Complete Guide on the Insurance Claims Process

You hope it will never happen: the car will not get stuck in the middle of the road, severe wind will not bend the roof tiles, health issues will never disturb. When any unpleasant thing happens, people are lost and don’t know what to do. Insurance claims, what to expect? Then insurance “doctor” is here to relieve some of your financial stress.

Whatever the incident’s cause may be, the first thing to do is to claim the issue. The process of claiming insurance can be a complicated procedure. There’s no universal way-out and the way insurance companies process the accidents depends on the type of a specific issue. 

A large part of damage reimbursement depends on what is written in your insurance policy card. People may wonder how the insurance claim process works and we are going to shed light on how to process insurance claims, key factors to consider and how the whole process works.


Empeek team of experts is ready to help you take your business to the next level.

What is insurance claim process

When you file an insurance claim, you’re making a formal request to your insurance company to receive costs to help you restore damages caused by a policy event. The event must be covered by your insurance policy. Insurance company usually sends a claims adjuster to investigate the issue. If the cause of the damage is validated, you receive a payout. The insurance company also reserves the right to deny compensation. Learn how to open medical billing company on your own in our guide.

There are various insurance types on the market: auto, home, business, pet, travel, life, medicare, disability and each of them has different claim procedure when you have already suffered a loss. Each insurance policy has details under which circumstances and conditions the insurance company pays out the claims. 

When a car accident happens, damaging the vehicle or causing personal injuries, the insurance company investigates the matter. If a natural disaster like a hail storm or tornado damages a home’s roof, a family can file a claim expecting to be recompensed. No entrepreneur would like to wake up to the news that someone broke into his business at night. Travelling abroad and within the country we still need the insurance. Life insurance helps your family be financially protected in case of your fatal accident or terminal disease.

Insurance policy plays a big part in the comfort of our lives, however do you know how to process the insurance claims?

What do I need to file an insurance claim

If you have suffered a loss or a damage, the first thing to do is to familiarize yourself with  policy details. The more you know about your rights, the more chances for getting money from insurance claim you have. Once the issue happens, contact the agent immediately. It’s highly important to maintain constant contact with the insurance company, since they will help you understand the tiniest detail throughout the claim process.

Complete Guide on the Insurance Claims Process 1

After filing a claim, you may be asked to fill out forms and provide photos of the accident or damages. When it comes to property damage, it’s vital to document as many details as possible. This helps the insurance company check the surroundings, identify the peril and decide how much of the losses or injuries they can cover. Of course, there are certain challenges in claims processing.

To file, or not to file?

Shakespeare probably never had the issue with the process of claiming insurance, but it’s the question you ask yourself after an accident. The response is: it depends. 

Actually, if your losses are less than your deductible, it’s not worth going through the insurance claim settlement process. 

A deductible is the sum of money you’re responsible for when filing a claim. The insurance company will subtract that figure from the total amount they should pay out if an accident happens. The higher your deductible is, the less you will pay in premiums for the insurance itself. Premiums are monthly payments to have insurance coverage.

You may also wonder when to file a claim? 

The response is IMMEDIATELY. There might be time limits you have to file the claim within. For example, you might have only two days to file a renters insurance claim after you’ve experienced a burglary. The time allocated for auto claim procedure for insurance varies by state. Despite the limits, it’s always best to contact the insurance agent as soon as the issue happens. 

How does the insurance claim process work

You may ask: “how does the insurance claim process work” and the workflow is simple. It consists of 5 steps:

  • Contact your broker. The broker is your main contact point when it comes to insurance policy.  He should be aware of all the details and give further instructions. Once you provide the broker with a detailed list of damaged or lost things, including photos or videos which can be helpful, an insurance agent will get in touch with you to continue the claim procedure for insurance.
  • Claim investigation starts. After the claim has been reported, the issue should be investigated by the insurance agent to determine losses or damages covered by the insurance policy. You can assist the agent by providing additional details and any visual materials.
  • The policy is reviewed. Once the investigation is completed, the agent will check your policy to determine what is and isn’t covered by the policy, and inform you of any deductibles that may apply to your case. Many isurance comanies use RPA in healthcare to process claims.
  • Losses evaluation is conducted. The insurance agent may involve engineers, appraisers or contractors to consider their professional advice and evaluate the losses you have suffered. As soon as the evaluation is completed the agent will provide you with a list of preferred specialists to help with repairs. It’s not obligatory to hire one of them, but it can save you plenty of time and research.
  • Payment is arranged. After the repairing works have been done and the damaged items have been replaced, the agent will reach you out regarding getting money from the insurance claim. The time needed to receive payment depends on the complexity of your situation.

Every claim is different. Although the process of insurance claim can vary, your agent will guide you through each point involved.

Complete Guide on the Insurance Claims Process 2

How do insurance companies pay out claims

When you have an insurance policy up and running, you know your dwelling, auto, health, etc. is protected. With automated claims processing insurance companies streamline the claim handling process in several times. So, how do insurance companies pay out claims?

Step 1. The insured individual files his claim.

After an accident or loss requiring the claim procedure for insurance happened, contact the insurance company right away. The agent will ask you several questions and conduct an insurance claim check process. You may be asked to provide additional information such as a police report, list of losses, photos of an accident if it was a car crash. All of these details will be included into the claims report.

Step 2.The insurance company evaluates the claim.

The insurance claims department reviews the documents after the claim has been filed. They make sure the policy is in effect and the claim meets the coverage guidelines. 

Step 3. The claim is approved or denied

After the claim is reviewed, the insurance company either approves or denies the pay-out. They might ask for additional details so as to approve the claim or they can deny the claim if it doesn’t meet the policy regulations. 

Step 4. The insured receives his payment

If the claim is approved, you’ll receive a pay-out for the amount of the loss according to the insurance policy. The payment can be sent to you or directly to the vendors involved in the loss, such as the auto repair service company. 

How long does getting money from insurance claims take? The time needed depends on several points:

  • How quickly you file the claim;
  • Whether the insurance company has all necessary documents;
  • How quickly you can meet with the insurance adjuster;
  • The number of people involved.
Health insurance

Consider Our Company Your Trusted Partner

Insured individuals want to be financially protected in case of an accident or emergency, insurance companies want people to never suffer a loss. Creating a software allowing to file an insurance claim directly in a hospital without having a trusted partner might be a complicated issue. It’s challenging to take into account all the important software features and keep an eye on them during the development process. If you wonder how to select medical billing development company, don’t guess, check our instructions. You can also Learn the benefits of outsourcing medical billing for healthcare organizations in our guide.

Empeek offers outsourcing software development services to help healthcare organizations create medical software according to their needs. One of our recent projects was digitalized medical emergency services. It’s core value is to simplify emergency reporting and allow emergency service personnel to easily access the patient’s medical records. 

Complete Guide on the Insurance Claims Process 3

When developing an insurance software solution, the experience gained throughout digitalized medical emergency services creation will be highly helpful. Just like insurance software, digitalized medical emergency services include features such as: patients/ensured data storage, claims monitoring, reports, billing and invoicing.

If you feel like having a trusted partner to help you create progressive software, contact Empeek to learn more about a smooth development process.


Let us help you achieve greater business results - our software development experts push the limits to deliver the most advanced solutions.

Final Thoughts

Thinking of filing an insurance claim is not the best feeling in the world, but when the issue happens, you should know what to do first and what the claim filing process involves. The insurance claim process typically involves four main stages, from the moment you report the issue to the resolution of your claim. Step-by-step: contact the broker, file necessary documents, wait for approval or denial, get pay-out. A progressive, spotless software will make the process of filing a claim a lot faster and easier.

Have hesitation whether you’ve included all the necessary features? Reach us out for a talk.


How to make an insurance claim?

Call your insurance agent first thing. Gather all the necessary documents, photos, evidence he might ask. File a claim following the agent’s instructions.

Can I keep the money from an insurance claim?

As long as your policy and state allow it, you can keep the money to use as you choose.

What is a deductible?

A deductible is the sum of money you’re responsible for when filing a claim. The insurance company will subtract that figure from the total amount they should pay out if an accident happens.

How long does the process of claiming insurance take?

The time needed to process the claim depends on several factors: how quickly file the claim, whether the insurance company has all necessary documents, how quickly you can meet with the insurance adjuster, the number of people involved. It can take from several days to several weeks.

What do I need to file an insurance claim?

When filing a claim you’ll be asked to provide basic details, such as place and time when the accident happened, contact information for everyone involved and detailed description of what happened. You might also be asked for an estimated cost of the damage.

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Written by:
Roman Konstantinov Roman Konstantinov Managing Partner & Co-Founder
Roman is the co-founder of Empeek who brings a breadth of knowledge to build, scale and transform healthcare organizations. He specializes in revitalizing struggling businesses and turning them into profitable enterprises. By emphasizing automation and effectively navigating the transition from startup to a sustainable and scalable model, Roman drives remarkable transformations to ensure long-term success.

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