The process for filing a claim
Amit told Ananya to keep her evening free for a meeting with the insurance agent. “But why, I thought we’d catch the Thursday premier of that new feature film today!”
“Hey, that can wait for the weekend, that’s our time together my dear, that’s why I decided to call him on a weekday…but see, we’ve just recently taken our policies and we need to know, both of us, how to operate it when or if the need arises. Yes, I know you think that’s morbid, but let’s be practical.”
Anaya wanted to know what operate the policies meant. He said, “Oh it’s about the claims process. Let’s see what he has to say.”
In the evening, Jatin the agent put them at ease saying, “This is an important process to know about, not that anything untoward should happen soon, God forbid, but it’s better to be prepared!”
Well, the Claims Process usually has some predictable steps.
|Filing a Life Insurance Claim|
Claim settlement is one of the key services that an insurance company provides to its customers.
Insurance companies are obligated to settle claims promptly.
The process is as follows:
You will need to fill a claim form and contact the financial advisor or insurance agent from whom you bought your policy and submit all relevant documents. Most claims are settled by issuing a cheque within 7 days from the time the documents are received. In case there is a problem with any part of your claim, you will be notified in writing.
Types of claims
|Let’s take the case of a Term Life Policy:|
|Maturity Claim – On the date of maturity, life insured is required to send maturity claim /|
Discharge form and original policy well before maturity date to enable timely settlement. Most companies offer/issue post dated cheques and/ or make payment through ECS credit on the maturity date.
Death Claim (including rider claim) – In case of a death claim or rider claim, the following procedure should be followed.
Follow these four simple steps to file a claim:
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| ||The claimant must submit the written intimation as soon as possible to enable the insurance company to initiate the claim processing. The claim intimation should consist of basic information such as policy number, name of the insured, date of death, cause of death, place of death, name of the claimant.|
The claimant can also get a claim intimation/notification form from the nearest local branch office of the insurance company or their insurance advisor/agent. Many insurance companies today, provide a downloadable form on their website.
|2.||Documents required for claim processing|
| ||The claimant will be required to provide a claimant’s statement, original policy document, death certificate, police FIR and post mortem exam report (for accidental death), certificate and records from the treating doctor/hospital (for death due to illness) and advance discharge form for claim processing. Based on the sum at risk, the cause of death and policy duration, insurance companies may also request some additional documents.||
|3.||Submission of required documents for claim processing|
| ||For faster claim processing, it is crucial that the claimant submits complete documentation as early as possible. A life insurer will not be able to take a decision until all the requirements are complete. Once all relevant documents, records and forms have been submitted, the life insurer can take a decision about the claim.|
|4.||Settlement of claim|
| ||As per the regulation 8 of the IRDA (Policy holder’s Interest) Regulations, 2002, the insurer is required to settle a claim within 30 days of receipt of all documents including any clarification sought by the insurer. However, the insurance company can set a practice of settling the claim even earlier. If the claim requires further investigation, the insurer has to complete its procedures within six months from receiving the written intimation of claim.|
|In case a situation for a claim arises, you should:|| || || |
| ||Contact the respective life insurance branch office|
| ||Contact your insurance advisor|
| ||Call the respective Customer Helpline.|| || || |
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|Claim requirements|| || || |
| ||For Death Claim:|
| ||Death Certificate|
| ||Original Policy Document|
| ||Claim Forms issued by the insurer along with supporting documents|
| ||For Accidental Disability / Critical Illness Claim:|
| ||Copies of Medical Records, Test Reports, Discharge Summary, Admission Records of hospitals and Laboratories|
| ||Original Policy Document|
| ||Claim Forms along with supporting documents|
| ||For Maturity Claims:|
| ||Original Policy Bond|
| ||Maturity Claim Form|
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| ||Incase of delay in settlement kindly refer to the relevant grievance redressal forum.|
In case of Motor Accident Insurance Claims:
Before you file a claim, you must notify people who may be responsible for the accident that you’ve been hurt and intend to file a claim for your injuries. This increases your chances
of getting a quick settlement and prevents others from later saying that your claim unfairly surprised them.
Next, after you’ve taken time to thoroughly investigate your claim by gathering evidence, establishing who was responsible for the accident, working out what you believe your claim is worth, and planning good arguments, you need to write a formal demand letter and submit it to the insurance company of the person who you believe is responsible for your injuries.
(This may include your own insurance company – for example, if you are covered by a no-fault automobile policy or need to make a claim for uninsured or underinsured motorist coverage.)
After this, you will engage in informal negotiations with the insurance company until you agree on a settlement you are comfortable with.
Many insurance claims are that simple, though sometimes you may find yourself dealing with a stubborn or unreasonable claims adjuster. If that’s the case, you must resort to more determined negotiation tactics – or perhaps consult an experienced personal injury lawyer.
“That said”, concluded Amit, “Thank you, Jatin, for an educative evening, well spent!”