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Claims Process in Insurance

Handling insurance claims can seem like a daunting task. To be honest, it doesn’t have to be. The claims process in insurance is relatively straightforward and simple if you know what you’re doing. This article will aim to educate you about the claims process in various branches of insurance like life, motor, health, and property.

  1. Life insurance claims process
  2. Health insurance claims process
  3. Motor insurance claims process
  4. Property insurance claims process

1) Claims Process in Life Insurance

There are 2 types of claim processes in life insurance. They are, maturity claims process, and death benefit claims process. A maturity claim is when the policyholder makes a claim after his policy term matures. A death benefit claim is when the policyholder’s nominee makes a claim request after the policyholder passes away. Let us understand both claim processes with simple illustrations.

Maturity Benefit Claims Process

Claim intimation form: The policyholder will need to intimate his insurance company about policy maturity. Once he has intimated his insurance company, he will need to duly fill in his claim intimation form and submit the same to the insurance company. The claim intimation form can generally be accessed through the insurance company’s website. You can also ask your agent to furnish you with the same.

Attaching Required Documents: You will also need to attach a variety of relevant documents with your claim intimation form. Documents required are:

  • Original policy document
  • Photo identification
  • Address proof
  • Cancelled check or copy of your passbook

Discharge voucher: The policyholder may also be required to sign and submit a discharge voucher. A discharge voucher acts as a receipt.

Payment received: If all documents are in order, the insurance company should furnish your maturity amount to you within 15-30 days.

Death Benefit Claims Process

Claim intimation form: It is important to intimate the insurance company promptly after the passing of the policyholder. Once the intimation is done, the insurance company will expect a duly-filled claim form submitted to them in due course. The claim form will ask for details such as the cause of death, date and time of death, place of death, etc. These details need to be accurately punched in without error.

Attaching required documents: You will also need to attach a set of required documents along with the form. Documents required are:

  • Copy of police FIR (if necessary)
  • Hospital Reports
  • Doctor’s certificates
  • Death certificate
  • Original policy document
  • Treatment records
  • Additional documents in case of a police case

You will need to submit these documents along with the claim intimation form to the insurance company. Ensure accuracy of the information for a smooth claim.

Payment received: Once the insurance company receives the above documents, they will send their experts to assess and investigate the situation. If everything is in order, the company will disburse your claim within 30 days. If your claim is not disbursed within that time you can approach the IRDA for relief.

2.) Claims Process in Health Insurance

Health insurance claims are of generally two types, reimbursement claims, and cashless claims.

Reimbursement Claims

A reimbursement claim is when you have to pay the hospital out of your own pocket, and the insurance company will later reimburse you the hospitalization amount after discharge. Let us briefly look at the reimbursement claims process:

Claim intimation: Again, the insurance company needs to be intimated immediately after admission. You can also intimate your insurance agent, he will intimate the company on your behalf.

Document collection: Ensure you have all hospital-related documents and bills collected. They will have to be sent to the insurance company after discharge. Documents you need to collect are:

  • Hospital bills and receipts
  • Pharmacy bills and receipts
  • Doctor’s certifications
  • Medical reports
  • Admission and discharge summary
  • FIR copy (in case of police case)
  • Remember, originals will need to be submitted to the insurance company, so be careful.

Payment: The company will disburse your claim amount within 30 days if all documents are in order.

Cashless Claims

A cashless claim is when the insurance company will directly furnish the required funds to the hospital. You will not be required to pay out of pocket. Let us briefly look at the cashless claims process:

Network hospital: You can only avail cashless facility if you get admitted to an affiliated hospital. Thus, it is important to zero in on an affiliated hospital before admission. This is an important point.

Claim intimation: You will need to intimate your insurance company during admission. Further, you will also need to submit your cashless insurance card to the hospital billing and admission desk. Once you do this, the hospital will correspond with the insurance company and initiate your admission.

Handing of reports and bills: You do not need to worry about handling bills or reports. The hospital will directly send the required documents to the insurance company.

3.) Claims Process in Motor Insurance

Motor insurance has 2 major types of claims, first-party claims, and third-party claims. Let us talk about the processes for both of them.

First-Party Claims Process

A first-party claim is when you make a claim yourself. For instance, you bump your car into a curb and damage the windscreen. You can now make an auto insurance claim with the insurance company. Let us understand its process:

Submission of the claim form: Intimate your insurance company immediately after an accident. Post intimation, submit your duly filled claim form to the company.

Surveyor: Post submission, the insurance company will send a surveyor to assess the vehicle damage. Surveyor will prepare a survey report. You can initiate repairs once you get this report.

Repairs: You can now initiate the repairs for your vehicle. Ensure that you keep your bills and receipts. Post repairs, you can now furnish all repair-related documents, bills, receipts, etc to the company.

Reimbursement: The company will furnish you with the claim amount within 30 days.

Third-Party Claims Process

This is where a third party makes a claim to you, and you pass on that claim demand to the insurance company. These incidents occur when you harm another person or their property. For instance, the policyholder bumps into a person while driving and given the opposite person a fracture. The opposite person can decide to make a claim.

Stay calm: Ensure that you stay calm during an incident. Realize that there is a process to be followed. Being cool in such situations can be beneficial for everyone involved.

Intimate your insurance company: Ensure that you intimate your insurance company about the third-party accident.

Legal notice: Firstly, the person affected can send you a legal notice. When they do, do not respond to them. Ensure that you send a copy of the notice to your insurance company.

Appointment of lawyer: The insurance company will appoint a lawyer in your defense at their expense. It is the job of this lawyer to represent you.

Court-ordered compensation: Upon completion of the trial, the insurance company will pay the victim whatever amount the court deems fit.

Case closed: Upon receiving the compensation, the case will generally be closed.

4.) Claims Process in Property Insurance

Again, there are two primary types of property insurance claims. They are first-party claims, and then there are liabilities claims. Mentioned within are the processes both.

First-Party Claims

These are claims made by the policyholder itself. For instance, a person having home insurance makes an insurance claim against home theft.
The process is as follows:

Claim intimation: Intimate your insurance company after the incident of theft, vandalism, natural disaster, etc. Intimation should be swift.

Police FIR: If it is a police case, you will be required to lodge an FIR with the nearest police station. Keep a copy of the same, you will need to send it to the insurance company.

Evidence collection: Take prompt photos and videos of any evidence to make your claim stronger.

Damage assessment: The insurance company will send their investigators to assess the damages and prepare a report.

Compensation: The company will disburse you the claim amount based on the report. If you are satisfied with the amount, the matter stands closed. If not, then you will need to approach the IRDA.

Liabilities Claims

These are claims made by third parties. For instance, you have a guest at your home and the guest is harmed due to your negligence. The guest can now send you a legal notice demanding compensation. Your property insurance company will also handle these types of claims. The process is as follows:

Stay calm: Staying calm in such situations is very important. You don’t want to make a bad situation worse by reacting incorrectly.

Intimate your insurance company: Firstly, ensure that you assist any affected person. Get them the medical help that they need. Post this, inform your insurance company about the accident.

Legal notice: There is a chance that the affected person can file charges against you. If that happens, send any legal notice that they send you, to your insurance company. Do not correspond directly, let the insurance company handle it.

Appointment of lawyer: If the matter goes to court, the insurance company will appoint a lawyer on your behalf.

Court-ordered compensation: It is the job of the insurance company to make good of any court-ordered compensation towards the affected party.

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