Insurance Claim Assistance — We're With You

Insurance Claim Assistance

Filing an insurance claim can be stressful, especially during a medical emergency or after losing a loved one. Understanding the claim process beforehand ensures smoother, faster settlement. This guide covers the claim process for both life and health insurance.

Health Insurance Claim Process

• Cashless claim (preferred) — Get treated at a network hospital. Show health card at admission. Hospital coordinates with insurer. You pay only non-covered items. Process: Pre-authorization form → Treatment → Insurer settles with hospital
• Reimbursement claim — For non-network hospitals. Pay the bill yourself. Submit documents to insurer for reimbursement within 15-30 days. Keep all original bills, prescriptions, and discharge summary
• Documents needed — Claim form, health card, ID proof, hospital bills (original), discharge summary, doctor prescriptions, diagnostic reports, FIR (for accident cases)
• Timeline — Cashless: pre-authorized within 2-4 hours. Reimbursement: settled within 15-30 days of document submission

Life Insurance Claim Process

• Notify the insurer — Inform the insurance company as soon as possible. Most companies have a dedicated claims helpline
• Submit claim form — Nominee fills the claim form (available on insurer website or branch)
• Documents needed — Death certificate, policy document, claimant ID proof, nominee ID proof, FIR (if accidental death), hospital records (if death during treatment), employer certificate (if applicable)
• Investigation — For policies less than 3 years old, the insurer may investigate. Claims after 3 years cannot be contested (except fraud)
• Settlement — Insurance companies must settle claims within 30 days of receiving all documents. If investigation is needed, 90 days maximum

Tips for Smooth Claims

• Keep policy documents accessible — Store physical and digital copies. Inform nominees about policy details
• Update nominee details — After marriage, children, or other life changes, update nominations immediately
• Disclose all health conditions — Non-disclosure can lead to claim rejection. Always be truthful during policy purchase
• Report hospitalization within 24-48 hours — Delayed intimation can lead to claim rejection or delays
• Keep all medical records — Bills, prescriptions, diagnostic reports, discharge summary. Keep originals for reimbursement
• If claim is rejected — Appeal to the insurer. If unsatisfied, approach the Insurance Ombudsman (free service). Last resort: Consumer Court