Understanding the Claim Payout Process | Department of Insurance, SC (2024)

Understanding the Claim Payout Process | Department of Insurance, SC (1)Insurance exists to help out with expenses after a disaster strikes. You may be one of many policyholders who want to know how quickly you can expect to receive your payout after you’ve filed a claim. And while processing times do vary from company to company and are dependent on the type of claim, Insurance Information Institute (III)has provided a good overview of what you can expect.

The initial payment isn’t final

In most instances, an adjuster will inspect the damage to your home and offer you a certain sum of money for repairs, based on the terms and limits of your homeowner's policy. The first check you get from your insurance company is often an advance against the total settlement amount, not the final payment. If you’re offered an on-the-spot settlement, you can accept the check right away. Later, if you find other damage, you can reopen the claim and file for an additional amount. Check your policy to know how long you have to reopen claims.

You may receive multiple checks

When both the structure of your home and your personal belongings are damaged, you generally receive two separate checks from your insurance company, one for each category of damage. If your home is uninhabitable, you’ll also receive a check for the additional living expenses (ALE) you incur if you can’t live in your home while it is being repaired. If you have flood insurance and experienced flood damage, that means a separate check as well.

Your lender or management company might have control over your payment

If you have a mortgage on your house, the check for repairs will generally be made out to both you and the mortgage lender. As a condition of granting a mortgage, lenders usually require that they are named in the homeowner's policy and that they are a party to any insurance payments related to the structure. Similarly, if you live in a coop or condominium, your management company may have required that the building’s financial entity be named as co-insured. This is so the lender (and/or, in the case of a coop or condo, the overall building), who has a financial interest in your property, can ensure that the necessary repairs are made. When a financial backer is co-insured, they will have to endorse the claims payment check before you can cash it. Depending on the circ*mstances, lenders may also put the money in an escrow account and pay for the repairs as the work is completed. Show the mortgage lender your contractor’s bid and let the lender know how much the contractor wants up front to start the job. Your mortgage company may want to inspect the finished job before releasing the funds for payment to the contractor. If your home has been destroyed, the amount of the settlement and who gets it is driven by your policy type, its specific limits, and the terms of your mortgage. For example, part of the insurance proceeds may be used to pay off the balance due on the mortgage. And, how the remaining proceeds are spent depends on your own decisions, such as if you want to rebuild on the same lot, in a different location, or not rebuild at all. These decisions are also driven by state law.

Your insurance company may pay your contractor directly

Some contractors may ask you to sign a “direction to pay” form that allows your insurance company to pay the firm directly. This form is a legal document, so you should read it carefully to be sure you are not also assigning your entire claim over to the contractor. When in doubt, call your insurance professional before you sign. Assigning your entire insurance claim to a third party takes you out of the process and gives control of your claim to the contractor. When work is completed to restore your property, make certain the job has been completed to your satisfaction before you let your insurer make the final payment to the contractor.

Your ALE check should be made out to you

Your check for additional living expenses (ALE) has nothing to do with repairs to your home. So, ensure that this check is made out to you alone and not your lender. The ALE check covers your expenses for hotels, car rental, meals out, and other expenses you may incur while your home is being fixed.

Your personal belongings will be calculated on cash value, first

You’ll have to submit a list of your damaged belongings to your insurance company (having a home inventorywill make this a lot easier*). Even if you have a replacement value policy, the first check you receive from your insurer will be based on the cash value of the items, which is the depreciated amount based on the age of the item. Why do insurance companies do this? It is to match the remaining claim payment to the exact replacement cost. If you decide not to replace an item, you’ll be paid the actual cash value (depreciated) amount for it.

To get replacement value for your items, you must actually replace them

To get fully reimbursed for damaged items, most insurance companies will require you to purchase replacements. Your company will ask for copies of receipts as proof of purchase, then pay the difference between the cash value you initially received and the full cost of the replacement with an item of similar size and quality. You’ll generally have several months from the date of the cash value payment to purchase replacements; consult with your agent regarding the time frame.

In the case of a total loss, where the entire house and its contents are damaged beyond repair, insurers generally pay the policy limits, according to the laws in your state. That means you can receive a check for what the home and contents were insured for at the time of the disaster.

We couldn’t have said any of this better than III did. The SCDOI gives credit to III for the information in this blog post.

Please click their link at the beginning to visit the original post and to access some excellent links.

Understanding the Claim Payout Process | Department of Insurance, SC (2024)

FAQs

How to answer insurance claim questions? ›

Below are some best practices to consider:
  1. Contact a lawyer. ...
  2. Keep in mind that despite the friendliness of the person taking your statement, that person is not your friend. ...
  3. Ask specifically that your statement not be recorded. ...
  4. Give brief answers. ...
  5. Don't volunteer information. ...
  6. Answer only the question asked.

What are the steps in the claim process? ›

Your insurance claim, step-by-step
  1. Connect with your broker. Your broker is your primary contact when it comes to your insurance policy – they should understand your situation and how to proceed. ...
  2. Claim investigation begins. ...
  3. Your policy is reviewed. ...
  4. Damage evaluation is conducted. ...
  5. Payment is arranged.

What are the four steps in settlement of an insurance claim? ›

But with these four essential insurance claim process steps, you'll go from confused to confident in the event of an accident.
  1. Notification. The first step is to notify: advising your insurance company that you want to file a claim. ...
  2. Investigation. ...
  3. Repair. ...
  4. Settlement.

How long does an insurance company have to settle a claim in South Carolina? ›

Insurance companies in South Carolina do not have a specific amount of time in which they must settle an insurance claim. Instead, state law requires them to settle claims with “reasonable promptness”.

What questions do insurance investigators ask? ›

Questions Insurance Adjusters Commonly Ask in Recorded Statements
  • What is your full name?
  • Are you aware that this interview is being recorded?
  • Do I have your permission to record your statement?
  • Can I share the information we discuss with another adjuster?
  • What is your address, telephone number, and date of birth?
Mar 7, 2019

What is the process of claim settlement? ›

Once the verification process is completed, and the insurer confirms there is no discrepancy in the claim application, your claim will be settled. The insurer is obligated to settle your claim within 30 days of the submission of all the relevant documents.

What is the claims processing workflow? ›

Claims processing or Claims adjudication is a process at a Payer's end that runs the claims through their adjudication/rules process to determine if the claim can be approved, denied or flagged for manual review.

What is the last step in the claim settlement process? ›

Claim Payment: Once you accept the settlement offer, the insurance company will provide you with the compensation. This might be in the form of a check, direct deposit, or other agreed-upon method.

What are the final stages of settlement? ›

After a case is settled, meaning that the case did not go to trial, the attorneys receive the settlement funds, prepare a final closing statement, and give the money to their clients. Once the attorney gets the settlement check, the clients will also receive their balance check.

How does the settlement process work? ›

A settlement occurs when the plaintiff and defendant agree that the defendant pays a certain amount in return for the plaintiff dropping the lawsuit. Once a settlement has been reached, the two sides do not proceed to trial. Sometimes an insurance company will make the payment and not an individual defendant.

How do insurance companies evaluate claims? ›

In addition, the adjuster will review police reports, medical reports, and other documentation related to the accident. Adjusters have also been known to dig into the plaintiff's past to see if they can uncover pre-existing conditions, previous personal injuries claims, and so on.

How long can a claim take to settle? ›

The length of time a case takes to settle a personal injury claim can vary significantly, simple cases where liability is admitted can be settled in around 12 months or so. Large, more complex, high-value cases can take longer to settle.

What happens if insurance doesn't want to settle? ›

If settlement negotiations stall, you might choose to escalate the matter by filing a lawsuit against the insurer. This is generally a last resort, but it begins the formal legal process. Negotiations might continue, but eventually, the lawsuit could end up in court.

How long before an insurance company offers a settlement? ›

Under the Fair Claims Settlement Practices Regulations guideline that California follows, an insurance company must settle a claim immediately, if possible. If it can't settle it immediately, it must do so within 40 days of receiving the proof of claim forms.

What to say when making an insurance claim? ›

When you file a claim, you'll be asked to provide some basic details, such as where and when the accident or incident took place, contact information for everyone involved and a description of what happened. You might also be asked to give an estimated cost of the damage from the accident—if you have that available.

How do I argue an insurance claim? ›

Steps to Appeal a Health Insurance Claim Denial
  1. Step 1: Find Out Why Your Claim Was Denied. ...
  2. Step 2: Call Your Insurance Provider. ...
  3. Step 3: Call Your Doctor's Office. ...
  4. Step 4: Collect the Right Paperwork. ...
  5. Step 5: Submit an Internal Appeal. ...
  6. Step 6: Wait For An Answer. ...
  7. Step 7: Submit an External Review. ...
  8. Review Your Plan Coverage.

What do you say when appealing an insurance claim? ›

To Whom It May Concern: I am writing to request a review of your denial of the claim for treatment or services provided by name of provider on date provided. The reason for denial was listed as (reason listed for denial), but I have reviewed my policy and believe treatment or service should be covered.

How do you explain an insurance claim? ›

An insurance claim is a formal request from the policyholder to their insurance company asking for payment after a covered incident, such as a hospital stay, a natural disaster, theft, and more.

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