Generally when it comes time to make an insurance claim, you have suffered a serious loss and need the benefits to be fully and promptly paid. It is important to understand your rights in the insurance claim process. If an insurance company is disputing your claim, taking too long to investigate, or asking you for things that sound unreasonable, you should consult a qualified North Carolina lawyer to make sure your interests are protected. These principles apply to home insurance, automobile insurance, renters insurance, disability insurance, life insurance, health insurance, and most other types of insurance policies.

How do I make an insurance claim?

When you suffer a loss that you believe may be covered by insurance, it is important to notify your insurance company immediately. For example, if you are hurt and begin missing work, making a claim right away with your disability insurer can be important for benefits to be paid promptly. Sometimes there are waiting periods that apply before benefits can be paid. If you wait, you may miss out on benefits that you would otherwise receive.

Your insurance policy itself will say how to make a claim. Claims can usually be made by mail, by telephone, and online. If you do not have a copy of your insurance policy but you know the identity of your insurance company, try looking on their website for instructions. You may be asked to provide information about your loss and documents to support it, such as an accident report, repair bills, or medical records.

What is the process my insurance company will follow?

Upon receiving notice of your claim, your insurance company will investigate whether the claim is covered by the policy and what if any benefits need to be paid to you as a result. The investigation may involve an independent insurance adjuster coming to your property, it may involve a medical exam by a physician chosen by the insurance company (if, for example, you are making a disability claim), or it may simply involve collection of documents from you and others such as medical records, repair invoices, and photographs. Once the investigation is over, the insurance company will inform you of the results, whether or not your claim is covered, and what if anything will be paid to you. There is no set time period for an insurance investigation and decision in North Carolina. How long it takes depends on the type of policy, the type of loss, and a host of other circumstances. That is part of the reason why it is so important to begin the process right away when you have a loss that could be covered.

What are my rights in the process?

North Carolina law requires that an insurance company act openly and honestly with policyholders during the claim process. Certain specific acts by insurance companies are compulsory or are prohibited under North Carolina law. For instance, an insurance company must acknowledge and act upon communications regarding claims reasonably promptly. An insurance company must admit or deny coverage of claims within a reasonable time after the policyholder gives proof of loss. An insurance company must settle claims promptly after liability has become reasonably clear, and they must not attempt to settle a claim for less than what a reasonable man would believe was appropriate. If a claim is denied, or a claim is partially paid as a result of a compromise settlement, the insurance company must also promptly provide a reasonable explanation for the denial or the offer of compromise. Finally, once a decision has been made to pay a claim, the payment must be mailed or delivered within ten days.

How can I protect my rights?

North Carolina law uses terms like “reasonable” and “promptly” when describing what an insurance company needs to do, which generally means their conduct in the claims process is at least partly dependent on yours. If you give immediate notice to your insurance company of your claim and the facts to support it, if are responsive to their requests for more information, and if you do not delay in getting documents together or scheduling required inspections, it will keep the pressure on your insurance company to be equally reasonable and responsive. You are also entitled to consult and rely on your own lawyer at any time in the process. You should consult a lawyer right away if your claim is extremely significant for you, or if your insurance company is asking for things like interviews or medical exams that are compromising and could affect your rights if mishandled. Finally, and this may be obvious, if your insurance company is rude to you, seems to be ignoring you, or has withheld or denied benefits without explanation then you may have an even more serious problem that calls for a lawyer’s attention.

Regardless of the type of insurance and your experience with insurance claims, a qualified lawyer is worth consulting when your claim is significant or your insurance company seems to be giving you the runaround. Insurance companies are held to high standards of trustworthiness and customer service under North Carolina law. It is important to know your rights, and take the proper steps to make sure they are protected.

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