Adjudication of Claims

Last Updated: June 28, 2018

Definition - What does Adjudication of Claims mean?

Adjudication of claims is a term used by the insurance industry to describe the process of evaluating a claim for payment of benefits. During an adjudication of claims, the insurer will determine whether a particular demand for compensation falls within the coverage of the individual's insurance policy.

The adjudication of a claim may involve several steps, beginning with the insured's initial filing of a claim and concluding with a determination by the insurer of the amount that will be paid or a denial of the claim.

Adjudication of claims is also called claims adjudication.

WorkplaceTesting explains Adjudication of Claims

An insured individual may seek reimbursement for costs or other amounts from his or her insurance company when an event is covered by the terms of the insured's policy. Common types of claims that may be adjudicated include claims for injuries or medical treatment. Usually, the method of adjudication is included in the terms of the insurance policy. In some instances, state or federal law may influence the adjudication process as well.

During an adjudication process an insured may be asked to submit addition information in support of a claim. Following adjudication a claim may be granted or denied, or denied in part. In some instance, liability for a claim may be divided among several insurers or the insurer and the insured.

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