Insurance claims are the moment of truth for the insured. A claim can be demanded in an insurance contract when the insured suffers an event that the policy covers. The claim processing or claim settlement process will start with the insured or their nominees filing the claim with the insurer.
Every insurance claim is guided and limited by the terms and conditions of the policy covering the contingency. Life insurance claims and health insurance claims processes differ a lot.
Where a health insurance claim may be cashless, a life insurance claim has to follow a long process and thorough verification.
Key Takeaways
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An insurance claim is a formal request to the insurance company, in writing, for the amount assured on the occurrence of an event as specified in the insurance policy. An insurance claim is a compensation against losses covered under your insurance policy. As an insured or as a nominee you are entitled to claim because of the premiums paid to the insurer in line with the terms and conditions of the policy document.
Insurance is a financial agreement in which you pay a fixed premium and in return, the insurer provides financial cover for losses incurred. In the case of life insurance, the loss of income due to untimely demise is considered a loss for the grieving family and is compensated to the extent of the sum assured. The objective of the “claim process” is to inform the insurance company that the event for which the insurance cover was offered has occurred and that the assured amount should be disbursed.
An insurance claim helps you avail the support of the insurer against the insurance policy you had purchased. For example, if you have bought a health insurance policy, you can file a claim with the insurer against the policy to:
Similarly, life insurance claims can help your family avail the financial support you planned with the insurance policy. They can simply file a claim with the insurer with all the relevant documents and receive the policy benefit.
Insurance claims across the policies follow a similar process, except for a few steps where claim processing can be faster. The usual procedure includes the following:
Claim processing time for each insurance company may vary. Life insurance claims may take anywhere from one working day to 30 days to process. On the other hand, motor and health policies may process the claim in real-time, i.e., with the bill generation. Real-time claim processing is more popularly known as cashless claim settlement.
The insured or nominees do not need to file claim forms or bill copies with the insurer. You also, spend only your part of the bill and the insurer pays its part directly to the vendor or hospital.
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In the case of life insurance, the nominee should register by submitting a death claim form along with identity and address proofs at the nearest branch. Once the claim is registered, the insurer would require a physician’s statement along with certificates from all the hospitals where the insured was treated for the illness that ultimately caused his/her death. A certificate from the insured person’s employer may also be asked for.
The following documents along with your claim form, are mandatory for filing a death claim:
You may have to submit additional documents related to the cause of death. For health or Mediclaim policies, the identity and address proofs of the insured have to be submitted along with copies of investigation reports, discharge summary, claim form and hospital certificate.
Customer-friendly companies that intend to settle genuine claims will have straightforward, transparent processes that respond to enquiries and grievances within reasonable turnaround times.
A numerical method to evaluate a claim experience is to look at the claim settlement ratio. For example, at Canara HSBC Life Insurance, this ratio currently stands at 99.43%^ for the FY 2024-25.
Here are a few pointers to keep in mind to avoid rejection of claims:
Learn if you can buy a life insurance policy without a medical exam in India.
Within life insurance, claims can be of two types, one, when the policy is maturing, the insurance company notifies the policyholder through an intimation letter and/or an email at least a couple of months before the date of maturity.
The policyholder will then have to fill out some forms including a wire-transfer form so that the maturity amount is directly transferred to the specified bank account. In case of claims arising out of the death of the insured, the nominee will have to send the claim form along with requisite documents.
| Life Insurance | Other Insurance |
|---|---|
| Fixed sum as a death/terminal / critical illness benefit | Asset and health (Mediclaim) insurance |
| May also offer maturity or survival benefit | The total available sum is capped as Sum Insured |
| Can also grow your money (investment option) | Covers major part of the incurred cost or loss |
| Nominees can file the claim after your death | The benefit is usually payable to the policyholder or the service provider (hospital, service centre, etc.) |
| Benefit payment does not depend on the cost incurred | Insurance may also compensate third parties affected by your actions/accident |
Mediclaim works a little differently. The insured can opt for cashless payments when hospitalization is pre-planned so that the process of paying and then claiming is simplified. The insurance company does due diligence of the treatment basis the details provided by the hospital and pays directly to the hospital.
Motor insurance covers both the damage claim for the insured vehicle as well as a third-party claim where someone else is injured or his/her property damaged. Motor insurance claims may need copies of police complaints, reports by surveyors etc. to be enclosed along with the claim form.
Insurance policies are a “must-have” and there is no second thought to it. However, when you select a policy from a plethora of options, look at something that will give you peace of mind. Your family should not feel stressed out at the time of claim, should that need arise. A high claim settlement ratio is an indicator of strong underwriting guidelines and exemplary customer focus.
Life Insurance or health insurance claims are essential to cover financial losses in case of unexpected events. However, certain myths and misconceptions create hurdles for individuals to make the right decision. Let’s break down some misconceptions in detail:
Keep in mind, insurance acts as a financial safeguard against financial setbacks, big or small. Considering policy for any valid claim is a great financial decision.
Insurance provides more than just monetary benefits; it provides stability. It reduces danger, calms anxiety, and gives you the confidence to face the uncertain future. Gaining benefits from any insurance can be made easier by knowing how to submit a claim. Invest in insurance for your resilience and peace of mind in addition to your belongings.
In India, the following individuals are eligible to submit an insurance claim:
The assignee or nominee under the policy
Any close relative of the insured
The insurance agent who handles the policy
Gather important papers, such as the original policy, the death certificate that details the reason for the accident, and pertinent records, such as the FIR. Send these papers to the branch together with a completed claim form. The insurance company then continues with the verification procedure, looking closely at information pertaining to the accident.
If you require any clarification or help, you can contact representatives by emailing customerservice@canarahsbclife.in, visiting the closest Canara HSBC Life Insurance branch, or calling 18001030003/18001800003 (BSNL).
The types of insurance claims in death claims typically include:
Natural Death Claims: Claims are filed when the insured person dies due to natural causes, such as old age or illness.
Accidental Death Claims: Claims filed when the insured person dies due to an accident.
Death Due to Critical Illness: Claims for deaths caused by critical illnesses covered under the policy.
Disclaimer - This article is issued in the general public interest and meant for general information purposes only. The views expressed in this blog are solely those of the writer and do not necessarily reflect the official policy or position of Canara HSBC Life Insurance Company Limited or any affiliated entity. We make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability, or availability with respect to the blog or the information, products, services, or related graphics contained in the blog for any purpose. Any reliance you place on such information is therefore strictly at your own risk. You should consult with a qualified professional regarding your specific circumstances before taking any action based on the content provided herein.
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