An insurance claim is a formal request to an insurance company asking for a payment based on the terms of the insurance policy. The insurance company reviews the claim for its validity and then pays out to the insured or requesting party (on behalf of the insured) once approved.
The non-life insurance industry is witnessing shifting trends across policy administration, and claims—the two core functions in insurance.
The claims process is the defining moment in a non-life insurance customer relationship. To retain and grow market share and improve customer acquisition and retention rates, insurers are focused on enhancing customers’ claims experience.
In a highly competitive insurance market, differentiation through new and more effective claims management practices is one of the most important and effective ways to maintain market share and profitability.
In particular, insurers can transform the claims processing by leveraging modern claims systems that are integrated with robust business intelligence, document and content management systems. This will enhance claims processing efficiency and effectiveness. It can benefit the insurers both operationally and strategically by enabling them to reduce claims costs to improve their combined ratio, improve claims processing efficiency, and drive customer retention and acquisition.
Today in any insurance office the claim process is built on
Normal claim process followed by General Insurers
How to Make a Claim under Motor insurance
A claim under a motor insurance policy could be
Third Party Claim
In a third party claim, where insured vehicle is involved, it is important to ensure that the accident is reported immediately to the police as well as to the insurance company. On the other hand, insured is a victim, that is, if somebody else’s vehicle was involved, he must obtain the insurance details of that vehicle and make intimation to the insurer of that vehicle.
Own Damage Claim
In the event of an own damage claim, that is, where insured vehicle is damaged due to an accident, insured must immediately inform insurance company and police, wherever required, to enable them to depute a surveyor to assess the loss.Insured must not attempt to move the vehicle from the accident spot without the permission of police and insurer.
If P H own vehicle is stolen, he must inform the police and the insurance company immediately. In addition you must keep the transport department also informed. As soon P H receives the policy document, he must read about the procedures and documentation requirements for claims.
If P H has to make a claim, he must ensure that he collects all the required documents and submit them along with the requisite claim form duly filled in, to the insurance company. There may be certain specific documentation requirements for specific types of claims. For instance in respect of a theft claim, there is a special requirement that P H should surrender the vehicle keys to the insurance company.
Property insurance claim
There could be several types of policies that cover property and the property itself could be stationery - like a building, or moving around - like your household goods being transported.
P h on receipt of policy document must familiarize himself with the documents required for a claim as well as the procedures to be followed.
Whether or not a claim arises P H must follow the various dos and don’ts in respect of his property for the duration of the policy. These dos and don’ts are termed warranties and conditions in the policy document. In general, losses and damages, including those due to theft, fire and flood need be intimated to the relevant authorities such as the police, the fire brigade and so on. It is important to ensure that P H must intimate insurance company to enable it to send a surveyor for surveying and assessing the loss.
Travel insurance claim
Travel insurance policy is generally a package policy that includes different types of covers like hospitalization, personal accident, loss/ damage to baggage, loss of passport and so on.
The procedure and documents required for a claim would vary from cover to cover.
For ease of procedure and convenience, insurers normally attach the claim form with the policy document. This will contain the list of documents required in case of a claim and also the contact details including phone numbers of the claims administrator either in the destination country to which you are traveling or in another country that is designated to receive and process your claim intimation.
Formalities for a health insurance claim
P H can make a claim under a Health insurance policy in two ways:
On a Cashless basis: For a claim on cashless basis, treatment must be only at a network hospital of the Third Party Administrator (TPA) who is servicing your policy. P h must seek authorization for availing the treatment on a cashless basis as per procedures laid down and in the prescribed form. He must read the policy document as soon as he receives it, to understand claim process and not read it at the time claim arises.
Claims on reimbursement basis: P H must read the clause relating to claims in policy document as soon as he receives it to ensure that he understands the procedure and the documents required for making a claim on reimbursement basis. When a claim arises he should inform the insurance company as per procedures required. After hospitalization, he has to ensure that he obtains and keep ready documents such as claim form, discharge summary, prescriptions and bills that he should submit for a claim.
Every insurer in their website clearly provide all relevant information relating to
This information are also included as part of policy document in every sales brochure or communication.