,500. Your deductible is $1,500. It might be better to pay it yourself to keep the claim off your insurance record.

Your agent will help you decide whether to file a claim and advise you on your rights.

An overview of the claims process

Insurance companies have their own claims departments, each with its own procedures. There’s no single process across all companies, but there are commonalities.

Here’s an overview of what to expect:

Report the incident, damage or loss

After you have an accident or loss, report it. This report is called the first notice of loss (FNOL).

• If you call Rathbun Insurance to discuss whether to file, this is not the FNOL.
• If you call your insurance company to report a claim, this is the FNOL.

Policy verification

Your insurance policy will indicate your policy’s coverage. If you decide to file a claim, your insurance Rathbun Insurance team is glad to review this information with you. But remember, the insurance carrier will make all decisions regarding claims. They may need to investigate before they make a decision.

Documentation of the claim

You'll need to provide details about the claim event. Document the incident with pictures, videos, receipts, expenses, witnesses and any other evidence. Your insurance carrier might require you to make a sworn statement, your legal testimony about what happened. Making a claim is like building a case for yourself. Treat it like you would your testimony in a court case.

Don’t lie or inflate damages, as this could be considered fraud. Don’t offer information beyond what they ask of you. Make your answers short, preferably yes or no, and to the point. Everything you write or say will be documented and used by the insurance company to decide on your claim. They could go for or against you. They are not there to advocate for you. They are there to figure out what happened and decide whether it’s covered.

Investigation and evaluation

Once the claim has been submitted, the insurance carrier will assign a claims adjuster. The adjuster will investigate the incident using interviews and site visits. They will also review evidence like medical reports, repair bills, videos, photos and sworn statements.

The claims adjuster works for the insurance carrier, acting as their eyes and ears. Claims adjusters are licensed insurance professionals who are familiar with claims, how damage occurs and the signs to look for.

Claim approval or denial

Based on the evidence and policy coverage, the claims adjuster will decide whether to approve or deny your claim. If they approve it, they’ll determine how much you will receive for your loss.

If you agree that the amount is fair, you can proceed with the disbursement of funds. If you disagree on the amount, your claim will move to dispute resolution. (See below.)

Disbursement of funds

After your claim has been approved and you’ve agreed to the settlement amount, the insurance carrier will pay you the funds or the repair service provider directly. The amount they pay is the total cost minus your deductible. For example, let’s say your car is damaged in an accident. The insurance carrier approves the repairs, and the shop fixes your car. When you come to pick up your car, the auto shop shows you a receipt that includes:

• A detailed description of the repairs
• The total cost of the repairs
• The amount the insurance carrier has agreed to pay
• The amount you’re responsible for

The cost of the repairs is $9,500. Your auto insurance deductible is $500. You pay $500, and the insurance company pays $9,000.

Dispute resolution

If you disagree with the claim settlement amount or if the claim is denied, there’s a dispute resolution process. Don’t sign anything. Instead, hire a licensed public adjuster to help with your claim. Public adjusters work for you, not the insurance carrier. You have the right to hire an insurance claim attorney or a public adjuster at any time during the claims process.

Claim closure

If there is no dispute and the claim payment has been made, your claim is closed.

Call the Rathbun Insurance team for help on a claim

Every claim is different. Call the Rathbun Insurance team if you need help deciding whether and how to file a claim. Some claims are obvious, like property damage due to severe weather. But even if you know you’re submitting a claim, inform your Rathbun Insurance team. They can guide you through the process.