Claim
Your formal request for the insurer to pay for a covered loss.
A claim is the request that turns a policy into money. Until one is filed, a policy is only a contract; the claim is what tests it. The process looks broadly similar across auto, home and renters, though the details differ by insurer and by state.
It usually runs in the same order. The loss is reported and given a claim number. An adjuster is assigned and investigates — photos, estimates, a recorded statement, sometimes an inspection. The insurer then makes a coverage decision: does this loss fall inside the policy, and for how much. If it does, payment follows, reduced by the deductible and capped by the limit.
There are two kinds. A first-party claim is made against one's own policy, like a hail-damaged roof or a stolen laptop. A third-party claim is made by someone else against a policyholder's liability coverage, and there the insurer also handles the legal defense. How much a first-party claim pays turns on whether the coverage is written at actual cash value or replacement cost.
Claims leave a record. Auto and property losses are generally reported to the CLUE database, which other insurers can pull when pricing a policy, and entries generally stay on file for about five to seven years. A claim can appear there even when it closed with no payment, and even when nobody was at fault, though a surcharge is usually tied to at-fault losses.
If a claim is denied, most states require the denial to point to the policy language behind the decision. Insurers run internal re-review processes, many property policies contain an appraisal clause for disputes over amount, and every state has an insurance regulator that takes complaints about claim handling.
In real life
A tree limb falls on a parked car during a storm. The driver reports it, gets a claim number, and an adjuster writes an estimate of $4,300. Because it was not a crash, the loss falls under comprehensive, which carries a $500 deductible. The insurer pays the body shop $3,800 and the driver pays $500. The loss shows on the CLUE report as a comprehensive claim.
Common questions
Does filing a claim raise my insurance?
It depends on the claim and the state. At-fault auto accidents and liability losses commonly lead to a surcharge at renewal. Comprehensive claims such as hail or glass are often treated more gently, and several states limit what insurers may surcharge for. Frequency matters too: multiple claims in a short window can affect pricing more than one larger loss.
How long do I have to file an insurance claim?
Policies generally require prompt notice rather than naming a hard deadline, and long delays can complicate a claim because evidence disappears. Separately, most property policies contain a suit limitation clause, often one or two years, capping how long a policyholder has to sue over a disputed claim. Exact wording and state minimums vary.
What happens if my insurance claim is denied?
In most states the insurer must state a reason and cite the policy language behind it. From there, common routes are asking for a written re-review with added documentation, invoking the appraisal clause when the dispute is about the dollar amount rather than coverage, or filing a complaint with the state insurance regulator.
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Definitions describe how these terms are generally used across the U.S. market. Wording, limits and exclusions vary by insurer, policy form and state — the policy you hold is what controls. See the full Insurance Glossary.