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Death

    Filing a Term Insurance Claim:

    Claim settlement is the most vital and imperative process because it safeguards your family from any financial loss in case of unfortunate event.

    As per the regulation 8 of the IRDA (Policy holder's Interest) Regulations, 2002, the insurer is bound to settle a claim within 30 days of receipt of all documents including clarification sought by the insurance company. The insurance company can settle the claim even earlier.

    In case of demise of the policyholder during the policy term, the death claim arises. The nominees/Claimants are required to go through the following steps for getting the death benefit under the term plan.

  • 1

    Intimate the insurance company

    Intimate the insurance company about the death of the life insured at the earliest by providing the listed details:

    • The name of the life insured
    • Policy number
    • Date of death
    • Cause of death
    • Place of death
    • The details of the claimant such as Name, Relationship etc.
  • 2

    Submission of the claim related documents

    It is essential for the claimant to provide the below listed documents integrated with the duly filled claim form to the insurance company. The list of documents is comprehensive and there could be some additional information or document which an insurance company could seek to settle the claim.

    • Original Policy Document/Pack
    • Complete and signed Claim Form by the claimant.
    • Nominee ID proof for the purpose of finding the relationship with Life Insured.
    • Address Proof and Contact number of the Nominee/Claimant/Beneficiary.
    • Death certificate issued by local authority/Hospital.
    • Medical Records (admission papers, discharge summary, test reports etc.)
    • Last Medical Attendance Report ( LMA)
    • Post Mortem Report (in case applicable)
    • First Information Report/ Panchnama Report(in case applicable)
    • Bank Account details.
    • The requirements and documentation may vary from insurer to insurer.

  • 3

    Verification of the documents by the Insurance Company

    The insurance company will review the documents submitted by the claimant and may contact you in the process to seek further information. On the merit of the case, the insurance company may either pay or repudiate the claim.

  • 4

    Claim Payment

    After examining, studying and verifying the submitted documents, the insurance company may either pay or repudiate the claim based on merit of the case. It may pay your nominees through electronic mode (NEFT/RTGS) or through Cheque/DD.

Critical Illness

  • The process in getting the critical illness claim involves:
  • 1

    Intimate the insurance company

    The illness / claim should be reported to the insurance company with an immediate notice by telephone or in Writing (email / letter).

  • 2

    Submission of the claim related documents

    The claimant is required to submit the following or may be additional documents to the insurance company seeking claim from.

    • Claim form duly signed along with the attending physician statement.
    • Discharge summary mentioning the diagnosis, date and time of admission and discharge, past medical and surgical history with duration.
    • A medical certificate confirming the diagnosis of critical illness from a doctor, not less qualified than MD/MS e.g. CAG report in case of Coronary artery disease/ Bypass Surgery or biopsy report in cancer cases.
    • Medical certificate which states the details of the treatment and fitness.
    • Investigation reports/ other related documents reflecting the critical illness diagnosis.
    • Medical certificate clearly mentioned the cause of the death
    • All supporting reports to prove the diagnosis.
    • First consultation paper.

    The requirements and documentation may vary from insurer to insurer.

  • 3

    Verification of the documents by the Insurance Company

    The insurance company will review the documents submitted by the claimant and may contact you in the process to seek further information. On the merit of the case, the insurance company may either pay or repudiate the claim.

  • 4

    Claim Payment

    The claims team of the insurance company will assess the claim for completeness of documentation and acceptability. Once the process is done, the claim payment will be processed,if the claim is deemed to be admissible as per policy terms and conditions. The insurance company will furnish the reason in case the claim is inadmissible or repudiated.

Cashless Claim

  • 1

    Intimate the insurance company

    Approach the insurance company or the TPA at the network hospital within 24 hours of hospitalization in case of an emergency. In case of planned hospitalization/ surgery, it needs to be approved by the insurer prior to the admission. It may take up to 7 days.
  • 2

    Show health card, ID proof

    Each network hospital has a TPA (third –party administration) that assists you filing your insurance claim. You need to present the health-card, provided by the insurer, along with an identity proof before the insurance claim assistance desk. Also, you need to fill in the pre-authorization form.
  • 3

    TPA will send the pre-authorization form to the respective insurance company

    Now the TPA/hospital will establish communication with your insurance company on your behalf. It will send the pre-authorization form with the documents to the insurer for approval.
  • 4

    Follow up with the TPA/hospital

    Normally the process requires about 6 hours in case of an emergency. You should be in touch with theTPA to know the status of the request you have applied with the insurer for approval.
  • 5

    Insurance Company approves the cashless treatment

    Once the insurer receives the documents, it interacts with the hospital, ask for further documents and information if required. If the insurer finds everything satisfactory, it authorizes the hospital to proceed with the cashless treatment.
  • 6

    You may need to pay residual amount

    When treatment is complete and you are discharged from the hospital, you may need to pay over and above the authorized, if there is any. Please note that under the certain policy terms & conditions, your policy may not cover all of the expenses incurred in the treatment. That extra amount will have to be borne by the policyholder.

Reimbursement Claim

  • 1

    Intimate the insurance company

    Approach the insurance company or the TPA at the network hospital or any other hospital within 24 hours of hospitalization in case of an emergency. In case of planned hospitalization/ surgery, it needs to be approved by the insurer prior to the admission. It may take up to 7 days.
  • 2

    Get Started

    While you have intimated the insurance company and authorization is under process, you can proceed with your treatment meantime.
  • 3

    Pay the hospital bill

    After you’re treated, you need to pay the bill on your own to get discharged from the hospital.
  • 4

    Apply for reimbursement

    Fill in the claim form, sign it and then submit with the TPA along with the documents listed below:

    • Prescription of the doctor in original.
    • Discharge summary in original
    • Final bill of the hospital (break-up) in original
    • Pathology bill in original
    • Pharmacy bill in original
    • All test reports
    • Policy copy
    • ID card
    • Cancelled cheque
  • 5

    The insurer verify the documents

    The insurance company will review the documents submitted and can contact you/TPA in order to approve the expenditure. On the merit of the case, the insurance company may approve/reject your claim.
  • 6

    Payment

    If the insurance company finds the documents satisfactory and claim is approved, it may pay you through electronic mode (NEFT/RTGS) or through cheque/DD.

In case of Accident

  • 1

    Intimate the insurance company immediately

    If you got injured in the document, first get treatment from the nearest hospital. Thereafter, intimate the insurance company about the accident mentioning the exact place and damage.
  • 2

    Take the vehicle to the nearest garage

    Request the insurer to arrange for a towing vehicle for sending surveyor.
  • 3

    Surveyor submit the report to the insurer

    The surveyor after evaluating the damage, submit his report to the insurance company depending on which the insurer authorizes the garage to repair the vehicle. The coverage will depend on the policy terms and conditions.
  • 4

    Drive away your vehicle

    In case the policy is cashless, you can take your vehicle after paying deductibles under the policy. If the policy does not have cashless benefits, pay the entire bill and then make claim for the reimbursement.
  • 5

    Apply for Reimbursement

    To get the expense reimbursed, you need to apply to the insurance company with supporting documents mentioned below:

    • Policy copy
    • Original garage bill
    • Vehicle RC (registration certificate)
    • Driving license
    • Original estimate
    • Original payment receipt
    • Cash memo of parts purchase
    • Address proof
    • Bank account details
  • 6

    The insurer verify the documents

    The insurance company will review the documents submitted and may contact you in the process. On the merit of the case, the insurance company may approve/reject your claim.
  • 7

    Payment

    If the insurance company finds the documents satisfactory and claim is approved, it may pay you through electronic mode (NEFT/RTGS) or through cheque/DD.

In Case of theft

  • 1

    Inform the police

    Immediately after the theft of your vehicle, lodge an FIR (first information report) with the police station that has the jurisdiction of the place where accident took place.
  • 2

    Intimate the insurance company

    Intimate the insurer about the incidence mentioning the policy number and other details.
  • 3

    File claim

    In case the vehicle is not traced within 90 days of the theft, contact the police to issue non-traceable report and then submit claim form duly signed along with following documents to the insurance company:

    • FIR copy
    • Non-traceable report
    • Policy copy
    • NOC from the financer (if financed)
    • RC (Registration Certificate)
    • Regional transport office intimation letter
    • Driving license
    • Original keys of the vehicle

In Case of third-party damage

  • 1

    Inform the police

    Immediately after the accident of your vehicle, lodge an FIR (first information report) with the police station that has the jurisdiction of the place where accident took place.
  • 2

    Intimate the insurance company

    Intimate the insurer about the incidence mentioning the policy number and other details.
  • 3

    File claim

    Submit claim form duly signed along with following documents to the insurance company:

    • FIR copy
    • Policy copy
    • RC (Registration Certificate)
    • Driving license

    Filing an Investment Plan Claim:

    Claim settlement is the most vital and imperative process because it safeguards your family from any financial loss in case of unfortunate event or compensates you at the time of maturity for which you have taken the investment plan keeping saving objective in mind. As per the regulation 8 of the IRDA (Policy holder's Interest) Regulations, 2002, the insurer is bound to settle a claim within 30 days of receipt of all documents including clarification sought by the insurance company. The insurance company can settle the claim even earlier.

  • 1

    Maturity Claim

    Maturity claim arises when a policyholder survives the policy term. The policyholder is required to fill the maturity claim form which is available at the local branch of the insurer or may download the same from the respective insurer’s website. Along with the claim form, submit the original policy bond/pack integrated with other specific documents asked by the insurance company before the maturity date ,to enable timely settlement of the claim.Post examining the documents, most of the insurance companies issue post dated cheques or transfer the maturity amount in the bank account of the policyholder on maturity date.

  • 2

    Death Claim

    In case of demise of the policyholder during the policy term, the death claim arises. The nominees/Claimants are required to go through the following steps for getting the death benefit under the investment plan.

  • 1

    Intimate the insurance company

    Intimate the insurance company about the death of the life insured at the earliest by providing the listed details:

    • The name of the life insured
    • Policy number
    • Date of death
    • Cause of death
    • Place of death
    • The details of the claimant such as Name, Relationship etc.
  • 2

    Submission of the claim related documents

    It is essential for the claimant to provide the below listed documents integrated with the duly filled claim form to the insurance company. The list of documents is comprehensive and there could be some additional information or document which an insurance company could seek to settle the claim.

    • Original Policy Document/Pack.
    • Complete and signed Claim Form by the claimant.
    • Nominee ID proof for the purpose of finding the relationship with Life Insured.
    • Address Proof and Contact number of the Nominee/Claimant/Beneficiary.
    • Death certificate issued by local authority/Hospital.
    • Medical Records (admission papers, discharge summary, test reports etc).
    • Last Medical Attendance Report ( LMA).
    • Medical Records (admission papers, discharge summary, test reports etc).
    • First Information Report/ Panchnama Report(in case applicable).
    • Bank Account details.

    The requirements and documentation may vary from insurer to insurer.

  • 3

    Verification of the documents by the Insurance Company

    The insurance company will review the documents submitted by the claimant and may contact you in the process to seek further information. On the merit of the case, the insurance company may either pay or repudiate the claim.

  • 4

    Claim Payment

    After examining ,studying and verifying the submitted documents, the insurance company may either pay or repudiate the claim based on merit of the case. It may pay you or your nominees as the case may be through electronic mode (NEFT/RTGS) or through Cheque/DD.

For Medical Expense

  • 1

    Intimate the insurance company

    Intimate the insurance company about the sickness as soon as possible
  • 2

    Apply for Reimbursement

    The completely filled in duly signed claim form need to be submitted with the respective insurance company to process the claim.

    Documents Checklist:

    • Policy copy
    • Claim form
    • Discharge summary
    • Doctor’s prescription (original)
    • Pharmacy bills (original)
    • Passport copy
    • Visa copy with entry and exit stamps
    • Cancelled cheque

In case of Trip Cancellation

  • 1

    Intimate the insurance company

  • 2

    File claim with the insurer

    If trip is cancelled, submit duly filled and signed claim form along with the following documents to the insurance company to process the claim:

    Documents Checklist:

    • Policy copy
    • Passport copy
    • Boarding pass, tickets & baggage tags
    • Copy of correspondence with airline authorities for the delay
    • Property Irregularity report from the airline authorities stating the reason for delay
    • Original bills/invoices and payment receipts for purchase of emergency items
    • Details of compensation received from the airline authorities
    • Cancelled cheque

In Case of loss of Baggage

  • 1

    Inform the airline authority about the loss of baggage and keep the complaint report.

  • 2

    File claim with the insurer

    If any of your baggage lost while traveling, submit duly filled and signed claim form along with the following documents to the insurance company to process the claim:

    • Policy copy
    • Passport copy with entry and exit stamps
    • Boarding pass, tickets & baggage tags
    • Copy of correspondence with airline authorities for the delay
    • Property Irregularity report from the airline authorities stating the reason for delay
    • Proof of ownership of items in the baggage
    • Details of compensation received from the airline authorities
    • Cancelled cheque

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