Types of Insurance Claims

Mini Balakrishnan

• August 19, 2024
• 7 min read
• Insurance

The reason why we opt for an insurance policy life/non-life is that we all need various kinds of help, financially and that under different circumstances, it can be claimed back from the insurance company we are insured with. So insurance claims are the major part of buying insurance coverage and using it for our benefits by paying a premium.

What Are The Types Of Claims In Insurance? 

In India, there are two types of claims and are 

1. Life insurance claims 
2. General insurance claims.

Both these claims are sub-categorised into various other claims and the details of all these are discussed further.

How Do You File A Life Insurance Claim?

Every insurance company is obliged to settle its customer’s claims promptly and religiously. For that, 

• The insured would need to fill in a claim form and contact the insurance advisor from whom you had purchased the policy. 
• After that you would have to submit all the relevant documents as required by your insurance company, based on the type of claim you make, to support your claim.

What Are The Types Of Claims Under Life Insurance?

First of all, we shall look into the first claim category, the life insurance claims. There are mainly two types of life insurance claims in India. They are 

1. Maturity Claim

This is regarding the maturity of your particular life insurance policy. On the actual date of maturity of your life insurance policy, you as a policyholder are required to send the maturity claim/ discharge form and original policy documents well in advance so that the claim settlement can be made on time before the due dates to ensure the last-minute issues. If there happens to be a delay from the insurance company’s side then you may certainly call the grievance cell of the company to get things done smoothly.

2. Death claim

This claim is made during the death of the policyholder. Here some procedures are to be followed. Let us have a look at those.

There are usually four steps to filing a death claim.

• Intimation of the claim – The person who is making the claim must notify the insurance company immediately after the incident.

• The claimant must get all relevant documents while making a death claim, like the policy number, place, time and cause of death, doctor’s certificate, etc. from the hospital

• The insured must Submit proper documents for smooth claim processing
• Claim settlement – The insurance company must settle a claim within 30 days of the receipt of the relevant documents as per regulation 14 (2) (i) of the IRDAI Regulations of 2017. 

What Are The Types Of Claims Under General Insurance?

Under General Insurance, there are several subcategories of insurance that will have different types of claim procedures.

1. Claim Under Motor Insurance 

• Third-Party Claim – For an injury or damage related to someone else the claimant makes a third-party claim to the insurer. In this, it is important to make sure that the accident or damage is reported to the police as well as the insurance company immediately with all the details of the third party vehicle insurance to make an intimation of the insurer of that person as well.

• Claiming for Own Damage – If the claim is made against the policyholder’s vehicle then the insured is supposed to notify the police and insurer immediately and is not supposed to move the vehicle from the accident spot without the permission of the police and insurer.

• Claim For Theft  – The policyholder in the event of a theft of his vehicle should intimate the insurance company immediately after finding out about the loss and has to file a claim properly to the insurer with a duly filled-in claim form etc. the claim form for theft claim will be a special form and it has to be filled. Also, the insured must surrender his vehicle keys to the insured till the claim gets settled.

2. Claim For Property Damage

Several types of claims can be made under property insurance policies like damage to stationery property or moving or shifting and damage occurring during the process of the same etc. the insured should get a good knowledge of the documents for making a claim and the correct procedures should be followed without getting into a wrong intimation passed to the insurer. Here also the police and the concerned authorities must be intimated while filing the claim as soon as the loss happens. The insurance company sends a surveyor to assess the claims for their validity.

3. Claim Under Travel Insurance

The insured must intimate the insurer about any incidents like hospitalisation. loss/damage of baggage or passport, accident, etc during traveling as per the type of travel insurance cover he has purchased. The particular claim form for the specific event should be duly filled in and all details must be provided. The claims administrator in the place where you are while the loss occurred will get in touch with the insurance company and look into settling the claim.

4. Claims Under Health Insurance

Under health insurance, the claims can be made in two ways like cashless claims that are made under the list of network hospitals listed under the insurance company. The reimbursement claims are those in which the claims payments are paid by the policyholder and then making the claim for the cashback. But the claims must be informed to the insurer.

Every insurance company provides all relevant information through their official websites relating to the claims procedures like:

• Lodging a claim
• Documents to be submitted
• The point of contact while making a claim
• Information related to the loss while making a claim
• The actual claim process is accepted by the insurer according to their terms
• Following up on an already filed claim
• Customer service details and help desk services

Procedure For Settling Claims Under General Insurance 

Insurers have got a different set of procedures while settling a claim as per the Insurance Law in India. The steps are detailed below.

1. The policyholder or the claimant notifies the insurer about any loss that might have arisen under the policy contract risk categories.

2. The insurance company is supposed to respond immediately and give proper instructions to the insured about the procedures to follow to file it as a valid claim. For the same, the insurance company will appoint a verified officer to assess the claim and inform the insurer within 72 hours of the intimation.

3. If the insured fails to give full particulars about the loss or fails to cooperate with the appointed surveyor, the procedures may be delayed than the standard time of settlement.

4. While assessing the loss incurred to the insured the surveyor appointed by the insurer should follow a code of conduct instructed by the insurer. The surveyor is supposed to intimate the insurer within 30 days of his findings about the loss occurring.

5. After the receipt of the findings from the surveyor, the insurer will notify the settlement of the claim to be done within 30 days. If in case the claim is proven to be invalid the insurer might reject the claim and this will be intimated to the insured in writing.

6. Once the valid claim is accepted by the insurer the claim settlement payment will be made to the insured within 7 days from the date of acceptance by the insurer.

7. If the payment settlement is delayed for more than 7 days the insurance company will be liable to pay an interest rate of 2% above the bank rate per that particular financial year.

Please remember to read all your policy documents carefully. All details would be provided in the policy documents themselves. People are specifically available in all insurance companies to guide you through if you have any doubts.