First-party claim
A first-party claim is a request for payment you make directly to your own insurer under your own policy after a loss, such as a collision claim on your auto policy, a fire claim on your homeowners policy or a PIP claim after a car injury. The insurer applies the policy's coverage, exclusions, limits, conditions and deductible.
Also called: first party
A first-party claim means you are asking your own insurance company to pay you under coverage you bought. You report the loss, the insurer checks whether the event is covered, and it pays the covered amount after your deductible, up to the limit. Your declarations page and the coverage section that applies tell you the most it can pay and how much stays with you.
How a first-party claim is paid, with real limits
A covered homeowners loss of $5,000 on a policy with a $1,000 deductible pays $4,000; the deductible is your share before the insurer pays, according to the NAIC consumer guide to home insurance (opens in a new tab).
Auto injury claims in New York show a statutory limit at work. New York sets basic economic loss for no-fault first-party benefits at $50,000 under N.Y. Insurance Law § 5102 (opens in a new tab). Take an illustrative $8,000 in medical bills and lost wages after a covered accident, with no deductible:
Hover or tap a row to highlight it.
| Item | Amount |
|---|---|
| Covered medical and wage loss | $8,000 |
| Deductible in this example | $0 |
| Insurer pays | $8,000 |
| Left for the injured person on those expenses | $0 |
| First-party benefit amount still available ($50,000 minus $8,000) | $42,000 |
The $8,000 loss and the zero deductible are illustrative. The payment still depends on proof, eligibility, exclusions and the fee rules that apply.
Coverage choices that change a first-party payout
Most first-party claims run through a handful of coverages, and each has its own limit, deductible or valuation rule:
- Collision and comprehensive: collision pays for crash damage to your vehicle; comprehensive covers specified non-collision damage such as theft, fire, flood, vandalism and animal impact. California's standard example uses a $500 collision deductible and a $250 comprehensive deductible, according to the California Department of Insurance (opens in a new tab).
- Medical payments, PIP and uninsured or underinsured motorist coverage: these pay for injuries regardless of fault or caused by a driver without enough insurance. Our guide on whether personal injury protection is worth it covers that choice.
- Home and contents limits: typical homeowners limits are 50% of the dwelling limit for personal property, 10% for other structures and 20% for loss of use, according to the NAIC home insurance guide (opens in a new tab), though a policy can use different percentages.
- Deductibles: flat-dollar deductibles such as $500 or $1,000 are common, and hurricane deductibles commonly range from 1% to 15% of the home's insured value, according to the NAIC (opens in a new tab).
Valuation also changes the number. Replacement cost pays to repair or replace with like kind and quality without subtracting depreciation, subject to policy conditions, while actual cash value subtracts depreciation.
Where you meet the term
First-party claims happen under auto, homeowners, condo, renters, life, health, pet and business policies, including commercial property, business interruption and inland marine insurance. The phrase rarely appears on a declarations page; you are more likely to see it in a claim letter, a no-fault form, a public adjuster agreement or a regulator's explanation.
The details that decide the claim sit in the declarations page, the insuring agreement, the exclusions, the conditions and any endorsements. Our guide on how to file a car insurance claim walks through the steps for an auto loss.
The opposite is a third-party claim, made by someone else against your liability coverage. One accident can produce both: a first-party collision claim for your car and a third-party claim from the other driver. You can often use your own coverage even when someone else caused the accident, and your insurer may later seek recovery from the responsible party through subrogation, according to the California Department of Insurance (opens in a new tab).
Claim rules in Connecticut and New York
In Connecticut, unfair claim settlement practices, when frequent enough to show a general business practice, include refusing to pay without a reasonable investigation, failing to affirm or deny coverage within a reasonable time after proof of loss, and failing to explain a denial, under Conn. Gen. Stat. § 38a-816 (opens in a new tab). For a first-party auto claimant, the same section bars a cash settlement lower than what the insurer would pay for repairs, unless you agree or the policy allows it.
In New York, eligible covered persons must receive first-party no-fault benefits under N.Y. Insurance Law § 5103 (opens in a new tab). Written no-fault notice generally must go in as soon as reasonably practicable and no later than 30 calendar days after the accident, and for collision and comprehensive claims the insurer generally must inspect an available vehicle and make a good-faith offer within six business days of notice, according to New York DFS guidance on filing under your own policy (opens in a new tab).
Questions to ask an agent or insurer
- Which exact coverage would pay this claim, and where is it in my policy? "First-party" describes who you are claiming against; the coverage section decides whether the loss is insured.
- What are the limit, the deductible and any percentage or catastrophe deductible for that coverage? Together they set the most you can receive and your share of the loss.
- Will the claim be settled at actual cash value or replacement cost, and what must I do before withheld depreciation is paid? The valuation method can change the payment a great deal.
- What notice deadline, proof-of-loss documents and cooperation duties apply? Policy conditions and state rules can set deadlines.
- Could this claim affect my renewal premium, eligibility or claim-free discount? Claims history can affect pricing, depending on state law and the insurer's rating rules.
Frequently asked questions
Short answers for people deciding whether and how to claim.
What is the difference between a first-party and a third-party claim?
A first-party claim is made under the claimant's own policy. A third party is someone other than the policyholder or insurer who suffered a loss and may collect because of the policyholder's negligent acts, according to the California Department of Insurance (opens in a new tab).
Does a first-party claim guarantee payment?
No. It begins the coverage review. Payment depends on whether the event and loss are covered and whether the limits, deductible, exclusions, conditions and documentation requirements are met.
Is every claim I report to my insurer a first-party claim?
Not always. You might report an accident to your own insurer while the payment you are after comes from another driver's liability coverage, or while your insurer handles a claim against you. The coverage involved and who is claiming decide which type it is.
What are New York first-party benefits?
They are no-fault payments for a covered person's basic economic loss from a motor vehicle injury, set at $50,000 under N.Y. Insurance Law § 5102 (opens in a new tab), subject to the statute and policy terms.