Marcia Hultman

Cabinet Secretary

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Division of Insurance - Claims Process


Making the Claims Process Easier

 

What Consumers Should Know When Faced with Making a Claim

Filing an insurance claim can be one of the most frustrating processes, especially during a crisis or following a major disaster. A delay in the claims process is the number one complaint of insurance consumers throughout the country.

Insurance companies are required to respond to all claim communications within 30 days. Although most claims are paid within 30 days, this does not obligate the companies to pay the claim within that period of time. If you have filed a claim and have not heard from the insurance company, you may want to contact them to verify they received your claim.

It is critical to provide all necessary information to your insurance company when making a claim. To help you avoid common pitfalls that could delay getting your claim paid, the Division of Insurance offers these tips:

Read Your Policy

  • Read your policy thoroughly. The policy is a contract between you and your insurance company.
  • Be acquainted with what is covered, what's excluded, and what the deductibles are in your policy.

File Claims as Soon as Possible

  • Do not wait for file your claim.
  • Do not let bills or receipts pile up.
  • Call your agent or your company's claims hotline as soon as possible.
  • Your policy might require that you complete notification to your insurance company within a certain time frame, and not filing in a timely manner could cause your claim to be denied.

Provide Complete, Correct Information

  • Be certain to give your insurance company all the information they need. Incorrect or incomplete information can cause a delay in processing your claim and possibly lead to the claim not being paid in full.

Keep Records

  • Keep copies and records of all correspondence and related documents between you and your insurance companies.
  • Write down information about your telephone and in-person contacts, including the date, name and title of the person you spoke with and what was said. Keep a record of your time and expenses.

Ask Questions

  • If you are unclear what is covered or what a particular provision in your policy means, ask.
  • If there is a disagreement about the claim settlement, ask the company for the specific language in the policy that is in question. Determine if the disagreement is because you and your insurance company interpret your policy differently.
  • If this disagreement results in claim denial, make sure you obtain a written letter explaining the reason for the denial and the specific policy language under which the claim is being denied.

Don't Rush into a Settlement

  • If the offer made by an insurance company does not meet your expectations, you do not have to accept it. Further discussions may result in a more equitable settlement or a better understanding of the basis for the company's offer.
  • If you have any questions regarding the fairness of your settlement, seek professional advice or contact the South Dakota Division of Insurance.

Auto and Homeowners Claims

  • Auto and homeowners policies might require you to make temporary repairs to protect your property from further damage. Your policy in most cases should cover the cost of these temporary repairs; keep all receipts documenting any temporary repairs. If repairs do not allow for the adjuster to see the damage, you could have difficulties getting your claim paid.
  • Maintain any damaged personal property for the adjuster to inspect. Take photographs or video when possible of the damage before making temporary repairs.

Other Tips for Filing Auto or Homeowners Claims:

  • Don't make permanent repairs before you have contacted your insurance company. An insurance company may deny a claim if you make permanent repairs before the damage is inspected.
  • If possible, determine what it will cost to repair your property before you meet with the claims adjuster.
  • Provide the claims adjuster with records of any improvements you made to your property, if applicable.
  • You may wish to ask the claims adjuster for an itemized explanation of the claim settlement offer.

Tips for Filing Accident and Health Claims

  • If you suspect a provider is overcharging or question the provider billing, you can ask the health provider for a detailed explanation or ask the insurance company to audit the bill to verify whether the provider properly billed.

Contact Your State Insurance Regulatory Agency

If you have a dispute with your insurer about the amount or terms of the claim settlement, you may contact the South Dakota Division of Insurance for assistance.

 

Contact the Division of Insurance