Know About Insurance Claim

Updated: 01-10-2019 12:05:43 PM

Insurance claim is the official request for compensation from the insurance policyholder to the insurance company. The policyholder requests the insurance company for the payment when the event for which the policy has been availed takes place. The policyholder has to fill up the claim form and submit the documents to support the claim.

Types  of Insurance Claim

• Life Insurance Claim: Claim by the nominee when the life insurance policyholder dies.
• Health Insurance Claim: Claim to meet hospitalization expenses by the health insurance policyholder.
• Motor Insurance Claim: On accident to the vehicle, claim by the owner to meet the expenses of the repair of the vehicle. This includes third party insurance claim as well.
• Commercial Insurance Claim: Claim by industries and businessmen to cover various needs related to business.
• Home Insurance Claim: Claim against accidents like fire, lightning, windstorm, fire, smoke, burglary, accidental damage, etc.
• Travel Insurance Claim: Claim against medical expenses, loss of luggage, loss of travel documents, flight accident and personal accidents.

How is Insurance Claim Processed?

Once the insurance company receives the claim from the policyholder, it is under obligation to initiate the process to validate the claim within the stipulated time-frame. Once the facts regarding the claim are validated, the value of the loss is determined if applicable, and payment is made to the policyholder or the nominee, as the case may be. Generally, the claim is processed by matching terms and conditions of the insurance policy with the claim.

If the claim amount is higher than the sum insured, the payment is limited up to sum insured. If the claim amount is less than the sum insured, the actual claim amount is payable subject to other terms mentioned in the policy and factual details. Depending upon the amount and gravity of the claim, the insurance company has the right to carry out the inspection and further examination or to ask more documents to process the claim.

How Should You Make Insurance Claim?

The timely presentation of the documents and following of actions by the policyholder can expedite the claim process. The claim with the right approach and paperwork helps to simplify the process from the insurance company, thereby, making the payment a faster process. The common steps to make your claim are mentioned below:

Step 1: Informing the company on priority

The first and foremost step to make a claim is to inform your insurance company about the happening of the unfortunate event as soon as possible. Usually, informing your insurance agent is good enough, and it is expected that he will carry forward further processes to help you. However, in addition to informing the agent, you should also directly call the helpline number of the insurance company and get your case registered. The company executive registers the case with primary information against your insurance policy and gives you a reference number. This reference number is important for any future communications.

Step 2: Compilation of the documents

Make sure to compile the documents carefully for your insurance claim. Although your insurance agent will help you with the list of documents and claim application form, aforementioned are the documents that are required in the process of insurance claim.

• In case of life insurance claim: Death certificate from the competent medical doctor, original policy documents and ID proof of the beneficiary.
• In case of health insurance claim: Test reports from the laboratory, doctors’ prescriptions and medical bills including laboratory invoices are necessary. Most health insurances cover the expenses incurred during hospitalization and one month before and after the hospitalization. You can arrange all the documents in chronological order for easy verification.
• In case of motor accident claim: Keep a photograph of the accident site with you, if possible. You can attempt to take photographs with the number plate of your vehicle visible. Moreover, for the documents regarding repair expenses, registration details of the vehicle and driving license are also required along with claim application form.
• For insurances like fire insurance: The claim process and documentation are a little bit complicated and depend on the situation and nature of the loss. The company may also ask you for the proof of valuation of lost assets. The surveyor’s report is the most important document in case of the claim under your fire insurance policy.

Note: For every kind of insurance claim, it is mandatory to submit the canceled cheque of your bank account, mentioning your name, your account number, and bank address. This process helps the insurance company to deposit the payment directly into your bank account.

Step 3: Submission of documents

Once the set of documents are ready, you should submit the same to the insurance company and take the proof of receipt of your application form.

Moreover, make sure to keep a  photocopy of all the documents that you have submitted to the insurance company. In case of any query at a later date, you may want to refer to the documents.

When you submit the claim application form along with supporting documents, kindly consider knowing tentative date of payment from the insurance company so that you can follow-up at the right time in case you do not hear from the insurance company within the stipulated time-frame.

Which Claims You Should Not Make?

Any claim that is fraudulent in nature, is taken by the insurance company seriously. The company may cancel your policy and may not review your policy next year. In case of serious misrepresentation, the company can file the police case as it is considered a breach of trust. Once it is proved that your claim was false and intended only to make money, it is highly possible that insurance company report the same to the other insurance companies as well, so you may not get the insurance from any other company.

Moreover, you can avoid making indeed “small” claims. The reasons are simple: The insurance company is bound to pay for every legitimate claim, big or small. However, you may lose No Claim Bonus (NCB) when you renew the claim next year because you’ve already used it for for a petty cover this year. Similar is the case with the health insurance. Minor one-day hospitalization could be borne by you to make your case eligible for a “No Claim Bonus”.

FAQs

1. Can my claim get rejected?

Yes, if you don’t have relevant evidence to support your claim OR your paperwork is not in place. Otherwise, there is no reason for your claim to be rejected.

2. How can I file my insurance claim?

When you are sure that you have a legitimate claim,  you can contact the insurance provider and submit the necessary documents and proof,  along with the details of your policy. This process is generally not lengthy.

3. How much time does it take for the claim to get approved?

Usually your claim is likely to get approved immediately or within a few days, if your documents are in order.