Claim
Claim is a formal request for payment, service, defence, or another policy benefit after an insured event or covered circumstance occurs.
The term becomes important after an incident, when the insured, broker, insurer, adjuster, and sometimes lawyers need to agree what happened, what is covered, what evidence is needed, and how payment should be calculated. For example, after a warehouse fire, the insured may notify the broker, protect damaged property, gather invoices, meet the loss adjuster, and submit evidence of repair costs and business interruption loss. A practical way to read it is to ask: what proof is needed, which policy period applies, which limits or deductibles reduce payment, and who has authority to settle. Timely notification and accurate evidence are important because late reporting, incomplete documents, or uncertainty about cause can delay settlement. . In practice, two policies can use similar wording but produce different outcomes because limits, exclusions, definitions, endorsements, and local law change the final interpretation. When in doubt, the safest approach is to compare the term with the exact contract wording and ask the broker, adviser, insurer, or administrator to confirm how it applies to the specific situation.
How to read it in your program
Where “Claim” shows up at VIMA
Pages that explain how this works inside a live employee benefits programme.
Related terms
Terms that often appear alongside “Claim” in a policy schedule.