Here's a scenario: a tree branch crashes through your bedroom window during a storm, or someone rear-ends you at a stoplight, or you slip on ice and break your ankle. What happens next? You file an insurance claim. But if you've never done it before, the whole process can feel like navigating a maze blindfolded. Let's break down exactly what an insurance claim is, when you should file one, and what you can expect along the way.
An insurance claim is simply your formal request asking your insurance company to pay for a covered loss. You've been paying premiums to protect yourself from financial disasters—a claim is when you actually use that protection. Whether it's auto, home, health, or any other type of insurance, the basic principle is the same: something bad happened, you're insured for it, and now you're asking your insurer to make you whole again.
When Should You File a Claim?
This is trickier than it sounds. Just because something is technically covered doesn't always mean you should file a claim. Here's why: every claim you file goes on your record, and multiple claims can lead to higher premiums or even policy cancellation. As a general rule, you should file a claim when the cost of the damage significantly exceeds your deductible.
Let's say your deductible is $1,000 and a hailstorm causes $1,200 in damage to your roof. You'd only get $200 from your insurer, but that claim could raise your rates for years. Not worth it. But if that same storm causes $8,000 in damage? Absolutely file a claim. You always want to report major incidents—serious accidents, significant property damage, injuries to others, or theft—even if you're not sure you'll file a claim. Your insurer needs to know, and you typically have a limited window to report incidents.
The Claims Process: Step by Step
Filing a claim isn't complicated, but being organized makes everything go smoother. First, make sure everyone is safe. If there are injuries, call 911 immediately. Your claim can wait—people can't. Once safety is handled, start documenting everything. Take photos from multiple angles, get contact information from witnesses, and if it's a car accident or involves theft or vandalism, call the police and get a report number.
Next, contact your insurance company as soon as possible. Most insurers let you file online, through their mobile app, or by phone. Have your policy number ready, along with details about what happened—date, time, location, and a clear description of the incident. The more information you provide upfront, the faster things move. In 2025, the average property claim takes about 32 days from filing to completion, though that can stretch longer for disaster-related claims.
Your insurance company will assign a claims adjuster—think of them as your case manager. They'll investigate what happened, assess the damage, and determine what your policy covers. For home claims, they might visit your property. For auto claims, they might use photo estimation technology, which can deliver damage assessments within 24 hours for 78% of claims. Be responsive when your adjuster reaches out. The number one reason claims get delayed is missing information or unreturned calls.
What to Expect During the Process
Timeline varies wildly depending on complexity. Simple claims with clear liability—like a tree falling on your garage during a documented storm—might settle in a few weeks. Complex claims involving injuries, disputed fault, or significant damage can take months or even over a year. Most states require insurers to accept or deny claims within 30 to 45 days, and once approved, payment typically arrives within 30 days, though some states like Texas require payment within five business days.
Here's something most people don't know: denial rates vary dramatically by insurance type. Health insurance companies deny about 19% of in-network claims on ACA marketplace plans, while Kaiser Permanente denies just 6% of claims. Life insurance sees initial rejection or delays on 10-20% of claims. Property and auto claims generally have lower denial rates, but it still happens. The good news? About 56% of appealed denials get overturned. The bad news? Fewer than 0.2% of people actually appeal. Don't leave money on the table—if your claim is denied and you believe it's covered, appeal it.
Once your claim is approved, you'll receive a settlement offer. Read it carefully. Make sure it covers everything it should, and don't be afraid to ask questions if something seems off. Your adjuster is there to help, but they also work for the insurance company. It's okay to push back if the settlement seems too low—just be prepared to provide documentation supporting your position.
Common Mistakes to Avoid
Don't start repairs before getting approval from your insurer unless it's to prevent further damage. If your roof is leaking, absolutely put a tarp on it. But don't replace the whole roof before your adjuster sees it, or you might end up footing the bill yourself. Keep every receipt, email, and text message related to your claim. Organization prevents headaches later.
Don't exaggerate or lie about what happened. Insurance fraud is a crime, and it's easier to detect than you think. Stick to the facts. Also, don't assume your policy covers everything. Review your policy or ask your agent before filing. Finding out after you've started the claims process that something isn't covered is frustrating for everyone.
Getting Started With Your Claim
Filing an insurance claim doesn't have to be stressful. The key is preparation and communication. Know what your policy covers before something happens—read through it now, while you're calm and nothing's on fire. Keep your agent's contact information handy. And when something does go wrong, document everything, file quickly, and stay organized.
Remember, insurance exists to protect you from financial catastrophe. Don't be afraid to use it when you need it. That's what you've been paying for. At 1800insurance.com, we're here to help you find the right coverage and understand how to use it when life throws you a curveball. Ready to review your policy or get a quote? Give us a call—we'll walk you through it.
