Claim Process and Assistance | Life Insurance

Cashless Basis
Reimbursement Basis

On a Cashless basis:

Cashless hospitalization is a facility provided by the Insurance Company wherein the policy holder can get admitted and undergo the required treatment without paying directly for the medical expenditure. The eligible medical expense, thus incurred, shall be settled by the Insurance Company directly with the hospital. The Cashless claim facility can be obtained only at the hospital listed in the network of the Insurance Company.

Inform your Insurer

Hospitalization happen under two circumstances - planned and emergency

Planned:

Once your doctor has recommended for the hospitalization, contact your insurer immediately and inform about the hospitalization.

Emergency:

In case of emergency hospitalization, you must inform your insurer within 24 hours of hospitalization.

Admit in the hospital

Get admitted to the hospital by showing your health ID card or policy number for identification purpose.Hospital will check your identity and fills up the Pre-Authorization Form with all the relevant details and send to the insurer.

Ready documents to be sent with pre-authorization form

Ready with you the below documents to be sent along with the pre-authorization form:

Policy Copy/ Health Card
ID proof with address
Investigation Test reports from Pathologist
Medico Legal Certificate (MLO)- in accident cases

(Note: you may require to send additional documents depending on your insurer's requirement)

Confirmation of insurer to proceed with services

Hospital will submit the pre-authorization form to the insurer. Insurer will review the documents and provide confirmation to the hospital to proceed with the cashless services. Normally, TPA issues a letter of confirmation within 3-6 hours provided all relevant documents are submitted.

Hospital sends bill to insurer during discharge

Hospital sends the final bill to the insurer at the time of discharge.

Direct payment

Once the bill is confirmed, insurer makes payment directly to the hospital.

Claims on reimbursement basis:

In case of a reimbursement claim, the policy holder pays the expenses himself with the hospital and then claims for a reimbursement of those expenses from the Insurance Company by providing necessary documentation.

Inform your Insurer

Hospitalization happen under two circumstances - planned and emergency

Planned:

Once your doctor has recommended for the hospitalization, contact your insurer immediately and inform about the hospitalization.

Emergency:

In case of emergency hospitalization, you must inform your insurer within 24 hours of hospitalization.

Get the treatment done

Avail the treatment as prescribed. Intimate your insurer in case of the treatment done outside the network hospital. In the meantime, you can proceed with your treatment and pay the bill. Get your all original documents and reports from the hospital.

Submit the documents to your insurer

Submit the following documents to your insurer:

Complete and signed Claim form with attending doctor's prescription
First prescription of the present illness, for which treatment has been undergone in hospital/nursing home
Medical advice for hospitalization
Discharge summary of hospital
Final bill of the hospital
Medical fitness certificate
All test reports supported by medical prescription (pre & post hospitalization)
All vouchers/bills/receipts pertaining to the tests mentioned above
All medicines purchased from outside the hospital at any point in time to be supported by original prescription

(Note: you may require to send additional documents depending on your insurer's requirement)

Claim documents review by Insurer

Your insurer will review the claim documents received and effect the payment within 7 days of receiving documents. If treatment claimed is not covered under your plan, a rejection letter will be sent to you stating the reason for the same.

Hospital sends bill to insurer during discharge

Ready with you the below documents to be sent along with the pre-authorization form:

Direct payment

Once the bill is confirmed, insurer makes payment directly to the hospital.

Get Claim Form, Locate Your Network Hospitals and Track Your Claim

Death Claim

When a person with a life insurance policy - called a life assured - dies, claim intimation should be sent to the insurance company as early as possible. The assignee or nominee under the policy can do this. So can any close relative or the agent who handles the policy.

Claim Intimation

The claimant must submit the written intimation to the insurer at the earliest to enable the insurance company to initiate the processing. The claim intimation should be supported with the basic information such as policy number, name of the insured, date of death, cause of death, place of death, name and contact of the claimant.

Documents to be submitted with insurer

The insurance company will respond to this intimation and will ask for the following documents:

Filled-up claim form
Certificate of death issued by Local Authority
Policy document
Claimant's Identity and Residence Proof
Medical Records at the time of death and past illnesses (Medical Attendant Certificate, Hospital treatment Certificate, Admission Notes, Discharge/Death Summary, and Test reports, etc)
Legal evidence of title, if the policy is not assigned or nominated
Copy of Post Mortem
Form of discharge executed and witnessed
Copy of FIR / Panchnama Report /Police Inquest Report / Police Final Report, in case of Un-natural death

(Note: Additional documents may be requested on company and case to case basis)

Settlement of the claim

As per the IRDA regulation, the insurer is required to settle the claim within 30 days of the receipt of all the documents.If claim is accepted, then payment is made to the nominee and if the claim is rejected, then the same is required to be communicated to the claimant stating the reasons.

If the claim requires further investigation, the insurer has to complete its procedures within six months from receiving the written intimation of claim.

Get Claim Form and Track Your Claim

Third Party Claim

If your vehicle is insured and has a third party liability cover, the compensation sought by the third party for damages in case of an accident will be fully paid by your insurance company.

Report to the Police

Where your vehicle is involved, it is important to report the accident to the police and obtain the first information report quoting the details such as registration number of the vehicle, license number of the driver, and the names/contact details of witnesses, if any.

Inform your insurer

Intimate your insurer immediately along with the basic details of the Policy, Driver, and Place of accident. If other's vehicle is involved i.e. if you are a victim, you must obtain the insurance details of that vehicle and intimate the insurer about that vehicle.

Submit documents to your insurer

Submit the following documents to the insurance company for processing your claim:-

Claim form
Policy copy
Registration Certificate
Driving License
First Information Report

Get Claim Form, Locate Garage Lists and Track Your Claim

Intimate your insurer

To lodge a claim, you must inform your insurer on their helpline number providing the necessary details.

Submit the Claim form & other documents

Fill up the claim form with the necessary details and duly sign it and submit to your insurer along with the following documents:-

Doctor's report
Original Admission/discharge card
Original Bills/Receipts/Prescription
Original X-ray reports/ Pathological/ Investigative reports
Copy of passport/Visa with Entry & exit stamp
Cancelled Cheque

(It is necessary to obtain attending Physician's signature on the form)

Claim Settlement

The actual claim process happens once you return back home in India. Your documents are reviewed by the insurer and you get your claim recovered.

Which are the necessary documents for the compensation of claim ?

List of necessary claim documents to be submitted for compensation are as following:

Claim form duly signed.
Hospital Discharge summary
Copy of photo ID of patient
Investigation reports
Hospital Main Bill
Investigation reports
Operation Theatre notes
Hospital Break up bill
Original investigation reports, X Ray, MRI, CT films, HPE, ECG
Doctors reference slip for investigation
Pharmacy Bills

Are there any investigations that happen once the receipt of claim done?

The Company may investigate claims at their own discretion to inspect validity of claim. Such inquiry shall be concluded within 15 days from the date of assigning the claim for investigation and not later than 6 months from the date of receipt of claim intimation. Verification carried out, if any, can be done by people or entities authorised .

Whom do i actually have to contact for claim intimation and settlement?

You must notify your insurer either at the call center or in writing, in the event of planned or emergency hospitalisation.

Here we help you to guide through the various claim process which you might go through with insurance companies. If in case you need further assistance, you may simply email us @ helpdesk@policyx.com

CLAIM ASSISTANCE

Health Claim Process

Life Claim Process

Motor Claim Process

Travel Claim Process

Home Claim Process

On a Cashless basis:

Inform your Insurer

Planned:

Emergency:

Admit in the hospital

Ready documents to be sent with pre-authorization form

Confirmation of insurer to proceed with services

Hospital sends bill to insurer during discharge

Direct payment

Claims on reimbursement basis:

Inform your Insurer

Planned:

Emergency:

Get the treatment done

Submit the documents to your insurer

Claim documents review by Insurer

Hospital sends bill to insurer during discharge

Direct payment

Death Claim

Claim Intimation

Documents to be submitted with insurer

Settlement of the claim

Maturity Claim

Maturity Claim / Discharge Form

Documentation

Claim Settlement

Claim intimation

Documentation

Claim Settlement

Third Party Claim

Report to the Police

Inform your insurer

Submit documents to your insurer

Theft Claim

Lodge an FIR

Inform your Insurer

Submit claim form and other documents

Claim Settlement

Own Damage Claim

Inform Insurer and police

Send your vehicle to the garage

Surveyor Inspection Report

Payment of Expenses

Reimbursement documents to be submitted to the Insurer

Intimate your insurer

Submit the Claim form & other documents

Claim Settlement

Intimate the Airline and Insurer

Submit Claim form & other documentation

Intimate the airline and insurer

Submit documents to the insurer

Inform insurer and do not enter into any agreement

Submit documents to the insurer

Intimate police

Contact Indian Embassy

Submit documents with insurer

Inform your insurer

Insurer appoints surveyor

Submit the documents to the surveyor

Claim Settlement

Which are the necessary documents for the compensation of claim ?

Are there any investigations that happen once the receipt of claim done?

Whom do i actually have to contact for claim intimation and settlement?