[보험공부] 보험금은 무엇인가?

오늘은 구글에 Insurance claim을 검색해보았다. 아래 사이트를 처음 봤는데 유용한 정보가 많은 것 같다.
아무튼 오늘은 보험금이 산정되는 방법과 손해가 났을 경우 보험회사가 손해사정사를 통하여 보험금을 판단하는것과, 보장의 간단한 종류를 알수 있었다.

https://www.squareone.ca/

Home Insurance Policies From $12/Month | Square One

What is an insurance claim?

Definition: A formal request by the holder of an insurance policy to have their insurance provider indemnify them following a loss.

When the holder of an insurance policy experiences a sudden and unexpected event that costs them money, it’s called a loss. Following a loss, the policyholder can ask their insurance company to pay them for what they’ve lost. This request is called a claim.

The purpose of insurance is to bring the insured back to the same financial state they were in immediately before a loss. This process is known as indemnification. If the loss is caused by an event that the insurance policy covers, the insurer will indemnify the insured; they’ll pay for the covered value of the loss, no more and no less (as long as it’s within the insurance policy’s limits).

How does an insurance claim work?

When you suffer a loss, you want your insurance company to pay for it. However, coverage is always limited to what the insurance policy states. Insurance companies are responsible for protecting thousands of customers; they can’t pay for excluded losses out of kindness. Insurers craft their coverage to protect as many people as possible, without covering so much that that they would go out of business, or need to charge unaffordable premiums.

When someone like Wade makes a claim, the insurance company will assign an adjuster. Adjusters handle individual claims on behalf of the insurer.

Check out our full explanation of insurance adjusters right here.

-보상은 보험 약관이 명시된 것에 한정되어있다. 위 예시처럼 Wade가 클레임 청구를 했을 때, 보험회사는 손해사정사를 배당한다. 그렇게 손해사정사는 보험회사를 대신해서 개인 클레임을 담당하게 되는 것이다. 손해사정사란, 손해사정사는 보험사고에 따른 손해액 및 보험금의 사정에 관한 업무를 업으로 하는 자이다.

위 예시를 보면, Nicole은 집에 대한 손해는 보상해주지만, 그의 가구나 기타 물건에 대한 손해는 보상받지 못한다. 그 이유는 넓은 보험을 들지 않았기 때문이다. (개인이 주거하고 있는 집에 대한 Home Insurance는 세가지가 있다. basic form, broad form, comprehensive form이다. basic form은 특정 재난 'fire, lightning, explosion, smoke'만 커버한다. broad와 comprehensive는 특정 예외 항목을 제외한 모든 risk를 보장하는데 broad의 경우 예외 항목이 comprehensive보다 많다.)

Following a significant loss, like damage from a storm or a fire, determining coverage isn’t always straightforward. Using Wade as an example: he wants his insurance company to cover everything that was damaged. The policy he chose, however, states that only his dwelling (the house and things attached to it) is protected from hail; the moveable contents of his home are not.

Wade claimed everything that the storm damaged. His adjuster adjusted that claim to include only what was covered by his policy: his damaged siding and windows. With that settled, the insurance company pays to repair the damage to Wade’s home. He is unfortunately stuck paying for the damaged furniture himself.

 

There are other aspects of a claim that the adjuster is responsible for determining as well. Insurers use different methods to determine what something is worth, depending on the type of policy that was purchased. One of these methods is the replacement cost basis. Replacement cost coverage means that the insurer will pay whatever it costs to replace that item with a similar new item.

 

There’s also the actual cash value basis, wherein the insurer pays whatever the item was worth at the time of the loss, factoring in its age and condition. You’ll find these payment bases within every insurance policy. The adjuster has to determine which applies to each claim.

 

보장의 형태에는 두가지가 있다. Actual Cash Value 와 Replacement Cost Coverage 가 있다. 전자는 가지고 있는 물건을 중고값으로 팔았을 때 받을 수 있는 가격을 의미하고, 후자는 같은 물건을 현재 새로 구입할 때 지급해야하는 가격을 말한다. 보장은 Replacement Cost Coverage가 더 좋다.

 

Liability claims are similar, but often much more complex. Rather than paying to replace or repair property, the insurer pays for legal fees and compensatory damages.

 

Compensatory damages are meant to compensate the victim, whereas punitive damages are meant to punish the offender. Home insurance policies don’t cover punitive damages.

 

With liability claims, the insurance company still has to determine what’s covered and for how much, but there’s a legal process that plays out before those things can be known.

 

https://www.squareone.ca/resource-centres/insurance-glossary/claim

What is an Insurance Claim? | How They Work, Process and More | Square One

*단어
indemnify 배상하다
indemnification 보상
straightforward 간단한
compensate 보상하다, 보험금을 주다