Insurance Claims
What is insurance?
Death Claim: Beneficiaries file a claim upon the death of the insured, and the insurance company pays the sum insured.
Health Insurance:
Medical Expense Claim: The insured submits medical bills for reimbursement under the terms of the policy.
Hospitalization Claim: When the insured is hospitalized, the insurance company covers hospital costs.
Basic insurance principles
Indemnity: indemnity is limited to the actual damage suffered.
Good faith: it requires acting with loyalty, truthfulness and diligence.
Interest: the insured must have an interest in the non-occurrence of the loss.
Mutuality: based on the distribution of risks among the insured.
Types of insurance
Insured object: damage insurance and personal insurance.
Compulsory nature: compulsory and voluntary insurance.
Branch: automobile, fire, life, home, travel, etc. insurance.
Scope: private and social insurance.
Phases of the insurance contract
The insurance contract consists of several stages:
Perfection: there is consent through application for insurance and acceptance by the insurer with issuance of the policy.
Duration: coverage period established in the policy (temporary or lifetime in life insurance).
Extinction: upon expiration of the term, non-payment of the premium, waiver or mutual agreement.
Claim: in the event of a covered loss, the insured notifies the fact and requests indemnity.
Obligations of the parties
Insurer: to pay indemnity in case of loss, except for agreed exclusions. To maintain the validity of the coverage.
Insured: to pay the premiums on the stipulated dates. To declare the risk completely and truthfully. Communicate the occurrence of losses.
Types of policies
There are several types of insurance policies:
Automobile insurance: damage, theft, civil liability, occupants, etc.
Home insurance: fire, theft, breakage, civil liability, etc.
Life insurance: covers the death or survival of the insured.
Travel insurance: medical assistance, loss of luggage, flight cancellation, etc. during trips.
Health insurance: reimbursement of medical and hospital expenses.
Business insurance: property damage, loss of profits, civil liability, etc.
The importance of insurance is unquestionable in today’s society. They allow the coverage of multiple risks, giving peace of mind against possible contingencies and claims of high economic cost.
Insurance claims: procedure and tips
When a loss or event covered by insurance occurs, the insured has the right to claim the corresponding indemnity from the insurer. However, sometimes problems arise in this process that force the insured to exercise his right through formal claims.
Time limit for making a claim
The insured has a certain period of time from the time he/she has knowledge of the loss to notify the insurer. In the case of damages, it is usually 7 days, while in the case of individuals it is longer. If this is not respected, the insurer may reject the claim as untimely.
Likewise, to file a claim there are prescription periods from the time of the loss that usually range between 1 and 2 years depending on the type of insurance. It is important to file the claim within the legal deadlines.
Each type of insurance is designed to cover specific risks and needs, and claims vary depending on the nature of the insurance. Some common types of claims for different types of insurance are described here:
Life Insurance
Death Claim: Beneficiaries file a claim upon the death of the insured, and the insurance company pays the sum insured.
Health Insurance
Medical Expense Claim: The insured submits medical bills for reimbursement under the terms of the policy.
Hospitalization Claim: When the insured is hospitalized, the insurance company covers hospital costs.
Automobile Insurance
Accident Claim: When an automobile accident occurs, the insured files a claim to cover damage to the vehicle and injuries.
Theft Claim: In the event of theft of the vehicle, a claim is filed to recover its value.
Homeowners Insurance
Home Damage Claim: Policyholders file claims to cover damage to the home due to fire, natural disasters or other covered events.
Theft Claim: In case of theft of personal property, a claim is filed to replace stolen items.
Civil Liability Insurance
Third Party Damage Claim: When the insured is legally liable for damages to third parties, the policy covers legal costs and indemnities.
Travel Insurance
Trip Cancellation Claim: If a trip is cancelled due to covered circumstances (such as sudden illness), the insured may file a claim for reimbursement of expenses.
Professional Liability Insurance
Malpractice Claim: If a professional faces a lawsuit for negligence or professional errors, he or she files a claim for his or her legal defense.
Business Insurance
Property Damage Claim: In the event of damage to business property, the insured files a claim to repair or replace the property.
Business Interruption Claim: If a covered event interrupts business operations, a claim is filed to recover financial losses.
Flood Insurance. Flood Damage Claim: When a flood occurs, homeowners file claims to cover property damage.
Earthquake Insurance. Earthquake Damage Claim: Following an earthquake, policyholders file claims to repair or rebuild their homes.
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Legal services related to insurance claims are essential to ensure that policyholders receive adequate compensation in situations of loss or damage.
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