Claim
Definition
A formal request by a policyholder to an insurance company for coverage or compensation for a covered loss. The claim process involves reporting, investigation, evaluation, and payment or denial.
Example
After a hailstorm damages their roof, a homeowner files a claim with their insurance company. An adjuster inspects the damage, estimates repair costs at $15,000, and the insurer approves and pays the claim minus the $1,000 deductible.
In Practice
Claims should be reported promptly to avoid coverage issues. Most policies require notice 'as soon as practicable' after a loss. The claims process involves documentation, investigation, coverage determination, damage assessment, and settlement. Policyholders have rights during the claims process, including the right to appeal denials. State insurance departments regulate claims handling practices.