Claim Process of General Insurance: Get the facts right!

Getting an insurance claim processed can be a tricky task. However, if you go about the job in a systematic manner, you will get the claim in no time. You just have to be aware of the various processes, the document requirements and the other steps needed to apply for a claim. In this article we speak about the claim processes of the various types of general insurance. Take a look.

Health insurance claim process

Let us start with the claim process of a health insurance plan. There are mainly two types of claims possible in a health plan – cashless and reimbursement.

If you opt for the cashless facility, the insurance provider will directly pay the hospital on your behalf. You have to get admitted to a network hospital for this. Network hospitals are nothing but the empanelled hospitals with the insurance company. If you opt for the reimbursement option, you will have to pay the bill and the insurer will compensate you later.

For cashless transactions you must:

  • Inform the insurance provider a few days prior to getting admitted in the hospital. This is possible for planned treatments.
  • Inform the hospital about the presence of your cashless health plan. You have to present your TPA card or any other identification card issued by the insurance company at the hospital billing desk.
  • Inform the insurance provider once you get hospitalized. . The insurer will communicate with the hospital and collect all the relevant documents such as your medical reports, doctors’ certificates, discharge summary, etc and process the claim accordingly.
  • For a medical emergency, first get admitted to a network hospital. Then inform the insurance provider at the earliest about it. This will help quicken the cashless process.

For reimbursement:

  • In case of reimbursement claim, you can get hospitalized in any hospital, even the one outside the network list.
  • Make the payment to the hospital once you get discharged from the hospital
  • Carefully collect all the documents and submit them to the insurance provider. The documents needed are:
    • Claim form
    • Medical certificate, signed by the consulting doctor
    • Discharge summary
    • Doctors’ consultation reports
    • Original copies of all medical bills
    • Cash memo from the hospital and pharmacy
    • Police investigation report, if any
    • Legal certificates (only for accidents)
  • After verification, the insurance company will reimburse the amount to your bank account.
  • In case your insurance company needs any further clarification regarding the documents, it will be duly notified to you
  • In case your claim gets rejected, the same would be informed to you along with the denial reasons

Claim process for motor insurance

Next, we come to the claim procedure for a motor insurance plan. Here too, you have the cashless and the reimbursement options.

For cashless claims you must take your car to a network garage. The garage will evaluate the damage and repair your vehicle and send the bill to the insurer. There are certain exclusions in a car insurance plan (like damage to the mirrors, etc). The insurer will evaluate the bills and pay the garage the required amount. If there is a balance arsing due to a policy exclusion, you have to pay it yourself.

For the reimbursement process, you simply have to pay the dues yourself. Thereafter, you have to collect the bills and the memos and submit them to your insurance provider, along with the claim form. If satisfied, the insurer will compensate you for it, after deducting the exclusions.

Claim process for travel insurance

There are different components in a travel cover. You have to deal with each aspect differently.

If there is a medical emergency, inform your insurance provider right away. Most insurers provide you with a local number that you can call on when travelling overseas. After you inform, collect all the documents carefully. You will need the medical certificates, discharge summary, police record (if applicable) and the original bills and receipts. Once you return to India, submit the documents along with the claim form to get a quick reimbursement.

For a change in itinerary or a loss of baggage, get a written application from the airline or the hotel as soon as it happens. Once back from your trip, submit the documents and your claim will be processed.

If your trip is affected due to a criminal activity, file a police report within 24 hours at the local police station. You will need to submit the report to your insurer once you are back in India.

In a nutshell

It is a misconception that insurance claims are not settled properly. If you have the right documents with you and you follow the correct steps, your general insurance claims will most definitely be settled. Keep the tips mentioned above and your job will become very simple.