When a loss occurs, the policyholder must ask for payment. A claim is the formal request by an insured or beneficiary for benefits under an insurance policy. It initiates the insurer’s investigation, evaluation, and possible settlement process.

Claims may be first-party, seeking recovery for the insured’s own loss, or third-party, seeking defense and indemnity for liability to others. Timely notice, cooperation, and submission of requested documentation are typical policy conditions. Incomplete or late claims can jeopardize coverage.

The insurer assigns an adjuster, verifies coverage, quantifies the loss, and determines the amount payable under the policy terms. Most claims resolve by negotiation; some proceed to appraisal, mediation, or litigation. The quality of claims handling strongly influences customer satisfaction and the insurer’s reputation.

• Formal request for payment under a policy
• May be first-party or third-party
• Triggers investigation and evaluation
• Subject to notice and cooperation duties