A claim under a motor insurance policy could be

• For personal injury or property damage related to someone else. This person is called a third party in this context) or
• For damage to your own, insured, vehicle. This is called an own damage claim and you are eligible for this if you are holding what is known as a package or a comprehensive policy.

Third Party Claim

• In a third party claim, where your vehicle is involved, it is important to ensure that the accident is reported immediately to the police as well as to the insurance company.
• On the other hand, if you are a victim, that is, if somebody else’s vehicle was involved, you must obtain the insurance details of that vehicle and make intimation to the insurer of that vehicle.

Own Damage Claim

• In the event of an own damage claim, that is, where your own vehicle is damaged due to an accident, you must immediately inform insurance company and police, wherever required, to enable them to depute a surveyor to assess the loss.
• Do not attempt to move the vehicle from the accident spot without the permission of police and the insurance company.
• Once you receive permission for removal of the vehicle and for repairs, you can do so.
• If your policy provides for cashless service, which means you do not have to pay out of your pocket for covered damages, the insurance company will pay the workshop directly.
• In either of these situations, you must intimate the insurance company immediately.

Theft Claim

• If your vehicle is stolen, you must inform the police and the insurance company immediately. In addition you must keep the transport department also informed.
• As soon as you receive the policy document, read about the procedures and documentation requirements for claims rather than wait for a claim to arise.
• If you have to make a claim, ensure that you collect all the required documents and submit them along with the requisite claim form duly filled in, to the insurance company.
• There may be certain specific documentation requirements for specific types of claims. For instance in respect of a theft claim, there is a special requirement that you should surrender the vehicle keys to the insurance company.

As a general practice familiarise yourself with the documents required for a claim as well as the procedures to be followed when you receive your policy. Whether or not a claim arises you must follow the various dos and don’ts for the duration of the policy. These dos and don’ts are termed warranties and conditions in your policy document.

For making a claim please ensure to

• Contact the Call centre of the insurance company immediately. The intimation of the loss can also be made through us.
• Kindly ensure that as far as possible the policy details are available with you before you intimate the loss.
• In case of Fire loss: Contact the fire brigade / police and try to minimize the loss and protect the property.
• In case of Theft/ Burglary claims: Loss should be reported to Police Authorities
• In case of Marine transit loss: If you observe the damage to packing insist on open delivery and simultaneously qualify the BL/LR/RR/MTD/AWB.

You can apply for a Health Insurance claim in 2 ways. You can either go for Cashless Claim or get Reimbursement for your claim.

On a Cashless basis: For a claim on cashless basis, your treatment must be only at a network hospital of the Third Party Administrator (TPA) who is servicing your policy. You have to seek authorisation for availing the treatment on a cashless basis as per procedures laid down and in the prescribed form. Please read the policy document as soon as you receive it to familiarise yourself with the process rather than wait for a claim to arise.

Claims on reimbursement basis: Read the clause relating to claims in your policy document as soon as you receive it to ensure that you understand the procedure and the documents required for making a claim on reimbursement basis. When a claim arises you should inform the insurance company as per procedures required. After hospitalisation, you have to ensure that you obtain and keep ready documents such as claim form, discharge summary, prescriptions and bills that you should submit for a claim.

Dealing with a death is immensely stressful, and it doesn’t help that it tends to come with a large amount of administration. A life insurance claim arises on the death of an individual (life assured) covered under a life policy. The nominee or assignee of the policy, who is entitled to receive the benefits, needs to inform the insurance company about the loss. The intimation of death should be in writing and accompanied by a copy of death certificate. It should contain details such as date, place and cause of death. This needs to be submitted at the nearest branch office of the insurance company.

Processing
The insurance company may appoint an investigator to ascertain the validity of the claim. If it is found to be valid, the amount is paid, otherwise a repudiation letter is sent to the claimant, listing the reason for rejection. In case there is no nomination or assignment in a policy, the benefit will be paid out only after the claimant has provided documentary proof of entitlement.

• Personal Accident claims Procedure
• If any person meets with an accident, attend the person first. Give him the necessary first aid. Arrange to shift the injured person to the nearest hospital.
• It is mandatory to intimate the accident to the insurance company