The whole purpose of getting an insurance policy is to get the nominee enough of a financial stability in case something happens to the insured. This happens by way of payment of sum assured to the nominee when it is life insurance and to the insured himself if it’s health insurance. To get this payment, one has to follow a detailed claim procedure without which the claims can be rejected and the nominee is denied the benefits for which the insurance plan was bought in the first place.
Here we will help you out with the basic claim procedure, but before that there are certain things to be considered whether it’s a health insurance or a life insurance plan:
When filling the form while buying the insurance cover, ensure that you furnish complete and accurate information. Don’t hide any facts or else the claims can be rejected later on. Complete details about your health, lifestyle, employment and the likes need to be mentioned. Even if your insurance agent is filling it on your behalf, do go through it before submitting it with the insurer. Also, do remember to update your insurer with any changes in your health or other conditions after buying the policy to ensure they have your most recent and up to date information.
2) Policy Details
Once you receive the policy documents, read them carefully to understand every term and condition. While buying the plan, you may only study the major features, but devil lies in detail! Know what is covered in the policy and what is not and under what conditions. This can also help you to know whether you’re getting what was promised at the time of buying the policy. Share the policy details with your nominee so that it comes to their aid at the time of filing claims.
Insurance companies ask for documented proof of death or medical emergency. Hence, it is of utmost importance for you to have a complete record of all necessary documents to be submitted so as to make it easier for your nominees to deal with the insurers.
It is important to intimate the insurance provider immediately at the time of death of the insured or hospitalisation. Any delay in intimating and filing of claims with relevant documents may result in rejection of the claims or delay in settling the claims as the insurers need to verify their authenticity.
5) Active Policy
Ensure that you’re paying your premiums on time and the policy is in active mode. Only then will your claims be entertained or else they will be rejected.
Once you have covered these basics, the next stage is to know process for filing claims.
Claim Process for Life Insurance:
- Inform the insurance company and be ready with the original policy documents for reference.
- Fill up the claim form and sign it duly
- Submit the nominee’s identity proof proving relationship with the insured
- Attach the copy of death certificate issued by relevant authorities
- Nominee’s address proof also needs to be submitted
- Complete medical records of the insured including all medical reports, tests reports, doctor’s prescriptions, discharge summary etc. need to be submitted
- In case of suicide or unnatural death, copy of post-mortem report along with FIR should be attached
Claim Process for Health Insurance
- In case it is cashless hospitalisation in an emergency, you have to contact the concerned TPA at the network hospital immediately at the time of admission in the said hospital.
- If it is planned hospitalisation, contact the insurance provider and TPA at least 7 days before hospitalisation for necessary approvals.
- For regular hospitalisation, fill up the claim form and fill it accurately.
- Attach the original discharge or transfer summary (in case patient is being transferred to another hospital) or death summary if patient has passed away.
- All medical reports along with complete bills and receipts need to be submitted.
- Proof of identity and residence has to be attached.
- In case it is an accidental hospitalisation, copy of FIR will be required
The insurers also want to settle your claims and honour their commitment because that’s how they get more business. But it is entirely up to you to meet their guidelines in terms of documentation and pre-defined timeframes. As per the Insurance Regulatory and Development Authority of India (IRDAI), if everything is in order on the insured’s part, then the insurance company has to settle the claims within 30 days of completion of all requirements. If the case requires further investigation or more documents, the insurer has got a maximum of six months to complete all formalities from the date of written initiation of the claim process. If it fails to do so, then it is liable to pay interest on the claim amount for the period the claim is delayed.
To ensure you receive your rightful dues on time, follow the above mentioned guidelines and safeguard your financial dues.