Your policy will serve as a guide as to what losses may or may not be covered. However, claims are settled on a case-by-case basis.

Although your agent may be able to review your coverage with you, only the claims adjuster or claims department of the insurance company will be able to determine if your situation will be covered.

Because the frequency, severity, and type of claims filed is an important consideration when applying for a new policy or renewing your current policy, you may wish to use the following information to help you decide if you should file a claim.

Sudden and Accidental

Applying the “sudden and accidental” gauge to a loss may help you determine if a loss may be covered under your policy. If your policy provides all perils coverage, all causes of loss except those excluded, a loss that is unpredictable is likely to be covered by your policy.

Maintenance-Related

A loss that is related to a lack of maintenance, or could be predicted, is not likely to be covered by your policy. For example, a tree branch touching your roof may, over time, lead to destruction of shingles, roof damage, and eventually lead to leaks and additional damage to your home. This situation is maintenance-related and may not to be covered by your insurance policy. However, if wind causes a branch from a nearby tree to break and damage your roof, this situation is unpredictable and may be covered by your insurance policy.

Does the cost to repair the damage exceed your deductible?  Get an estimate before filing claims for small damage. If the cost to repair does not exceed your deductible, there is no need to report the claim. If the cost to repair exceeds your deductible by a small amount, you may want to pay for the repairs without filing a claim.

Preserve all evidence of the loss, including the damaged property, so that it can be inspected by your insurance company. Do not throw away damaged property until your adjuster tells you to do so. 

• Keep copies and records of all communication between you and the adjuster.
• Take photographs or video of the damage before things are cleaned up or repaired, to give to the adjuster.
• Prepare a detailed list of destroyed or damaged items to help you settle the claim.

• Wait on making permanent repairs until your insurance company has inspected the property and you have reached an agreement on the cost of repairs.
• If it's safe, make temporary repairs to prevent further damage by covering broken windows, leaking roofs, and damaged walls. Keep your receipts for the adjuster.

• If you cannot stay in your home because of damage, most policies have coverage for additional living expenses while repairs are being made.
• Save all receipts, including hotel stays, reasonable meals, and any necessities that you must buy.

Soon after you report your loss to the insurance company, an adjuster will be sent to inspect your property.

Insist on being present during the inspection, so that you can assure that the adjuster does not overlook any damage.

The adjuster will assess the damage to your home and estimate the costs of repairs. They will also determine whether the damage is covered under the terms of your policy.

You may want to bring your own contractor to inspect the loss and act as your representative during the inspection.

In some instances, your insurer will request a signed, sworn statement called a Proof of Loss. Your company will provide you with a standardized form to use. This will be the basis for determining the value of your claim.

• In most cases, you will be asked to estimate the actual cash value of the household items you have lost and the cost to repair your home.
• You must provide the company with evidence if you have purchased a replacement item.
• Contractors, catalogs, and local stores are good sources of current cost information.
• Find out if you should include sales tax in your cost estimates and whether you should use exact costs or round numbers to the nearest dollar.
• Do not forget to include small items such as kitchen utensils or clothing accessories, as the replacement cost of these items can add up.

Replacement cost payments for small building damage claims will be made whether or not actual repair or replacement is complete.

For large losses, insurance companies will only pay the difference between actual cash value and replacement cost when the property has actually been repaired or replaced.

If, at the time of loss, the amount of insurance purchased does not equal the specified percentage, usually 80%, of the full replacement cost of the building before the loss, the insurance company will pay less than the replacement cost.

The amount the insurance company will pay is the greater of the actual cash value or the replacement cost less a penalty specified in the policy. The policy will never pay more than the stated policy limits.

After the adjuster has reviewed the damage to your property, the adjuster will prepare or obtain an estimate of the cost to repair or replace your home and personal belongings.

If you disagree with the adjuster’s estimate, explain your reasoning in writing to your company. It is possible your company has overlooked something and is willing to make adjustments.

If you continue to disagree with the company’s valuation of your loss, you are entitled to resolution of your dispute through a process called appraisal.

• Post-Disaster Claims Guide