One term that’s regularly misunderstood by insurance customers and lawsuit filers alike is “filing a claim.” Because this term can be used interchangeably in a variety of legal contexts, it can be difficult to know what filing a claim means, how it works, and when you should file one.

Below, we’ll break down what filing a claim means and how you can file a claim for insurance and/or lawsuit purposes. Alternatively, you can call Schwartzapfel Lawyers at 1-516-342-2200 or visit us online to learn more and schedule your free consultation now.

What Is “Filing A Claim”?

Filing a claim involves formally requesting compensation or assistance from an insurance company or a legal entity, such as a court of law. Technically, the act of filing a claim is typically reserved for initiating an insurance-related claim, whereas filing a legal action refers to pursuing the specific action you have in mind (e.g., filing a lawsuit).

However, because the terms are often used interchangeably, their explanations call for a bit more detail.

Filing An Insurance Claim

Filing a claim to an insurance adjuster means making a request for a payment of money based on the terms of an existing insurance policy.

For example, say that you take out an auto insurance policy. Under the terms of the policy, you receive an insurance payout if you enter into a car accident and suffer property damage or medical bills. The auto insurance company doesn’t automatically provide you with money, however.

Instead, the onus is on you as the insurance customer or policy claimant to file a claim. When you do this, you officially ask the insurance company to pay you money in exchange for your monthly premium, which you pay regularly. The insurance company then decides whether or not to accept your insurance claim.

When filing claims, you are required to provide a substantial amount of contact information, not limited to:

  • Your policyholder name
  • Your phone number
  • Your driver’s license number
  • Your Social Security number
  • Any relevant additional information

Once you certify that you have fulfilled all the eligibility requirements, you’ll typically begin receiving benefit payments and/or cash value based on what your insurance information says. Note: the formal request process is roughly the same for homeowners insurance, health insurance claims, and other related claims.

It’s also important to mention that the process is similar to unemployment insurance benefits. To this end, when you file an unemployment claim to access UI benefits, you’ll likely need to supply your personal details as well as speak with an insurance agent.

Filing A Lawsuit Or Legal Action

In a legal sense, filing a claim often means filing a lawsuit or pursuing some other legal action.

For instance, you might be injured in a slip-and-fall accident at a restaurant. You believe the restaurant is responsible for your injuries, so you want to file a personal injury claim against them. This involves filing a lawsuit. You want the restaurant to pay for your medical bills and associated expenses because they were at fault for those damages.

In a legal case, filing a claim means requesting legal action or judgment in some civil or criminal matter. In the above example, filing a claim against the restaurant owner means you petition the courts to force that restaurant owner to pay you money to cover associated expenses.

To learn more now, call Schwartzapfel Lawyers at 1-516-342-2200 or visit us online now!

How Do Insurance Claims Work?

An insurance claim works roughly the same way, no matter which type of insurance policy you hold.

In a nutshell, you pay an insurance company a monthly premium. The monthly premium is usually affordable, although higher premiums correlate to greater insurance coverage. In exchange, if you encounter a high unexpected cost, the insurance company will likely foot the bill for most or all of that cost. Insurance companies make a profit because the risk of major costs and expenses is spread out across all of their customers.

In most cases, your insurance policy will probably also determine how much you have to pay before your provider provides you with any money. This is called the deductible. As an example:

  • You have a car insurance policy that covers you for up to ($50,000) in damages and medical bill costs
  • However, you have a deductible of ($1,000)
  • You are injured in a car accident, and your medical bills are ($25,000)
  • Because of the terms of your insurance coverage, you must pay ($1,000) before your insurance coverage kicks in
  • After you pay $1,000, your insurance company pays the remaining $24,000 in medical bills

In this example and all other similar insurance examples, you must file an insurance claim to get your insurance payout. Do not expect the insurance company to voluntarily give you the money you are “owed.”

Do You Need To File A Claim For Workers’ Compensation?

Even though you are entitled to workers’ compensation payouts if you are injured on the job or in the performance of job-related duties, that doesn’t mean you’ll automatically receive the money as soon as you are injured.

Just like other insurance coverage claims, you must file a claim for workers’ compensation with your employer’s insurance provider and follow the specified claims process. That’s the only way to get the money you are entitled to.

If you have further questions on this topic, please call Schwartzapfel Lawyers at 1-516-342-2200 and speak with one of our workers’ comp attorneys now at no charge. Otherwise, please continue reading.

What Is An Example Of Filing An Insurance Claim?

Virtually everyone will find themselves in a situation where they need to submit an insurance claim at some point. This extends to health insurance, car insurance, workers’ compensation, and beyond. For a deeper analysis, let’s take a look at an example of filing an insurance claim for healthcare payments.

Say that you’re injured in an auto accident and incur a series of expensive medical bills as a result. However, you have health insurance. Under the terms of your health insurance policy, your health insurance provider is on the hook to pay for those medical bills (including both past and future medical bills) once you file a claim.

Therefore, you contact your health insurance provider and ask for a payment. In many cases, medical organizations like hospitals and clinics will do this automatically. Rather than having you file a claim with your insurance provider, they will likely bill your insurance provider directly after you have reached your deductible.

What Is An Example Of Filing A Lawsuit?

Filing a legal claim can be complicated. For instance, suppose you’re injured in a train accident because you weren’t given a seatbelt. Now you wish to file a lawsuit against the train company.

To do that, you’ll file a legal claim of fault against the at-fault party. That will typically involve collecting paperwork, filling out the right forms, and formally serving your employer lawsuit papers, which notes your intent to sue them for compensation. Your employer will usually have a chance to respond to your accusations.

When you file a lawsuit, both you and your employer will likely proceed to present your respective evidence either in a court or at an arbitration session if a swift settlement isn’t reached. During this phase, a judge typically determines any potential awards, if applicable. Alternatively, an amicable resolution might also be achieved within an arbitration meeting.

Do You Need A Lawyer To File a Claim?

You do not legally need a lawyer to file a claim of any type, either to an insurance company or to a court system. However, it’s usually a good idea to hire a skilled lawyer anyway.

Lawyers are trained professionals who know the ins and outs of the claims filing process. They know what to look for, the paperwork you need to complete, and where you should submit paperwork. This is especially important when it comes to filing a legal claim, like a lawsuit or accusation of fault.

When you file an insurance claim, the process is relatively straightforward, and the steps are usually included in your insurance paperwork. You contact your insurance provider, file a claim online or by phone, then wait for a response.

When it comes to filing a legal claim, you typically must:

  • Gather the right paperwork or forms
  • Fill those forms out correctly
  • Send the legal claim forms to the right legal system, like the county clerk’s office, the courts, and beyond

During these initial phases, it’s easy to make mistakes. Still, even one error can slow down your pursuit of justice and may even cause your claim to be flatly rejected by the courts.

As such, you should be sure to contact a seasoned lawyer if you wish to file a legal claim of any type. A skilled lawyer will make sure that your legal claim doesn’t falter before getting off the ground and will work to ensure an optimal outcome for you and your loved ones.

For more information at no charge, call Schwartzapfel Lawyers at 1-516-342-2200 or visit us online to schedule your free consultation and/or case evaluation today!

Contact Schwartzapfel Lawyers Today

Filing a claim is something that many people will eventually have to do, either in insurance or legal contexts — or both. To that end, you should never file a claim without proper legal counsel. And you don’t have to.

At Schwartzapfel Lawyers, our knowledgeable attorneys can help you understand what you need to file a successful insurance or workers’ compensation claim. We can also help you decide whether you have grounds to file a successful lawsuit against the at-fault party in an auto accident or personal injury case.

Call 1-516-342-2200 now or visit us online to schedule your free consultation and/or case evaluation.. It will be our honor and privilege to help you however we can, as best we can, no matter your situation.

But you shouldn’t wait, as your window to file a claim and recover all the money and benefits you deserve may soon close forever. To keep that from happening, have Schwartzapfel Lawyers fight – and win – for you, starting today!

DISCLAIMER: Nothing on this page should be considered legal advice. You should seek the appropriate counsel your situation requires. For more information, call 1-516-342-2200 now!


Schwartzapfel Lawyers, P.C. | Fighting For You™™

Claim | Wex | US Law | LII / Legal Information Institute

Deductible – Glossary |

What is Workers’ Compensation? | Workers’ Compensation Board

Lawsuit | Wex | US Law | LII / Legal Information Institute

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