Claiming insurance money

Do you know how to file an insurance claim? We tell you what all you need to do for faster claim settlement.
Teena Jain Kaushal/Money Today        Print Edition: July 2014
Claiming insurance money

Imagine this. You head out of town for a vacation. You have to travel a long distance and are driving at high speed. Suddenly, a bike, waiting to cross the road, cuts from one end to the other. You try to stop, but in vain. The car hits the bike. Boom! There are no injuries on either side. You feel relieved. But your car is damaged badly. The bumper is broken and there are cracks on the ceiling and the windshield. You know you are in trouble.

While you wait for the police to arrive, you wonder silently how to file the insurance claim for the car. Should I go home? Should I first inform the insurer's call centre? Should I stay back in this unfamiliar city till the car is repaired? Insurance, by definition, is complex. You pay for an event you don't want to happen. And when it happens, you find yourself staring at uncertainty. You do not know how to start the claim process. This may cost you a lot. For example, if you meet with another accident while taking the damaged car back, you will not be paid for the subsequent losses.

Similarly, you must know which documents you need while filing a claim as even one missing document can delay the process.

The good news is that insurers too have started focusing on their claim departments like never before. From setting up separate claim divisions to paying interest on late payments, they are ready for anything but bad publicity from a policyholder. They are also bringing in new technology for improving customer experience.

For example, they have started adopting mobile technology in a big way. Among other things, this will enable a policyholder to take pictures of his damaged car from a phone and upload them on the insurer's system for smoother claim settlement.

Apart from keeping bad publicity at bay, smooth claim settlement also helps insurers keep costs down, which these days is a top priority for them in view of fall in sales.

NM Beherais, deputy director (health), IRDA, wrote in the latest IRDA journal, "Statistics show that the outstanding motor third-party claim amount as on 31 March 2013 was around Rs 22,000 crore. Even if 50% of these claims are to be settled in time, the outstanding claims will carry the extra baggage of a minimum of Rs 550 crore towards interest awards every year, even at the lowest simple interest rate of 5%."

Clearly, timely settlement is good for the policyholder as well as the insurer. By walking that extra mile in understanding what it takes to file a claim you can do your bit to speed up the claim process. We tell you what you must do for a smooth and speedy ride.

If you meet with another accident while taking the damaged car back, you will not be paid for the later losses

LOST YOUR DEAR ONE: HOW TO FILE A LIFE INSURANCE CLAIM
The death of a near one can leave the family facing a tough situation. While nothing can assuage the feeling of bereavement, financial security can help the family, to a small extent, cope with the situation. So, don't stop at buying a life policy. Be informed about the policy fine print and tell your family how to claim the insurance money. Here is a step-by-step guide to filing a life insurance claim.

Step 1. Inform the insurer. This can be done by calling up its call centre or walking into the nearest branch. One can also get in touch with the agent the policy was bought from. Keep the policy details handy.

Step 2. The nominee will be required to give a claimant's statement (a form provided by the insurer for giving details about the deceased and the claimant), original policy papers, death certificate and police first information report (FIR) & post-mortem report if the death is due to an accident. For medical-related claims, you will have to arrange for medical reports such as discharge summary and hospital records. The insurer can ask for additional documents based on the cause of death, policy duration and risk cover (See Documents To Be Submitted).

Step 3. The insurer starts the evaluation process. If it feels the need for a further examination, it conducts an external investigation to check the veracity of the claim.

Step 4. The claim is settled after all documents are received.

Step 5. Norms require that insurers settle all claims within 30 days of completion of all requirements. If there is need for a further investigation, according to norms, the insurer should complete the procedure within six months of the written intimation of the claim. If it fails to do so, it has to pay interest on the claim amount for the period the payment is delayed.

There can, however, be some complex situations such as late reporting or death in a foreign country. We discuss a few such situations and how you should deal with them.

You came to know about the policy late and so told the insurer after a time lag:

Law gives you three years to file a claim in the event of death. But late claims may at times take longer to settle as gathering information is a challenge for the insurer in such a case. Hence, one should intimate the insurer as early as possible.

Insurers have started adopting mobile technology in a big way. Among other things, this will enable a policyholder to take pictures of his damaged car from a phone and upload them on the insurer’s system for smoother claim settlement

Vikas Gujral, executive vice president and head, customer service and operations, Max Life Insurance, says, "The procedure does not change for delayed reporting. But insurers do extra due diligence in such cases to ward off possible fraudulent claims."

If the person is missing and you do not have any proof of his death: In case of missing persons, the settlement is governed by Sections 107/108 of the Indian Evidence Act, 1872. Section 107 deals with presumption of continuance and Section 108 deals with presumption of death.

Experts say that as per Section 108, presumption of death can be raised only after seven years from the date the person has been reported missing.

Mayank Bathwal, deputy CEO, Birla Sun Life Insurance, says, "The Indian law prescribes that a missing individual is presumed dead seven years after he/she is reported missing. If the family or claimant does not have adequate proof of death, the nominee can submit as proof of death in lieu of death certificate an 'Order of Presumption of Death' obtained from a competent court of law under Section 114 of the Indian Evidence Act."

He says it is important to pay premiums through the duration of seven years to make sure that the policy does not lapse and is in force when the claim is filed.

If death has taken place in a foreign country: "The requirements are the same as for a regular claim. However, in addition, the insurer will ask for a death certificate attested by the Indian embassy along with the certificate authorising the transport of mortal remains. The nominee may also have to submit a copy of the deceased's complete passport," says Vighnesh Shahane, whole time director and CEO, IDBI Federal Life Insurance.

If you think the deceased had an insurance policy but you cannot find it: "The nominee can write to the life insurance company to this effect and provide an attested copy of the death certificate issued by the municipality/panchayat. The nominee should also submit a claim form along with the indemnity bond," says Shahane.

Tips for speedy settlement Submit the documents in one go. Doublecheck the list of documents required either from your agent or the nearest office of the insurance company.

After having said that, not all claim processes are hassle-free, even after the submission of all the documents.

Complicated situations such as dispute between the claimant and other legal heirs (for example wife and mother) and suicide and murder cases where the police may take time to certify the cause of death may take time for settlement.

MET WITH AN ACCIDENT: HOW TO CLAIM MOTOR INSURANCE MONEY

Not long ago, one had to go to a policy-issuing office for filing motor insurance claims. Not only that. The policyholder was expected to go to the office with salvaged/broken parts so that these could be mentioned in the claim form.

The insured used to get the money within 10-15 days of getting acknowledgement of the broken parts. Today all you need to inform the insurer about the accident is a mobile phone. The claim number is generated instantly, after which you need to follow up with your insurer and surveyor. Here is a detailed guide on what you need to do while filing a motor insurance claim.

Step 1. Register the claim immediately by calling up the insurer's toll free number mentioned in the policy document. You will have to provide the policy number and driving licence details to the call centre executive. You will be given a claim number for future reference.

Step 2. It is advisable to park your vehicle at a safe place to avoid any subsequent damage.

Step 3. Shift your vehicle to a nearby workshop as advised by the insurer's call centre executive.

Step 4. You need to fill the claim form. If the vehicle is taken to an authorised workshop or a dealer that has a tie-up with the insurance company, you can get the form from there. Else, you can download it from the company's website.

Step 5. A surveyor is appointed to inspect the vehicle. You need to be ready with all documents-duly-filled claim form, copy of the registration certificate, or RC, and the driving licence-which you will have to furnish during the inspection.

Step 6. In case of third-party damage or injury, you need to file an FIR

Step 7. Once the inspection is done, the claim is taken care of by the representative of the insurance company who keeps in touch with the insured as well as the workshop for repairs and disbursal of funds.

Step 8. You can track the status of your claim with the help of the claim number. Insurers also send updates through SMSes.

We also discuss some common queries related to auto insurance. When to file FIR?: You should immediately approach the nearest police station in case of theft or accident involving injury to self or a third party.

What if the accident happens out of town?: If you have auto insurance, you're likely to be covered regardless of where the accident occurs or where you get your car repaired. But to prevent further damage to the car it is recommended that you get it repaired before driving it again as consequent losses will not be covered by the motor insurance policy.

What if my car is stolen?

The claim settlement process remains the same, says Vijay Kumar, chief technical officer, motor insurance, Bajaj Allianz General Insurance, except that you need to intimate the police and file an FIR. "You also need to provide documents such as duly-filed claim form, a copy each of RC, driving licence and FIR, besides keys and other original documents of the vehicle to the insurance company." You may have to submit both key sets to prove that the car has not been stolen due to your negligence.

Tips for speedy settlement

-It is advisable to call up your insurer and then take the car to the nearest garage to avoid further damage.

-In case of bodily injury, immediately report it to the nearest police station

-Keep both sets of keys handy. You may need them at the time of making a claim.


Got hospitalised: How to claim health insurance money

Ritu Gupta, 33, was overdue. The doctor advised her to wait for a week before going for a c-section. The family made all the preparations for the big day, except one. It did not take pre-authorisation approval from the TPA. "We came to the hospital with my health card thinking it will be sufficient.

We did not know about preauthorisation approval," she says. The approval came but not without a long wait. Though everything went off smoothly, last-minute procedural hurdles gave the couple stress. "It is good to know the procedures in advance as last-minute hassles can leave you stressed out," she says.

To avoid running from pillar to post, here is a stepby-step guide to filing a health insurance claim.

For planned hospitalisation:

Step 1. Choose a network hospital for treatment and finalise the dates, the treatment plan and tentative expenses.

Step 2. Call up the insurer or the TPA and tell it about the hospitalisation at least 48-72 hours prior to admission by way of a pre-authorisation request. The pre-authorisation letter can be collected from the accounts department of the hospital. The department forwards it to the insurer or the TPA concerned.

Step 3. You have to present the authorisation letter and the photo ID card to the hospital at the time of hospitalisation. The hospital may also ask for some advance deposit, which will be refunded after discharge or approval of the claim amount. You will also have to submit KYC (know-your-customer) documents to the hospital.

Step 4. At the time of discharge you need to pay expenses which are not reimbursable under the policy.

Step 5. Get copies of investigation reports and discharge summary for own records as the original papers will be kept by the hospital.

For emergency hospitalisation

Step 1. In emergency situations some advance deposit may have to be paid at the time of hospitalisation. KYC documents are also required.

Step 2. After admission, intimate the insurer's call centre as soon as possible.

Step 3. Provide the patient's health card and photo ID proof to the hospital. Intimate the insurer or TPA about the hospitalisation by way of a pre-authorisation request with the help of the hospital.

Step 4. The hospital will send the pre-authorisation form to the TPA along with necessary medical details such as the investigation report. TPA approval usually takes four to five hours.

Step 5. Verify and pay expenses which are not reimbursable. Get copies of all reports and discharge summary for your own records as the original papers will be kept by the hospital for the purpose of claim.

We also discuss some common queries regarding planned hospitalisation. What if pre-authorisation request is rejected?: Mukesh Kumar, a member of executive management and head, HR marketing and strategy planning, HDFC Life, says, "In cases where the pre-authorisation request for cashless treatment is not approved, you still have the option of submitting the original documents to the TPA and apply for reimbursement of the amount paid to the hospital.". What if it is not a network hospital?: "If the hospital is not part of the insurer's network, you need to go through the reimbursement route, under which you need to first pay and later claim the amount from the insurer," says Kumar.


Claim process for reimbursement
-Intimate the call centre about the hospitalisation within 15-30 days of getting discharged.

-The time limit may vary from insurer to insurer.

-You will receive the claim number, which should be quoted for future reference.

-Send the claim form and all original documents to the TPA.

-If additional documents are required, the insurer will contact you, generally within seven days of receiving the claim documents.

-The insurer pays within 30 days of receiving all the documents

If the hospital is not part of the insurer's network, you need to first pay the hospital and later claim the amount from the insurer

Tips for speedy settlement

-Inform the insurer on the toll-free number

-Mention the claim number or the health card number or the policy number in all correspondences.

-Carry your health card, ID proof and KYC documents to the hospital

-In case of planned hospitalisation, make a preauthorisation request for cashless treatment in advance

-For reimbursement, submit all the documents in one go


Struck by disaster: Claim for home insurance insurance money

Don't wait for a disaster to understand how the process works. A little knowledge will help you take timely action and speed up the process. Here is how.

Step 1. If a burglary takes place, visi the police station immediately and file an FIR.

Step 2. The next step is to intimate the insurance company and share the details of the loss and provide information related to the insurance policy.

Step 3. The company will appoint a surveyor to visit your house in the next 48 hours for inspection.

Step 4. Prepare a list of stolen items along with their value and provide it to the surveyor.

Step 5. The surveyor will inform you about the list of documents to be submitted for processing the claim.

Step 6. The claim form should be filled carefully and documents such as FIR should be attached. All documents must be sent to the insurance company within the stipulated time, which is generally 15 days.

Step 7. The claim is generally processed within seven days of the submission of documents. What extra a policyholder needs to do while filing a claim for breakdown of machinery or natural disaster: Sanjay Datta, chief, underwriting and claims, ICICI Lombard, says, "The policyholder will have to estimate losses as well as take an invoice from the contractor for reinstatement of the house which has been damaged.

It is also imperative for the policyholder to keep the property papers handy. In case of breakdown of machinery, an invoice from the authorised service centre needs to be prepared for repairs." Tips for speedy settlement It is important to maintain a list of items kept at home. "One may also record a video of the contents which can be referred to at the time of inspection," says Datta.

All the details should be mentioned in the claim form and documents such as FIR attached for items that are lost or damaged. It is also essential to send a cancelled cheque to the insurer so that the amount can be transferred directly.

Don't wait for a disaster to happen to understand how to file a claim. A little knowledge will save you from a lot of trouble at the last moment.




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