What Is a Claim? – Simple and Easy Explanation

A clear, friendly guide to understanding what an insurance claim is and how it works when you experience a covered loss.

A claim is a request you make to your insurance company asking for payment after you experience a loss that your policy covers.

What Is a Claim?

A claim is simply a formal request from you — the insured — to your insurance company, asking them to pay for a loss covered under your policy. When something unexpected happens, like a car accident, a house fire, or a medical emergency, you file a claim so the insurer can review the situation and provide the financial protection you pay for through your premiums.

If the loss fits the terms of your policy, the insurance company sends payment, repairs the damage, or reimburses you, depending on the type of insurance you have.

How Does a Claim Work?

Filing a claim usually follows a simple process:

1. A covered loss occurs
   Something happens that your policy protects you against — a stolen phone, a broken windshield, flood damage, or a health treatment.

2. You notify your insurance company
   This can be done online, using an app, over the phone, or through your agent.

3. You provide details and evidence
   The insurer may ask for photos, receipts, a police report, or other documents to understand what happened.

4. The insurer reviews the claim
   A claims adjuster examines the situation to decide if the loss is covered and how much the company should pay.

5. Payment or repair is issued
   If approved, the insurer sends compensation, arranges repairs, or pays the service provider directly.

A claim is essentially the bridge between your insurance policy and the protection it promises.

When Should You File a Claim?

Not every situation requires a claim, but you should always consider filing one if:

• The damage or loss is significant

• Someone is injured

• The cost is much higher than your deductible

• You’re unsure whether it’s covered (you can ask your insurer)

For smaller issues — like a minor scratch on your car — some people choose to pay out of pocket to avoid possible rate increases. But for big issues, filing a claim is exactly why insurance exists.

Common Examples of Claims

Claims happen in everyday life more often than people realize. Here are a few simple examples:

Auto Insurance Claim

You’re in a car accident, and your bumper is damaged. You file a claim, share photos of the damage, and the insurer pays for repairs after your deductible.

Homeowners Insurance Claim

A strong storm causes roof damage. You contact your insurer, and they send an adjuster to inspect it. If approved, they pay to fix the roof.

Health Insurance Claim

You visit a doctor. The clinic often files the claim for you, and the insurance company pays its portion of the bill.

Life Insurance Claim

A beneficiary submits a claim when a policyholder passes away so the insurer can release the death benefit.

These examples show how claims help protect you financially in many different areas of life.

What Happens If a Claim Is Denied?

Sometimes the insurer may deny a claim if:

• The loss isn’t covered

• The policy has expired

• The deductible is higher than the cost

• There’s missing information

• The cause of loss falls under an exclusion

If this happens, you can usually appeal the decision, submit more documents, or clarify what happened.

Tips for Filing a Smooth Claim

To make your claim process easier:

• Report the loss as soon as possible

• Take photos or videos to document everything

• Keep receipts or estimates

• Be honest and detailed when describing the incident

• Ask questions if you’re unsure about coverage

The more information you provide, the faster your insurer can help you.

Final Thoughts

A claim is the way you activate your insurance protection when something unexpected happens. It’s your request for financial help after a covered loss, and it’s the core reason insurance exists in the first place. Understanding how claims work can make tough moments feel less stressful — and help you get the support you need quickly and confidently.

Want to explore something else? Here’s another article you might enjoy:

• What Are Claims Adjustment Expenses? – Simple and Easy Explanation