Introduction
When you choose an insurance policy, you might start paying your premiums carefully. It can be for life insurance, medical insurance, or for fire insurance as applicable. Here, as you keep paying your premium subscriptions, you have your policy account on an activated mode. The insurance claim process begins when you face a contingency that aligns with the policy terms you initially selected, allowing you to file a claim based on the coverage you’ve chosen.
On this note, let us discover the main stages that entail the insurance claim process:
Insurance Claim Process- Steps Explained
These are the main stages that are involved in the insurance claim process:
- 1. Contact Your Insurance Company
This is the first and foremost step you have while getting into the claim submission process. You must contact your insurer as soon as possible. You must contact your insurance service provider at the earliest and inform them as to what type of claim are you looking for. Is this for a life insurance claim, a health reimbursement claim, or for a fire accidental claim? The details must be prescribed to your insurance company at length. You must prepare a report or invoice and that depends on whether the loss is of a life or that of property.
- 2. Keeping The Time Frame Intact
The next important consideration is for you to keep up the time frame. For a cashless hospitalization, you must initiate the claim process at least within 24-48 hours from the time the patient has been admitted inside the hospital premises.
Similarly, for a reimbursement claim, you must contact your insurance company and submit the relent forms at least within 10-15 days from the event of contingency.
For every insurance rider or benefit, there would be a deadline timeframe that is given for you to initiate and complete your claim process and you must initiate the process within the given time frame. When you delay the claim submission process, then your reimbursements or claim refunds get delayed even further.
- 3. Attach Documents Along With Duly Filled Claim Forms
You must attach the relevant documents along with the insurance claim form. For instance, if you are applying for a life insurance claim on behalf of a demised primary holder, then you must provide the person’s death certificate and other related medical statements that conform to the person’s death.
For a medical insurance claim, you must attach hospital bills and daycare bills that testify to the fact that you were admitted for a critical illness at the hospital and the claim amount must be in lieu of the coverage amount that you are most likely eligible for.
Likewise, for every type of claim form, you must attach relevant proofs or documents that testify to the nature of the contingency for which you have applied the claim.
- 4. A Surveyor Evaluates The Scene
In case of an accidental policy or a motor insurance policy, a general surveyor inspects the scene of the crime. And, this surveyor is representing the insurance service provider.
The surveyor evaluates the scene of the accident and then further evaluates if the damages as mentioned on the claim documents match the intensity of the accident that has been incurred here.
For a life insurance or medical claim, the insurance company starts processing the claim request within 24-48 hours of having received the claim forms and related documents.
- 5. Acceptance Of Your Claim
The insurance company would then look into whether the claim forms have been filled in compliance with the policy document’s terms and conditions or not. The claims are then processed accordingly.
For a cashless hospitalization claim, the insurance payment or the health coverage money will be processed according to the claim form and the amount will get settled with the concerned healthcare service provider.
In case of a reimbursement claim like fire damages or accidental damages, the claim amount would get processed and credited as a bank settlement within 10-15 days from the time of you having submitted your claim forms to the insurance service provider as such.
In case of a life insurance claim, a cheque or a demand draft is sent to the nominee’s name that was nominated by the primary policyholder and this is done in the event of death of the primary or principal policyholder.
- 6. Rejection Of Claims
The claim forms can also get rejected by insurance firms if the policy norms have not been covered accurately. Therefore, the policyholder is required to fill out the claim forms precisely. No overwriting is allowed while the claim forms are being duly filled in.
At the same time, the claim forms can also get rejected if the policyholder submits inaccurate information with respect to his age, date of birth, or residential address details, as such. Therefore, correct details must be provided by the policyholder when the claim forms are submitted to the insurance companies.
Claim forms can also get rejected if policyholders resort to misappropriation in terms of filing fudged documents as proofs that get attested to the claim forms. Therefore, as a policyholder, you must furnish the correct set of documents or proofs that go along with the claim forms if you want refunds or claim amounts to be initiated sooner.
Suggested Reads- How to cancel insurance renewal
What Are The Steps You Must Follow For A Third-Party Claim-
These are the series of steps you must follow to initiate a third-party claim. Helping you through with a run-down into the same:
- 1. Exchange Of Details Between Drivers
When you meet with an accidental collision, there are two parties involved here. The first person is yourself under whose name the vehicle is registered. The other vehicle that collides with yours becomes the third-party owner.
Therefore, in case of an accidental collision, two parties are involved. Here, you must exchange insurance documents between the two of you. The insurance contains details about both of your car registration numbers and policy coverage info.
- 2. Gathering Evidence And Details
You must gather the necessary information from third-party evidence. This way, you testify to the insurance firm that a car accident has happened at that particular scene. Photos or infographic evidence must be submitted by both parties to the motor insurance contractor.
- 3. Contacting Your Insurance Company
Once you have gathered the requisite proof concerning the accident that happened between your car and a third-party car, you must contact the insurer and begin the insurance claim process. You must fill the claim forms correctly and diligently by providing the other driver’s car details and further elaborate on the scene of the accident if you had a feeling that the other driver was at fault concerning the accident that had occurred at the scene. you can contact your insurance company via phone or write an email to them.
- 4. Investigation Of The Accident
The surveyor from your insurance company then inspects the scene of the accident and further determines who the prima face is. If it is found that the other driver was at fault, then your motor insurance company would file for claim damages against the other driver’s insurance company.
- 5. Process Of Claim In Your Favor
Finally, once it has thoroughly been proved that you were right in your claim, then the claim gets processed in your favor. Your insurer will cover damages concerning repairs of the vehicle that got impacted due to the collision involved.
Suggested Reads: How to file an insurance claim in five steps
The Bottom Line
Most insurance companies follow hassle-free procedures helping policyholders receive their claim amounts correctly. However, to initiate the claim process, the policyholders must fill out claim forms and attach requisite documents correctly so that you can get your claim request processed as soon as possible.
Policyholders can get in touch with the customer care departments of insurance companies by sending emails to them or by dialing the hotline numbers provided on the policy disclosure agreements.
Frequently Asked Questions or FAQs
- 1. How does the insurer company process your claims?
Answer: a. The insured gets a professional understanding of what the claim item is about. The referenced loss amount must be clearly stated on the claim forms by you as the policyholder to ensure a timely receipt of your claim amount.
b.. The relevant documents along with the claim form are scrutinized by the insurance company.
c. The insurance team checks if the coverage amount matches the cover as stated on the policy documents.
d. Above all, the claim form and attached proofs are verified before the claims are accepted and processed accordingly.
2. Do you get a full refund or a partial refund of the claim amount?
Answer: The policyholder gets a refund to the extent of the policy coverage as stated on his/her insurance documents.
3. Why does the insurance company reject a claim?
Answer: The insurance firm rejects the claim if the service provider feels the claim amount is inflated to stage the event to get maximum coverage. The insurance company also rejects claims wherein incorrect details have been provided by the policyholder or if fudged or misappropriated proofs are attested along with the claim form.
