Understanding General Insurance Claims

In this blog post, we’ll explore what general insurance claims are, how they work, and some tips to ensure your claims process is as seamless as possible.

What is a General Insurance Claim?

A general insurance claim is a formal request by an insured individual to their insurance company for coverage or compensation for a covered loss or policy event. The insurance company validates the claim and once approved, issues payment to the insured or an approved interested party on behalf of the insured.

Claims are honoured by an insurance company in good faith that the policy has been set up correctly and that all relevant information has been disclosed at the time the policy began, at each renewal following, and at the time of claim.

Types of General Insurance Claims
General insurance encompasses various types of insurance policies, including:

  • Vehicle Insurance: Covers damages to your vehicle or liabilities [third party property] resulting from a vehicle accident.

  • Homeowners Insurance: Provides coverage for damages to your home due to events like fire, theft, or natural disasters.

  • Travel Insurance: Protects against travel-related emergencies and financial losses.

  • Business Insurance: Coverage for contents, stock, commercial buildings, commercial vehicles and liabilities. Events covered may include theft, burglary, malicious damage, damage from natural events, or fire. It can also include cover for damage to property belonging to others.

The Claims Process
The general steps involved in filing an insurance claim are:

  1. Notification: Inform your insurance provider or broker/adviser about the incident as soon as possible.

  2. Documentation: Gather all necessary documents, such as police reports, medical records, proof of ownership, and quotes for replacement items.

  3. Claim Form: Fill out the claim form provided by your insurer with accurate details of the incident.

  4. Assessment: The insurance company will assess the claim to determine the extent of their liability.

  5. Approval: If the claim is valid, the insurer will approve it and calculate the compensation amount.

  6. Payment: The insurer will then arrange to settle the claim.


Tips for a Smooth Claims Process

  • Understand Your Policy: Be aware of what your policy covers and what it doesn’t.

  • Maintain Records: Keep a detailed record of all communications with your insurance provider.

  • Hold onto receipts and purchase documents so these can be easily accessed when making a claim.

  • Make lists and photograph items before a claim occurs.

  • Be Honest: Provide accurate information to avoid any delays or denials. Inaccuracies may cause the insurer to decline your claim and/or cancel your insurance policy.

  • Ask Questions: If you’re unsure about any aspect of the claims process, don’t hesitate to ask your broker/adviser for clarification.

Your insurance is there to protect you, and understanding how to effectively navigate the claims process means that you can make the most of your coverage when you need it the most.

Making use of your adviser/broker at claim time is a bonus so you can be guided through the claims process with ease. Your broker will be able to liaise with the insurer, so you don’t have to. This can be especially useful when things need to be followed up or queried.

General Insurance Claims Examples Reviewed by IFSO
[Insurance and Savings Ombudsman]

  1. Fraudulent Insurance Claim Backfires: A man named Mikey* made a fraudulent claim for his car after the Auckland floods, providing a quote from a mechanic for repairs. However, the insurer found inconsistencies and declined his claim due to fraud. This led to Mikey being uninsured and at risk of losing his house as his house and contents policies were cancelled.

  2. Business or Displeasure? Graham’s insurance claim was declined because he failed to inform his insurer that he was using his vehicle for business purposes, which is a breach of policy terms.

These examples highlight the importance of understanding your insurance policy and the terms and conditions that apply. It’s crucial to provide accurate information and to be aware of the details of your coverage to avoid disputes and claim rejections.

On the flip side, the ombudsman’s office is here for anyone who believes their insurer has not settled their claim fairly.

*Names have been changed to protect confidentiality.

For more detailed information on these cases, you can visit the IFSO’s case studies page2.