Certified Professional in Health Care Risk Management (CPHRM) Practice Exam 2025 - Free CPHRM Practice Questions and Study Guide

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What is the definition of a claim in an insurance context?

An informal notification of loss

A formal notification seeking monetary damages

In an insurance context, the term "claim" is defined as a formal notification seeking monetary damages. When an individual or an organization experiences a loss that is covered by an insurance policy, they file a claim to request compensation or coverage for that loss. This formal process typically involves submitting detailed information about the loss to the insurance company, which will then assess the claim to determine if it is valid and to what extent the insurer is liable for payment.

The act of filing a claim is a crucial component of the insurance process, as it initiates the investigation and evaluation by the insurance company. The terminology used emphasizes the official nature of this action, which distinguishes it from informal notifications or requests, thus ensuring that each claim is handled with the formality and thoroughness that is necessary in the insurance industry.

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An appeal for a policy review

A request for a policy adjustment

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