FAQs:

Can a policy holder have both paper and electronic policies?

Can anyone become or set up an Insurance Repository?
Can I take health insurance plan for my parents who are senior citizen? Is there any tax
benefit available if I pay premium for them?
Can I take two policies and get claims under both of them?
Can policy holders have multiple e Insurance Accounts if they have multiple Insurance
policies issued by various Insurance Companies?
Can the eIA be operated by the Policy holder only?
For how long should I insure?
How can Insurance Repository provide free service to policy holders? Where is the catch?
How do I collect the maturity amount from the insurance company?
How do I convert my existing paper policy into electronic form?
How do I open an e Insurance Account (eIA)?
How do I reduce the cost of buying life insurance?
How do I understand a life insurance Policy?
How long will it take for the Insurance Repository to open AN e Insurance Account?
How much does life insurance cost?
How much health insurance I should opt?
How much should I insure for?
How much sum assured I should take?
How pension plan works?
I am already covered by my Employer in a Group Mediclaim policy, do I need to buy a
separate policy ? In case of a claim will I get paid from both policies?
I am healthy. Why should I take health insurance?
I do not believe in taking health insurance instead of that I prefer in creating my own fund.
I have not paid premium for some time. Can I revive my policy?
I have not paid premium for some time. I want to discontinue my policy. Do I get anything
back from the insurance company?
I want to save tax and plan for my 1-year old child's higher education. Which is the good
insurance policy for this?
If I already have an e IA, how do I buy a new policy in electronic form?
If I get heart attack, cancer, stroke will I get covered in a health Insurance policy ?
If there are problems with claims what can I do?
Is it compulsory for all Insurance Companies to offer electronic policies?
Is it compulsory to issue policies in only electronic form? (i.e. is dematerialization of
insurance policies compulsory, as in the case of shares?)
On what basis is claim paid?
Should I buy a life insurance policy even if my employer has insured me in a group insurance
scheme?
Should I take Life Insurance?
Should I use insurance as an investment?
There is no return under Term Plan then why should I take Term Plan?
What are the basic elements of Life Insurance?
What are the benefits of group life insurance?
What are the benefits of holding Insurance Policies in electronic form?
What are the documents required to open an eIA Account?
What are the Tax benefits applicable to me if I invest in a Life Insurance Policy?
What are the tax benefits on Health insurance policy ? any additional tax benefits in
proposed DTC ?
What are the various types of insurances?

What coverage available under health insurance plan?

What do I do if I need to make any changes to my policy or e IA? Do I submit a request to
the Insurance Company or to the Insurance Repository?
What do I get if I insure?
What do I get if I survive the term of the policy?
What do I need to pay to maintain electronic policies in my e IA? And what is the fee for
converting my existing paper polices into electronic policies?
What does my family get on my death?
What is "Waiver of Premium"?
What is a child plan?
What is a Guaranteed Surrender Value?
What is a medical examination when buying insurance?
What is a Money Back plan?
What is a Whole Life insurance product?
What is an e Insurance Account (e IA)?
What is an Insurance Repository?
What is Deferment Period?
What is Endowment product?
What is Fund Value and how it is determined?
What is general insurance?
What is Grace Period?
What is Group Life Insurance?
What is insurance?
What is Life Insurance?
What is Pre existing, Waiting periods and Exclusions in a health Insurance policy ?
What is Redirection?
What is Switching?
What is Term Insurance?
What is the difference between "Nomination" & "Assignment"?
What is the difference between health insurance plan of General Insurance Companies and
Life Insurance Companies?
What is the fee I need to pay for opening an e Insurance Account?
What is the guaranteed Savings/bonus applicable under a Life Insurance Policy?
What is the periodicity of premium payments?
What is the right age to buy a Health Insurance Policy ?
What is the tax benefit available under health insurance plan?
What is unit linked insurance plan?
What is vesting age?
What kinds of policies are there?
What should be the duration (term ) of my insurance policy?
What should I do if I lose/misplace my insurance policy?
What type of insurances should I have?
What's the advantage of starting early in health insurance ?
What's the difference between Health Insurance & Mediclaim ?
When should I insure?
Which Insurance Policies can be held in electronic form?
Which Life Insurance Plan I should opt?
Which Policy is better - from General Insurance co, Health Insurance Co. or Life Insurance
cos ?
Which type of policy is best suited for me ?
Who is an Authorized Representative (AR)?

Who should buy general insurance?

Whom should I insure?
Why do different people have different premiums ?
Why do I need Insurance?
Why should I buy life insurance?
Why should one insure ?
Will my family receive the insurance amount immediately after my death?
Will my premium amount increase after I have bought a policy?

Home

Consumers

Claims Process

Claims Process
Filing

Life

Insurance

Claim

Claim settlement is one of the most important services that an insurance company can provide to its customers. Insurance companies have an
obligation to settle claims promptly. You will need to fill a claim form and contact the financial advisor from whom you bought your policy.
Submit all relevant documents such as original death certificate and policy bond to your insurer to support your claim. Most claims are settled
by issuing a cheque within 7 days from the time they receive the documents. However, if your insurer is unable to deal with all or any part of
your claim, you will be notified in writing.

Types of claims
Maturity Claim - On the date of maturity life insured is required to send maturity claim / discharge form and
original policy bond well before maturity date to enable timely settlement. Most companies offer/issue post dated cheques and/ or
make
payment
through
ECS
credit
on
the
maturity
date.
Incase of delay in settlement kindly refer to grievance redressal.
Death Claim (including rider claim) - In case of death claim or rider claim the following procedure should be followed.
Follow these four simple steps to file a claim:
1.

Claim intimation/notification
The claimant must submit the written intimation as soon as possible to enable the insurance company to initiate the claim
processing. The claim intimation should consist of basic information such as policy number, name of the insured, date of
death,
cause
of
death,
place
of
death,
name
of
the
claimant.
The claimant can also get a claim intimation/notification form from the nearest local branch office of the insurance
company or their insurance advisor/agent. Alternatively, some insurance companies also provide the facility of
downloading the form from their website.

2.

Documents required for claim processing

The claimant will be required to provide a claimant's statement, original policy document, death certificate, police FIR and
post mortem exam report (for accidental death), certificate and records from the treating doctor/hospital (for death due to
illness) and advance discharge form for claim processing. Based on the sum at risk, cause of death and policy duration,
insurance companies may also request some additional documents.|

3.

Submission of required documents for claim processing

For faster claim processing, it is essential that the claimant submits complete documentation as early as possible. A life

insurer will not be able to take a decision until all the requirements are complete. Once all relevant documents, records
and forms have been submitted, the life insurer can take a decision about the claim.
4.

Settlement of claim
As per 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 six months from receiving the written intimation of claim.

Claim intimation
In case a claim arises you should:
Contact the respective life insurance branch office.
Contact your insurance advisor
Call the respective Customer Helpline

Claim requirements
For Death Claim:
Death Certificate
Original Policy Bond
Claim Forms issued by the insurer along with supporting documents
For Accidental Disability / Critical Illness Claim:
Copies of Medical Records, Test Reports, Discharge Summary, Admission Records of hospitals and Laboratories.
Original Policy Bond
Claim Forms along with supporting documents
For Maturity Claims:
Original Policy Bond
Maturity Claim Form
Incase of delay in settlement kindly refer to grievance redressal

To check various claim processes, click on the respective links.

Claims Procedure
AEGON Religare Life Insurance Company Ltd.

http://www.aegonreligare.com/customer_faqsc.php

Aviva Life Insurance Co. India Pvt. Ltd.

http://www.avivaindia.com/en/CustomerService/ClaimsProcedure.aspx

Bajaj Allianz Life Insurance Company Limited

http://www.bajajallianzlife.co.in/claims.asp

Bharti AXA Life Insurance Pvt. Ltd.

http://www.bharti-axalife.com/customer-care/claim_intimation.asp

Birla Sun Life Insurance Co. Ltd.

http://insurance.birlasunlife.com/CustomerSupport/Claims/tabid/146/Default.aspx

Canara HSBC Oriental Bank of Commerce Life

Insurance Co. Ltd.
DHFL Pramerica Life Insurance Company Limited

http://www.dhflpramerica.com/GrievanceProcedure.aspx

Future Generali India Life Insurance Co. Ltd.

http://www.futuregenerali.in/Life_Insurance/Claims/Claim_Procedure.aspx

HDFC Life

http://www.hdfclife.com/CustomerServices/Claims/Claims.aspx

ICICI Prudential Life Insurance Co. Ltd.

http://www.iciciprulife.com/public/Life-Claims/Claim-Introduction.htm

IDBI Federal Life Insurance Co. Ltd.

http://www.idbifederal.com/Download/Pages/default.aspx

ING Vysya Life Insurance Co. Ltd.

http://www.inglife.co.in/customer-service/claims/claims-process

Kotak Mahindra Old Mutual Life Insurance Limited

http://www.kotaklifeinsurance.com/ver2/claims.htm

Life Insurance Corporation of India

http://www.licindia.com/download_forms.htm

Max Life Insurance company Ltd.

http://www.maxnewyorklife.com/downloads/claim_form.aspx

PNB MetLife India Insurance Company Limited

http://www.metlife.co.in/MetLifeKCenter_FAQ_Claim.aspx

Reliance Life Insurance Company Limited.

http://www.reliancelife.com/rlic/Claims/ClaimsOverview/claims_overview.aspx

Sahara India Life Insurance Co, Ltd.

SBI Life Insurance Co. Ltd.

http://www.sbilife.co.in/sbilife/content/17_1026

Shriram Life Insurance Co. Ltd.

Star Union Dai-ichi Life Insurance Company Limited
Tata AIG Life Insurance Company Limited

http://www.tata-aig-life.com/Claims/default.htm

Claims Manager Career Responsibilities

By Exforsys | on November 20, 2006 | Comments: 0
Career Tracks

The Important Role of a Claims Manager

There are many different jobs and professions which one can engage in these days. From
participating in the medical field to being a sales representative for a small company, one
who is searching for a job has a wealth of options available to them.
One such position which interests many job seekers is that of a claims manager. By looking at
the general responsibilities of a claims manager and the specific duties which they undertake
each and every day in their job position, one can make an informed decision whether the job
position of claims manager is right for them.
What Is a Claims Manager?
Prior to detailing the responsibilities and duties of a claims manager, it is important to define
the position of a claims manager. A claims manager is an individual who works with insurance
claims to ensure that insurance issues have been settled and claims have been paid out to
interested parties. They must also ensure that the payments which were made were correct
and in accordance with company regulations.
General Responsibilities of a Claims Manager
A claims manager is responsible for undertaking many jobs related to their position. As for
general responsibilities, one who is a claims manager must maintain the insurance claim files,
review such files and ensure that payments have been completed and are correct. They must
follow up with any and all issues related to the insurance claims and direct such issues to
pertinent parties when necessary to have them resolved by those individuals. In the case of
litigation regarding the insurance claims, it is the claims managers responsibility to discuss
the matter with legal counsel and aid them in pursuing the litigation.
Specific Duties of a Claims Manager
One who fills the role of claims manager will find that their days are chock full of duties
relating to the carrying out of their occupation. One specific duty of a claims manager is to
maintain insurance claim files. They must keep the files in an organized manner and store
them in a secure location where they will not get lost or misplaced. They need to ensure that
the insurance claim files are able to be pulled out whenever they are needed for review or
action.
An individual who is a claims manager is also responsible for reviewing voluminous
documents relating to insurance claims. They must review insurance claim files to check on

the status of the file and ensure that claims have been paid out in a proper manner. The
claims manager is the individual who checks to see that claims have been filed in accordance
with the rules and regulations of the insurance company.
The claims manager must also complete a large amount of correspondence in their daily job
duties. The correspondence may take place via a variety of methods such as telephone, postal
mail, email, fax and in person. Correspondence will be between the claims manager and
claimants, company officials, doctors and lawyers. This type of communication is engaged in
for a variety of reasons such as ensuring that payment is/was made, resolve issues and obtain
necessary information so that the claims payments can be made as quickly as possible.
A claims manager must also undertake the completion of a number of different reports.
These reports must be made for a variety of reasons at various times such as during the
claims payment process or at the completion of a claims matter. The reports will usually
details current issues with a claims payment or state the resolution of a claims matter.
Claims managers must also deal with reserve issues. The reserve issues will be reviewed to
ensure that they are in accordance with company procedures. Written and verbal reports on
these issues will be given by the claims manager on a periodic basis.
One who is a claims manager must also provide verbal updates and lectures to company
officials and other employees regarding general or specific claims issues. The amount of
updates or lectures one is required to give will depend on a variety of factors such as their
position in the company and amount of claims issues which need to be discussed.
Positive Traits for all Claims Managers to Possess
Although every claims manager is different, there are a few different traits which claims
managers can really use in their daily work environment. An important positive trait for
claims managers to possess is wonderful analytical skills. Claims managers spend much of
the day reviewing insurance claim files and documents to ensure that claims have been paid
and they have been paid correctly. If a claims manager has good analytical skills, they will be
that much more likely to breeze through their daily job routine in an easy and efficient
manner.
One who is a claims manager should also deal well with other individuals. Since claims
managers will often have to consult with other company employees and outside parties, it is
important that they know how to deal with others in an effective and efficient manner. By
doing so, the claims manager will help to complete their job duties the best way possible.

Good public speaking skills are also important for a claims manager to possess. Claims
managers have to give verbal reports and lectures on a frequent basis so it is helpful if the
claims manager possesses good public speaking skill as this will help them in this part of the
job.
Wonderful researching skills will also aid the claims manager in their daily job duties
regarding the insurance field. Many times the claims manager will have to search for the
answer which they are looking for, whether it be relating to a particular case file or pertain to
company rules and regulations regarding claims. Whatever the case may be, excellent
researching skills will help the claims manager carry out their duties.
Conclusion
Filling the position of claims manager will provide an individual with interesting work on a
daily basis. As every insurance claim is different, the claims manager will appreciate the fact
that their job will vary from day to day as they will have to deal with a variety of insurance
claim issues. If one is looking for a position which allows the employee to apply wonderful
analytical and researching skills as well as correspond with a variety of different individuals,
becoming a claims manager might just be the perfect position for that individual to apply for
at an insurance company.

Insurance Claim Process

Click each product listed below to learn about the insurance claim process:General Insurance Claim Process

Claims under Fire / IAR policies

Burglary Claims / Money Insurance / Fidelity

Machinery Breakdown

Electronic Equipment

Household goods in transit

Health Guard Insurance Claim(for non-

Travel Companion Insurance Claim

cashless claims)
Personal Accident Claims

Hospital Cash

Marine Transit Loss

Workmen's Compensation

Rural Insurance (Cattle)

Car and Two Wheeler

Life Insurance Death Claim

Health Insurance Claim Process

Health Insurance Reimbursement Process

Claim Submission-FAQ

General Insurance Claim Process

All insurance contracts are based on the information provided by the insured in the proposal form. The
proposal form forms the basis of insurance contracts.
Some important points, which would help you in the claims procedure are:The loss or damage should be reported to the insurer immediately.
On receipt of claim intimation, the insurer will forward a claim form.
Submit the completed claim form along with an estimate of the loss to the insurer. It is preferable to
submit an itemized estimate with separate values.
The insurer will arrange for inspection of the damaged items to assess the loss. In case of major
losses, a specialist-licensed surveyor is deputed.
The insured has to provide the required documents to substantiate the extent of loss.
In case the cause of loss is not established, it is for the insured to prove that the loss or damage has
occurred due to an insured peril.
On agreement of claim amount between the insured and the insurer, the claim is settled.
Average Clause - As per the terms and conditions of the insurance policy.
Excess as stated as per the Policy terms and condition will be deducted from the claim payable.
In view of varied nature of policies, certain points distinct to individual policies, in addition to the above, are
listed below (documents mentioned are indications and based on the circumstances of the claim, insurer may
request additional documents).
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Claims under Fire / IAR Insurance

Firstly the insured should take all possible steps to minimize the loss.
The fire brigade may be intimated immediately.
Lodge a police complaint in case of a fire arising out of - rioting mob, striking workers, malicious
damage by third parties or terrorist damage.
Inform insurer as early as possible , in no case later than 24 hours.
To co-operate with the surveyor appointed by the insurer by relevant information.
Obtain a meteorological report in case of loss due to cyclone, flood & inundation. if the loss is
localized like in the case of flood & inundation from a local water source, MRO report may be obtained.
If the policy is on 'reinstatement basis', the claim is settled only after completion of
repairs/replacement of the damaged items and submission of bills for claim payment.
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Burglary Claims / Money Insurance / Fidelity

Immediately report to the police and obtain a non-traceable certificate that the items are not found.
Notify insurer as early as possible.

The insurers will insist upon a letter of undertaking on a stamp paper of appropriate value - letter of
Subrogation, for refunding the claim amount when the stolen property is recovered.
Obtain a final report from Police.
Insured has to provide the surveyor complete book of accounts and bills substantiating the loss on
the day of incidence.
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Machinery Breakdown
Immediate notification to the insurer.
Notice of claim and estimated cost of repairs should be filed with the insurers to arrange for
inspection.
In case of partial losses, no depreciation is charged but when the items are not insured for its present day
replacement value, the items are treated as underinsured and the claim amount is proportionately reduced.
Depreciation is only applied for Total Loss claims.
If an appliance is partially damaged, it should be repaired (on approval from insurance company)
before it is put to use, as otherwise further loss is not covered.
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Electronic Equipment
Immediate notification to the insurer.
Notice of claim and estimated cost of repairs should be filed with the insurers to arrange for
inspection.
In case of partial losses, no depreciation is charged but when the items are not insured for its present day
replacement value, the items are treated as underinsured and the claim amount is proportionately reduced.
Depreciation is only applied for Total Loss claims.
If an appliance is partially damaged, it should be repaired (on approval from insurance company)
before it is put to use, as otherwise further loss is not covered.
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Household goods in transit

In case any damage is suspected in transit, open delivery should be insisted upon the carrier and
their certificate should be obtained.
In case of loss/damage in transit, a monetary claim should be lodged with the carrier within the time
limit to protect recovery rights, without which, the claim may not be admitted.

Health Guard Insurance Claim (for non-cashless claims)

Notice of claim should be lodged within 24 hours.

The insured should submit 'discharge summary' of the hospital/nursing home along with original
hospital/medical bills,reports of the labs and investigation reports.In other words every item in the claim bill
should be supported.
Leave certificate from the employer, wherever needed.
Fitness certificate from the Doctor.
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Travel Companion Insurance Claim

The claim procedure varies from country to country and therefore the insured should get in touch with
the overseas claim settling agents of the insurers immediately.
The Insured should carry the policy document with him, which may be produced as evidence if
necessary. The policy document also contains the full information as to how to get in touch with the claim
settling agents for assistance.
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Personal Accident Claims

Immediate notification to the insurer.
In case of accidental death, the capital sum is paid to the legal nominee/assignee of the insured. If
the insured fails to provide the name of the nominee, succession certificate from a court of law is necessary.
In case of other claims, the insurers may get the insured examined by a specialist or refer the matter
to medical board as is necessary, the cost of which will be borne by the insurers.
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Hospital Cash
Discharge card from hospital to be submitted.
Any additional information requested by insurer.
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Marine Transit Loss

Original Invoice & packing List - if forming part of Invoice.
In case any damage is suspected in transit, open delivery should be insisted upon the carrier and
their certificate should be obtained.
Original LR/ BL - Qualified with remarks for the Quantity damaged or lost in the transit.
In case of Declaration Policy - The consignment should be declared and the within the limit of
balance Sum insured.
In case of loss/damage in transit, a monetary claim should be lodged with the carrier within the time

limit to protect recovery rights.

Damage / Shortage Certificate from the carrier.
A surveyor ( mutually agreed by the Insurer) must be appointed to determine the nature, cause and
extent of loss/damage.
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Workmen's Compensation
Work / Job profile.
Wage proof for last 12 months.
Age proof.
Employment proof.
Injury details and Medical Certificate.
Disablement Certificate.
Postmortem report in case of death.
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Rural Insurance (Cattle)

Ear tag.
Post-mortem report with cause of death.
Doctor's certificate for treatment.
Photograph of deceased animal.
For PTD claims - opinion of two doctors.
Other additional proof for substantiating loss.
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Car and Two Wheeler Insurance Claim

Notice of an accident (not necessarily a claim) involving third parties should be reported to the
insurers.
The insured may be interested to pay compensation without going into whether he is liable to pay or
not. It is therefore an express condition of the policy that no claim should be admitted or a compromise
arrived at, without the approval of the insurers.
In case of major claims, the insurers may be willing to defend criminal case against the driver also on
the basis of which compensation claims may be decided in the civil courts.
Every accident involving third parties is required to be reported to police. . The M. V. Act provides that
a third party victim can proceed against the insurers directly. If the alleged accident is not reported to the
insurers, the insurers can consider this as violation of policy condition. In such circumstances, even if
insurers are required to pay compensation by a court of law, they have an option of recovering such claim
amounts from the insured for violation of specific policy condition.
The insured can proceed with repairs provided the insurers are submitted an estimate of repairs and

the estimated cost of repairs does not exceed Rs.500 in case of Private cars and Rs.150 in case of two
wheelers.
Claims under Comprehensive policies
Steps to be taken in case of an accident:Notice of accident should be filed with the insurers.
If damage is a major one, the accident may be reported before the vehicle is removed from the spot
so that the insurers can arrange for spot inspection of damage.
The vehicle may then be moved to a workshop, preferably to authorized workshop, for estimation of
repair charges.
On receipt of completed claim form and estimate of repairs the insurers will arrange detailed
inspection of damage and cost of repairs will be ascertained.
The insurers will ensure that a person duly licensed drove the vehicle at the time of accident and that
the vehicle is the one insured in their books. To that end, they will verify the Registration Certificate and the
Driving license of the driver who drove at the time of the accident.
Upon completion of the above procedure, the repairers will be authorized to carry out repairs. The
insurer may undertake to settle the repair bills directly with the garage or reimburse the insured.
Insurers would like to collect the damaged parts for which replacements have been allowed, as
salvage. To ensure that replacements with new parts, have in fact, been effected.
In case of theft of the car or its accessories, it has to be reported to the police and final report should be
submitted.
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Life Insurance Death Claim

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Health Insurance Claim Process

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Health Insurance Reimbursement Process