Insurance Claim: Legal Definition

An insurance claim is a formal request submitted to an insurance company asking them to cover certain losses or expenses related to an accident or event.

When a person takes out an insurance policy to cover their car, home, business, or another asset, this policy is a contract between the policyholder and the insurance company. If the policyholder pays the monthly premiums, the insurance company should cover damages as outlined in the policy.

Insurance Coverage and Payouts

Insurance policies either cover the policyholder’s investment or are liability policies to cover other people’s damages caused by the policyholder. Some types of insurance are legally mandated or required in different ways. All motorists in Pennsylvania must carry:

• Personal injury protection policies to cover their injuries; and
• Auto liability policies to cover the injuries and damages of another person in an accident the policyholder caused

Your mortgage company likely requires you to have homeowner’s insurance to cover damage to your home and liability to cover injuries to someone who visits your home.

When you file an insurance claim, you are asking for compensation based on one of these policies.

For example, imagine you file an insurance claim in a slip and fall case following a fall at your neighbor’s house. We would file a formal request for compensation with the property owner’s liability policy.

The Insurance Claims Process

In theory, once the insurance company receives a claim, it investigates the incident and should approve or deny it based on the insurance policy. If they approve the claim, they will issue a payment to the person who filed the claim or their attorney.

What If the Insurer Denies Your Claim?

Filing an insurance claim should be the easiest and most direct route to recovering the compensation you need after an event or incident. This is rarely the case, though.

Insurance is a business, and adjusters must adhere to the law by practicing “good faith” while also taking care of the company’s bottom line. They may look for reasons to deny a claim or only pay it in-part.

If this happens to you, you may need to take additional action to recover the compensation you need and deserve. If you are pursuing damages in a liability claim, the team from Berger and Green may be able to build a solid case and file a personal injury lawsuit on your behalf instead.

Talk to a Pittsburgh Personal Injury Attorney About Your Case

If you suffered injuries in a Pittsburgh accident or incident, Berger and Green offer free case reviews. We can help you understand if your injuries occurred because of someone else’s negligence and if you may be able to hold them liable.

We can help you file an insurance claim, attempt to negotiate an out-of-court settlement or file a personal injury lawsuit. Our founding partner Lawrence B. Green has more than 40 years of experience helping Accident victims in Pennsylvania. Let us go to work for you today.

Call us at 412-661-1400 for a complimentary case evaluation and consultation.