Insurance is all about your financial security during uncertain moments. Health insurance to cover medical expenses, life insurance to protect future or term insurance to secure your family’s future, the true value of insurance is realized when you successfully file a claim. Most of the policyholders find the claiming process confusing & difficult to understand due to technicalities, lengthy paperwork and lack of guidance.
This guide will explain in detail how to file an insurance claim in India, covering both life insurance and health insurance claims. We’ll also break down the two types of health insurance claims cashless and reimbursement – to help you understand the step-by-step process clearly.
Why Understanding the Claim Process is Important
Insurance is about protecting your & your family’s future and getting about at the emergency time. It helps you to be financially protected and knowing how to claim it is the most important part. A smooth claim settlement process in advance saves stress and gets the amount on time. Understanding the claim process will increase the chances of quick approval, reduce stress and delays.
Filing the Claim of Life Insurance in India
Life insurance is a way to provide financial support to a policyholder's family after your demise. The process of claims involves following steps carefully & submitting the correct documents.
Step-by-Step Claim Process of Life Insurance
Immediately inform to Insurer
Once the demise of the policyholder takes place, notify the insurance company soon.
One can visit the branch, contact the customer care or connect with an agent.
Collect and Submit Documents
The claimant (usually nominee/legal heir) needs to submit essential documents:
Death Certificate (issued by municipal authority)
Original policy document
Claim Form (provided by insurer)
Identity and address proof of nominee
Medical records (if death occurred in hospital)
Police FIR/post-mortem report (in case of accidental or unnatural demise)
Documents Verification by the Insurance Company
The policy details are checked. The documents alongwith the payment of premium is being verified by the insurer.
In some cases, an investigation may be conducted if death occurred within the first few years of the policy (as per the contestability clause).
Claim Settlement
Once the verification is done, the sum assured is transferred by the insurer to the nominee’s bank account.
As per IRDAI (Insurance Regulatory and Development Authority of India) guidelines, insurers must settle life insurance claims within 30 days* of receiving all documents.
If need arises, settlement must be completed within 120 days*.
Tips for Hassle-Free Life Insurance Claim
Ensure nominee details are correctly updated in the policy.
Avoid policy lapses by paying premium regularly.
Receipts and medical records must be organized in a file, complemented with the policy documents.
Filing a Health Insurance Claim in India
The procedure to file a claim during health insurance is different compared to life insurance as the former involves hospital expenses, medical bills as well as treatments. The claims can be made in 2 ways: Cashless & Reimbursement Claim.
1. Cashless Health Insurance Claim
In a cashless claim, the insurer directly settles the bill with the hospital. The insured doesn’t have to pay anything (except non-covered items like food, consumables, or certain service charges). Below are the steps to file a cashless claim:
Step 1: Choose a Network Hospital
Check your insurance provider’s list of network hospitals before getting admitted.
Cashless facility is available only at empanelled hospitals.
Step 2: Exhibit Health Card or Policy Details
One is required to furnish a health insurance card/policy number at the hospital desk.
Step 3: Pre-Authorization Request
The hospital’s TPA (Third Party Administrator) sends a pre-authorization form to the insurer.
The particulars like patient details, diagnosis, and estimated treatment costs are included in the form.
Step 4: Insurer’s Approval
The cashless treatment is approved by the insurer/TPA preceded by review of TPA/insurer.
The time period of the approval is within a few hours in case of emergencies.
Step 5: Treatment and Settlement
The insured undergoes treatment without paying upfront (except excluded expenses).
After discharge, the hospital sends final bills and reports to the insurer for settlement.
The insurer settles the hospital bills on your behalf.
Points to Recollect for Cashless Claims
In case of emergency hospitalization, intimate to the insurer/TPA within 24 hours.
One needs to notify the insurer up to 72 hours before admission for planned surgeries.
Retain copies of all documents (bills, discharge summary, test reports).
2. Reimbursement Health Insurance Claim
If the insured chooses a non-network hospital or pays upfront, they can later claim reimbursement. Get the guidance step by step to file a Reimbursement Claim.
Step 1: Pay the Hospital Bills
The insured pays for hospitalization, medicines, and other expenses directly.
Step 2: Collect All Documents
Keep the following:
Original hospital bills & receipts
Doctor’s prescription & diagnosis report
Discharge summary
Pharmacy bills
Diagnostic test reports
Insurance claim form
Step 3: Submit Claim Form and Documents
Attach all the documents with the duly filled complete claim form and submit them to the insurance company/TPA.
Step 4: Verification by Insurer
Medical records, bills, and policy coverage are being verified by the insurer.
If the details are unclear, additional queries may be raised.
Step 5: Claim Settlement
Once approved, the insurer reimburses the expenses into the insured’s bank account.
The duration for the claim settlement after document submission usually takes up to 4 weeks.
Suggestions for Reimbursement Claims
Before submitting the documents, ensure to have photocopies of the documents.
Submit claims within the specified time (usually 7–15 days* post-discharge).
Make sure that hospital bills are itemized and stamped.
Common Reasons for Claim Rejection
Non-disclosure of pre-existing diseases.
Policy lapsed due to non-payment of premium.
Treatment not covered under the policy.
Submitting incomplete or false documents.
Lapse of claim submission form period.
Conclusion
If we understand the process of filing an insurance claim, it would be smoother and not as overwhelming as one assumes.
If a person is looking to file for a life insurance claim, then the insurer must be informed quickly. In addition, he needs to submit the required documents to the insurance firm and can expect settlement within 120 days*.
On the other hand, a health insurance claim is slightly different as one can look for cashless treatment (hospital on panel of insurance) else get reimbursed by furnishing the required hospital bills.
A right claim procedure can ensure the insured to obtain the benefits without any unnecessary stress.
If a person is well aware, choses right insurer, maintains proper documentation, he can expect nothing less than a hassle-free claim experience.