A claim is a demand by an insured to recover damages under an insurance policy. A claim is not the same thing as a loss. The insured or a third party makes a claim and the insurance company’s adjuster determines if the claim is valid and the amount of the claim. Once the insurance company agrees the claim is valid, it becomes a loss.For example, a person may claim that he or she was bitten by the neighbor’s dog and request reimbursement for medical expenses related to the bite from the neighbor’s homeowners insurance company. After investigation it is found that this is not the case. Thus, a claim was made, but there was no loss. (See Loss).
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UK: A demand by the insured for an indemnity or benefit under the policy. The claim will be met, subject to any limits, if the loss event is caused by an insured peril and is not excluded.
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REINSURANCE: A demand made by an insurer on its reinsurer(s) to be paid under a reinsurance contract. A claim is payable under an insurance or reinsurance contract if it is caused by an insured peril and it is not excluded under the terms of that contract.
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A request for disbursement of the benefits promised in the contract.
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US: A request for payment of a loss which may come under the terms of an insurance contract.
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Depending on the context this term may refer to (01) A demand by the insured for payment under his Policy. Claim covers loss caused by perils insured against. The insured is entitled to lodge the claim and recover the loss from Insurance Company. Claim is a demand for payment under an Insurance contract or bond. (02) Estimated or actual amount demanded. (03) A demand made by a third party on a policyholder to be compensated for some injury, damage or loss for which the third party blames the policyholder. In this case, claims are referred to the insurer to handle on behalf of the insured in accordance with the term of the Policy. (04) A demand made by an insurer on its reinsurer(s) to be paid under a reinsurance contract. A claim is payable under an insurance or reinsurance contract if it is caused by an insured peril and it is not excluded under the terms of that contract.
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Depending on the context this term may refer to: (a) a demand made by a policyholder on his insurer(s) for payment or some other contractual benefit under an insurance policy; (b) a demand made by an insurer on its reinsurer(s) to be paid under a reinsurance contract; or (c) a demand made by a third party on a policyholder to be compensated for some injury, damage or loss for which the third party blames the policyholder. A claim is payable under an insurance or reinsurance contract if it is caused by an insured peril and it is not excluded under the terms of that contract.
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MEDICAL,USA: Formal request for payment (bill) sent to an insurance carrier or fiscal intermediary for a private insurance program, managed care plan, or a government program for medical services rendered to insureds or beneficiaries; also called insurance claim.
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UK: invocation of a right to a payment under a contract of insurance; also the amount set aside in the accounts of an insurers respect of payments made or anticipated.
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Notice to an insurer that under the terms of a policy, a loss maybe covered.
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US: Used in reference to insurance, a claim may be a demand by an individual or corporation to recover, under a policy of insurance, for loss that may come within that policy.