Rediff.com« Back to articlePrint this article

How to make a claim for insurance

June 05, 2007 08:55 IST

Claiming insurance compensation can sometimes claim your peace of mind. The territory is agog with complaints like that of Mumbai-based jeweller Rohit Bajaj, 36. His insurer did not pay him to get his car back on the road after an accident. But, then, the fault was his: he had not followed the correct procedure for making the claim. The lesson from his case is that we should never give the insurer an excuse to refuse a rightful claim.

Remember, an insurance company is not a charity. Profligacy can make it go belly up. So, it scrutinises every claim before making the payment. Since you have agreed to the insurer's terms, you should stick to them and not provide it an escape route when you make a claim. It is not enough to buy the right covers, you should also know what to do in case something goes wrong and the need for making a claim arises. To save money, effort, time and, most important, headaches, always do the following:

Apart from these steps, which apply to all kinds of insurance, measures specific to different kinds of cover need to be taken.

Health Insurance

It is broadly of two types: the standard mediclaim and the critical illness cover.

Mediclaim: It reimburses hospitalisation and surgery bills after you have spent the money. In a cashless policy, the insurer takes care of the bills through a third-party administrator (TPA) if you undergo treatment in an empanelled hospital. These policies cover surgeries for hernia, piles, sinusitis and gall bladder stones only from the second year; knee replacement surgery, prolapsed disc and joint replacement surgery are covered from the third year. The following is the procedure for cashless mediclaim:

Critical illness: This cover is paid on the diagnosis of an illness in the list and often takes care of hefty treatment costs.  Kartik Jain, head (marketing and E Channel), ICICI Lombard, says a policyholder must know whether the claim is payable on diagnosis or after the survival period, which is usually 30 days after diagnosis. If the person dies in this period, the claim will not be honoured. Some private insurers like ICICI Lombard pay on diagnosis of critical illnesses.

Personal Accident cover

This insurance is usually bundled with life cover policies for a small premium or given free with credit cards. Some general insurance companies also give personal accident covers on a yearly basis. Kausal Mishra, senior vice-president, Tata AIG General Insurance, says in most instances family members of persons who have personal accident cover are unaware of it. In such cases, there is chance that the policy may go unclaimed if the policyholder dies in an accident.

If an accident leads to the death of the policyholder, it is essential to intimate the insurance company at the earliest. Here are the steps you need to take:

Car Insurance

It is mandatory for a car owner to have at least third-party cover, but it is advisable to have full car insurance. There are three cases when there can be a claim.

Road accident: The bulk of the claims come under this head. S. S. Gopala Rathnam, president (operations), Cholamandalam MS General Insurance Company, says customers are more aware about claims procedures for motor insurance than other insurances.

If your car hits another vehicle:

Travel Insurance

This cover is compulsory for those travelling to the US. Antony Jacob, managing director, Royal Sundaram, says that the travel insurance claims procedures are generally quite simple and are mentioned in the policy document. However, people face problems if they do not carry the policy details, helpline numbers and other  necessary information with them during travel. They also face problems when they are not aware of the claims procedure

Home Insurance

This covers all the valuables in your home. Like in the case of other covers, often policyholders don't know how to claim compensation under this insurance. Here's how to go about it:

Bridget S Leena, Outlook Money