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How to make an insurance claim - Economic Times

11 March, 2010

We often read or hear about insurance claims being rejected by insurers on flimsy grounds. Sometimes, however, the insured is also to be blamed simply because he/she is found to have made false declarations while taking the policy or failed to go through the fine print before buying one. On a few occasions, complaints about insurance policies are also the result of confusion over the wording of policies and the way the claim was made.

Here, therefore, we take a look at a few things to be taken care of while lodging an insurance claim:

1) A claim should be made promptly
A delay in submission of documents or filing a claim will give the insurer less time to verify the facts and also send a wrong signal to the insurer. Therefore, you should never delay in making a claim.
The preliminary intimation about the claim, in fact, can be made to the TPA over the phone or can also be made online to the insurer. However, the claim form along with all the documents should be submitted within the timelines as stated in the policy terms and conditions, informs Ajay Bimbhet, managing director, Royal Sundaram
Alliance Insurance Company Ltd.

2) Declare multiple insurance policies
You should also try to share all the relevant information, if any, about multiple insurance policies with your insurer.
Always declare multiple insurance policies. Should the insurer come to know about this at a later stage, there could be delay in processing, as this information could be probed further, says Bimbhet.

3) Give accurate information about health conditions
There is also need to state accurate information about the duration of your health conditions. For instance, if you have a health condition for three years, don`t say that you had this condition for six months. Be honest and forthcoming about pre-existing conditions because if the insurer were to gain access to the authentic health records, this can be termed as malicious intent to suppress information and the insurer could deny the claim of the customer, says Bimbhet.

4) Submit dated bills with required signatures
When submitting bills for a claim, never submit undated or unsigned bills. Otherwise this could result in a claim delay or even denial.

5) Be patient with your insurer
Don`t rush your insurer to settle the claim without submitting all the
relevant documents. There are procedures and systems to be followed meticulously by the insurer and the decision about the claim can only be arrived at after their completion.

6) Cooperate with your insurer
Always keep a cooperative attitude during the claim process when the insurer sends its representative to verify information.

There could even be a requirement for the insured person to be examined by a medical practitioner appointed by the insurance company. You, however, need to cooperate with your insurer.

7) Precautions in motor-specific claims:
a) Inform the insurer immediately

The insurer should be intimated immediately. The policy document
clearly states that the insurer should be informed about the loss without delay, otherwise the claim will be declined.

b) Give the actual sequence of events In case of an accident, always go by your experience and give the actual sequence of events and don`t take the advice of others on what
they think you should say.

c) Verify the vehicle`s condition post accident before you start the engine
After the accident, don`t drive your vehicle and aggravate the damages unless you are absolutely certain that it is in driving condition. If your engine gets seized while driving your vehicle post accident, please remember that the insurance company does not pay for a seized engine, says Bimbhet.