According to the current norms, the claim would have to be intimated to the insurance company in a prescribed form within a specified number of days, which, in most cases, is 7 days. After this intimation, the insurance company will carry out its investigations, loss assessment and provisioning and, then, make the final claim settlement.
In case a claim arises, the policyholder will have to first contact the respective insurance company's branch office, or the insurance advisor. If these two fail, he or she would need to contact the company's customer helpline. After the claim is registered, the company will give a reference number that needs to be referred to in all future communications.
To make claim settlement faster, it is important that the policyholder fills the claim form and submits all relevant documents, such as hospitals bills, original death certificate and policy bond, to the insurer. Under the regulation 8 of the IRDA (Policy holder's Interest) Regulations, 2002, the insurer is required to settle a claim within 30 days of receipt of all documents including clarification sought by the insurer.
However, the insurance company can set a practice of settling the claim even earlier. If the claim requires further investigation, the insurer has to complete its procedures within 6 months from receiving the written intimation of claim. However, some complicated third-party claims can take years for settlement. The claim amount is either sent through a cheque or remitted to the bank directly.
The claimant has to submit the claim form, which has details like basic information such as policy number, name of the insured, date, place and reason of hospitalization or death and also the name of the claimant. The claimant will be required to provide a claimant's statement, original policy document, death certificate, police FIR and postmortem report (for accidental death), certificate and records from the treating doctor/hospital (for death due to illness) and advance discharge form for claim processing. At times, the insurance company can also request for some additional documents.
Insurance agents say that to make the claim process faster in case of health insurance, the family members of patient should find out the third-party administrator on the policy, which is mentioned on the policy schedule. They should collect all bills connected to pre- and post-hospitalization expenses, including prescriptions and receipts of consulting fees paid to doctors, invoices and receipts provided by the hospitals and the pathology laboratory, the consultation reports and receipts. These documents have to be submitted at the time of filing the claim form, duly signed by the doctor. The discharge certificate from the hospital also needs to be attached with the form. One should also keep a photocopy of all the bills and the filled claim form for records.