Insurance Claims Handling Process

The Insurance Claims Handling Process

Insurance coverage is something that nearly everyone has to purchase to provide financial protection from catastrophes. When you actually experience a catastrophe, the process of getting money from your insurance company can be confusing. Filing a claim and then going through the process requires a certain amount of patience and knowledge on your part.

Filing the Claim

o    Every insurance company is a little different when it comes to how it handles claims that are filed. Some insurance companies have a call center that you have to get in touch with to file a claim. Other companies would prefer that you call your insurance agent to get the process started. Regardless of who you have to talk to, you will have to provide information about the property that is damaged as well as what type of loss occurred. You have to be as detailed as possible during this process.

Small Claims

o    If you have a small claim, the adjuster could have the authority to settle almost immediately. For example, if you file a homeowners insurance claim for damage to your flooring, the adjuster will come out from the insurance company and take a look at it. If the damage is only a few hundred dollars, the adjuster might offer to simply give you a check. You can take the check and use it any way that you please at that point. While this is the quickest way to resolve the issue, you might get less money than you are entitled.

Large Claims

o    If you have a large claim, the process will typically take a little bit longer. The insurance company will send the adjuster to look at the damage and it might also want to get some professional opinions on how much it will cost to repair. For example, if you have damage to your car, you may have to get estimates from several mechanics to give to the insurance company. Some insurance companies also employ experts that can look at the damage to a house and determine how much it would cost to fix.

Time Frame

o    Once your claim is initiated, it could take some time to resolve. Adjusters like to get claims resolved quickly because they reflect positively on them. At the same time, they have to go through the appropriate processes to make sure that you are taken care of fairly. If you do not like the settlement that you are offered, you can hold off on accepting it. If you prolong the process and dispute the amount of the settlement, you may be able to negotiate a higher amount.

INSURANCE CLAIM NOTIFICATION

An Insurance Claim Notification contains information about a loss or injury that is necessary for an insurance company to create a First Notice of Loss (FNOL) or First Report of Injury (FROI) claim notification. A claimant is a person who asks for a reimbursement for any damage done to life or property. A claim is when damage is informed and refund is requested. A claim could be of many kinds:

1. Car insurance claim
2. Health insurance claim
3. Life insurance claim
4. Claim against theft
5. Claim against fire
6. Accidental claim
7. Compensatory claim
8. Deposit refund claim
9. Retrenchment reimbursement claim

But a claim can be requested only when there has been a prior understanding between the claimant and the company who is expected to clear the claim. A Claim Letter is a tool informing a company of the partial or full damage done and requesting a decent reimbursement against it. It however may either be written by the claimant informing about the loss or the company giving the reimbursement informing the claimant of the reimbursement that is on its way may also write it.

DOS AND DON’T’S OF CLAIM LETTER

·         A Claim Letter should be written by the claimant as soon as the damage is done

·         It should be written by the company as soon as the reimbursement is being sent

·         The letter must bear the date on the top left corner indicating details of its origin

·         It should be brief and to the point

·         Only the details of the policy and reimbursement requested/agreed should be dealt with in the letter

·         A Claim Letter should always have a reference number against which the claim is being requested/agreed so that it becomes easy to track its past record

·         The letter should always be only addressed to the person with the full name and address who is being given the claim or to the company with its full address who is being requested for the reimbursement against the claim

·         A Claim Letter should give all details about the policy against which the claim is being made. For example, the claim reference number, date when the policy was taken, terms of the policy, how much reimbursement is due, what is the timeframe within which the reimbursement will come through

·         A Claim Letter has to always be accompanied by documents supporting the damage or loss, for example the police report, death certificate, etc 

Claim process

Filling a life insurance claim

Claim settlement is one of the most important services that an insurance company can provide to its customers. Insurance companies have an obligation to settle claims promptly. You will need to fill a claim form and contact the financial advisor from whom you bought your policy. Submit all relevant documents such as original death certificate and policy bond to your insurer to support your claim. Most claims are settled by issuing a cheque within 7 days from the time they receive the documents. However, if your insurer is unable to deal with all or any part of your claim, you will be notified in writing.

Types of claims Maturity Claim - On the date of maturity life insured is required to send maturity claim / discharge form and original policy bond 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. Incase of delay in settlement kindly refer to grivence redressal Death Claim (including rider claim) - In case of death claim or rider claim the following procedure should be followed. Follow these four simple steps to file a claim: 1. Claim intimation/notification 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. Alternatively, some insurance companies also provide the facility of downloading the form from 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, 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 essential 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 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.

Claim intimation

In case a claim arises you should:

Contact the respective life insurance branch office. Contact your insurance advisor Call the respective Customer Helpline

Claim requirements

For Death Claim: Death Certificate Original Policy Bond 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 Bond Claim Forms along with supporting documents For Maturity Claims: Original Policy Bond Maturity Claim Form In case of delay in settlement kindly refer to grievance redressal