Claims

What is an Insurance Claim?

An insurance claim is a formal request by a policyholder to an insurance company for coverage or compensation for a covered loss or policy event. The insurance company validates the claim and, once approved, issues payment to the insured or an approved interested party on behalf of the insured. Insurance claims cover everything from death benefits on life insurance policies to routine and comprehensive medical exams. In many cases, third-parties file claims on behalf of the insured person, but usually, only the person(s) listed on the policy is entitled to claim payments.

Car Insurance Claim Process - A Step By Step Guide For Claims --

Motor insurance is compulsory in India. It is one of the most purchased insurance products. This is because a growing percentage of the Indian population is buying their own vehicles these days. As a result, motor insurance claims have also gone up. But many a time, the policyholders do not know exactly what they can do to get their car insurance claim. If you too want to know about the procedures, take a look at the claims processes explained below.

Car insurance claim for damages to your own car

First and foremost, as the policyholder, you will have to submit a duly filled in claim form along with the requisite documents to the insurance company and inform the insurance company before you send the car to the garage for any repairs. The forms are available on the insurers’ websites as well as at their offices.

The insurance company will send a surveyor to assess the damages. The surveyor will prepare a report and pass it on to the insurer and you will also receive a copy.

If the damage is severe and requires immediate attention, then the surveyor will reach the spot of the accident at the earliest.

Based on the surveyor’s report, you can arrange for your car to be repaired..

After the work is completed, you will have to take the duly signed bills and documents from the garage and submit them to surveyor, who in turn will send it to the insurance company.

If all the documents are in place, the insurance provider will reimburse your bills. Remember that the insurance company will not reimburse your bills if you do not submit them immediately after your car is released from the garage. So you cannot keep the small bills and hope to submit them at the end of the year.

How Does Health Insurance Claim Process Work?

Your insurance provider offers either a Reimbursement Process or a Cashless Claim Process. But how do you approach these processes if you are not aware of how do they work? Read on to understand the nuances of the claims.

Cashless Claim Process

Cashless, as the name recommends, frees you from the pain of handling cash in bulk. So how do you pay the bills? As an insurance provider, you become liable to provide your insurance details to the hospital in order to avail their facilities. It could be with the help of physical proof or even an e-card which is issued during the mediclaim policy purchase. Based on these proofs only, the hospital accepts your request to treat you and process the claims accordingly. However, the illness for which you have been admitted requires that that disease is covered under your insurance plan. After you are discharged from the hospital, it is the responsibility of the hospital to forward all the bills to the insurance provider.

As soon as these bills are received by the hospital, the bills are scrutinized thoroughly by the respective departments to understand the nature of the expense, and settle the payment such that all dues are cleared. This process is known as a cashless settlement where payment instruction flows between the hospital and the insurance provider. As an insurance holder, you do not have to keep track of the bills physically or stress about how to pay the medical bills. But as an insured citizen, how do you go about the claim anyway? Well, there are a couple of methods which can be kept in mind when you face such a dilemma.

Claim Through Reimbursement Process

This one is a little tricky for the insured since the process demands that they have to claim it from the service provider after they have been discharged.in simple words, it means that you pay your bills initially and apply for reimbursement later to get the entire amount back. In such cases, it is not mandatory that the hospital you seek treatment from, be a network hospital. Walk into any hospital that can treat your ailments and keep the bills of payment safe. However, you cannot make use of cashless claim process in this case because it stands null and void.

Provide original bills from the treatment, each one of them, to the insurance company. No insurance company will support or accept your claim without the original bills. Most of the bills are analyzed and verified before it is cleared. Often third-party authorizing vendors are hired to ensure that there are no false claims associated. False claims can refer to fraud bills, manipulated documents, etc. If the claim falters or is found to be incorrect at any stage of verification, the claim is rejected then and there. Therefore, it is recommended that you keep the bills intact such that they are legible and do not fail authorization at any step.

After the claim is verified and found legitimate, the claim is processed easily without any hassles, and the payment is made to the registered bank account of the insured. However, if the payment is rejected due to any condition, the insured is notified of the same through customer advising methods. It could be via email, post or even a call from the claim-processing department.

It is only natural that one might question that if medical bills are enough documentation to claim reimbursement from the healthcare provider. Of course, you need a certain set of documentation in place to make the process a success. Any missing document can put your claim progress on hold. Now you do not want to run pillar to post just because you do not know what document it is! So, we have a consolidated list which you can follow during the claim process. Even it differs across organizations; you can always have a follow-up conversation with the agent you purchased your mediclaim policy from to give you a manual which contains all the details.

The most important documents which are also mandatory are as follows:

A duly filled and signed claim form. This is the document which can be downloaded online or obtained from the insurance office.

Investigation report

All original bills, receipts, memo, etc. Any bill missing will account for your loss.

A medical certificate, your case file and other documentation which should be signed by your doctor. It is more like an attested copy of your illness track record while in the hospital.

Cash memo for medicines that have been purchased from an external pharmacy.

Discharge card, summary report and all clearance documents.

If it was a medical emergency such as an accident or a casualty, an FIR should be deposited. If the FIR is unavailable, a Medico-Legal Certificate should be mandatorily provided.

After all, documents are duly verified and processed; the claim is deemed to be completed. The final step is crediting the entire claim amount to the insurer's account which is declared at the time you buy health insurance.

Usually, third-party administrators are responsible for verifying your documents and claims. As incentives are higher to limit claims, they take stringent steps to cancel or reject any claim that comes their way. This is in line with the instructions given by the insurance providers themselves.