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Insurance claims Process

Insurance claims Process

Insurance policies promise compensation for the financial loss that you suffer in case of emergencies which are covered under the policy. You buy an insurance policy for this promise and so when the covered contingency occurs, you expect the insurer to fulfil its promise and settle your claims.

What is an insurance claim?

Claim in an insurance policy is when you make a demand on the insurance company for payment of the policy benefits. A claim occurs when the event, which the policy covers, happens and such happening causes a financial loss. If the claim is covered under the insurance policy, the insurer pays the benefits promised under the plan and covers your financial loss.

When it comes to insurance claims, you are supposed to follow a specific process to get your claim settled. This insurance claim process is different for different types of insurance policies. So, let’s understand the insurance claim process for some of the most popular types of insurance plans –

Insurance claims under motor insurance policies –

Motor insurance policies can be car insurance plans or bike insurance plans. The insurance claim process for both car insurance and bike insurance is the same. Let’s understand what the process is –

Under motor insurance policies, there are two types of claims – third party liability claims or own damage claims. The insurance claim process for both these instances is different. Here’s what is the process under each instance involves –

  1. Third party claims:Third party liability claims occur when any other individual is hurt or killed by your vehicle or if any third party property is damaged. The insurance claim process for third party claims is as follows –
    • You should inform the insurance company immediately of the claim
    • File an FIR with the local police authority
    • The claim would be taken to the motor accidents tribunal which would pass a ruling on the financial liability that you face
    • Depending on the ruling of the tribunal, the insurance company would settle the claim
  2. Own damage claimsOwn damage insurance claim means when your car or bike itself suffers damage. Own damage claims can, further, be subdivided into two types – damages suffered by the vehicle or theft of the vehicle. Here’s the insurance claim process for each –
    • Damages suffered by the car or bike:
      1. Inform the insurance company immediately of the damage
      2. The company would then provide you the details of the nearest preferred garage where you can take your vehicle
      3. Once your vehicle is in the garage, the company’s surveyor would visit and assess the damages. After assessing the damages the claim report would be prepared
      4. Depending on the claim report submitted by the surveyor, the insurance company approves the repairs
      5. Once the repairs are approved, the vehicle is repaired. The company pays the repair costs directly to the garage and the claim is settled on a cashless basis
      6. If, however, you get your car repaired at a non-networked garage, you would have to bear the repair costs and the insurance company would then reimburse the costs to you when you submit all the bills
    • Theft of the car or bike:
      1. If your vehicle is stolen, you should immediately inform the insurance company of the theft
      2. A police FIR is also mandatory
      3. Once the FIR is filed, the police try and locate your vehicle. If they fail, they would issue a non-traceable report to you
      4. You would have to submit this report to the insurance company along with the claim form
      5. The insurance company would then pay you the Insured Declared Value (IDV) of your insurance policy and the claim would be settled

Documents required for vehicle insurance claims

In case of vehicle insurance claims, the following documents would have to be submitted –

  1. The RC book of the vehicle
  2. Driving license
  3. PUC certificate
  4. Claim form which should be duly filled and signed
  5. Police FIR, wherever necessary
  6. Identity proof of the policyholder
  7. Any other documents as required by the insurance company

Insurance claims under health insurance policies

The insurance claim process under health insurance policies is as follows –

  1. To avail a cashless claim you should seek treatment at a hospital which is tied-up with the insurance company. In a cashless claim, the insurer settles your hospital bills directly with the hospital and you don’t have to shoulder the financial burden
  2. You have to get the pre-authorization form, fill it and submit it to get cashless claim settlements. The form is available at the hospital. You should submit the form within 24 hours of emergency hospitalisation and 3-4 days before planned hospitalisation.
  3. The insurance company assesses the pre-authorization claim form and approves cashless claims
  4. The hospital bills are, then, paid by the insurance company directly
  5. After you are discharged, you should fill up a claim form and submit it with the discharge summary and all the medical documents
  6. If you take treatments at a non-networked hospital, you have to bear the medical expenses yourself. You can then submit the claim form and all the medical bills and reports and the insurance company would reimburse you for the expenses incurred

Documents required for health insurance claims

For getting a settlement of your health insurance claim, the following documents would be required:

  1. Claim form which should be completely filled and submitted
  2. Discharge summary from the hospital
  3. Police FIR (in case of accidental claims)
  4. All medical bills and receipts
  5. All medical documents and investigative reports
  6. Identity proof of the insured

How are health insurance claims handled?

Health insurance claims can be handled by either TPAs or the insurance company’s in-house claim settlement team. Let’s understand the difference –

  1. TPAsTPAs mean Third Party Administrators. TPAs are specific companies which help facilitate a health insurance claim between you and the company. You make a claim to the TPA which would assess your claim and then forward it to the insurance company. The insurance company would then reject or settle your insurance claim. TPAs are, therefore, middlemen in the insurance claim process.
  2. In-house claim departmentIn case of in-house claim department, the insurance company does not engage the services of a TPA. Instead, the company creates a dedicated claim handling department itself. You can, therefore, directly report your insurance claim to the insurance company through its in-house claim settlement department. The department would then assess your claim and make a decision on it.
  3. Which is better: TPA or in-house Health Insurance Claim?In-house claim settlement departments are better as your claims get settled within a shorter period of time compared to TPAs. The company might also offer you value-added benefits for your claims through its claim settlement department. In case of TPAs, they are tasked only to act as middlemen. They cannot accept or reject your claim. So, if a large number of claims get piled with TPAs, your insurance claim process would become too long and time-consuming. That is why try and buy a health insurance policy from a company which has an in-house claim settlement department.

Insurance claims under life insurance policies

Under life insurance plans, insurance claims are categorised under the following two heads –

  1. Maturity claimsThis is when the term of the plan comes to an end and you are alive to collect the plan benefits.
    • Insurance claims process for maturity claims:
      1. Maturity claims are initiated by the insurance company itself as the policy approached maturity
      2. You have to submit a maturity discharge form and the policy bond to receive the claim
      3. Once the documents are submitted, the claim would be credited to your bank account
    • Documents required for maturity claims:
      1. Maturity claim form
      2. Policy bond
      3. Your identity proof
      4. Your bank account details for receiving the maturity proceeds
  • Death claimsIn case of death during the policy tenure, death claims occur. Death claims are collected by the nominee whom you appoint in your insurance policy.
    • Insurance claim process for death claims:
      1. The nominee has to inform the insurance company about the death of the insured
      2. A claim form should be filled and submitted and you would also have to submit various relevant documents
      3. The company would verify the claim and the documents submitted
      4. Once verified, the company would pay the claim directly to the nominee’s bank account
    • Documents required for death claims:
      1. Claim form, filled and signed by the nominee
      2. Identity proof of the nominee
      3. Original Policy bond
      4. Death certificate
      5. Police FIR (in case of accidental death)
      6. Medical reports (if available)
      7. Coroner’s report, punchnama, post mortem report, etc. (in case of accidental deaths)

So, these are the insurance claim processes of some of the most popular insurance plans. understand the claim process so that if you face an insurance claim you would know exactly how to get your claims settled and the documents required for the same. Alternatively, you can also contact Turtlemint’s team for your insurance claim settlements. Turtlemint has a dedicated claims handling department which gets your claims settled for you. Turtlemint’s claim department handles the insurance claim process making it convenient for you. Just intimate the claim by calling Turtlemint’s helpline at 1800 266 0101 or by sending an email to claims@turtlemint.com . Then you can relax and Turtlemint would ensure that your claims are settled at the earliest.

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