How Are General Insurance Claims Processed?


An insurance policy helps provide financial coverage for any unexpected losses that you might face. These situations can be related to health, accidents, or other losses. Whatever the case, a general insurance policy sought specifically to cover such a contingency comes to the rescue.

What is an insurance claim?

An insurance claim is the process where you, the policyholder, seek compensation from the insurance company when a contingent event occurs. Not all contingent events are covered by the general insurance policy, but only those that are mentioned within the policy’s scope. The insurance company basically promises to compensate you when such a contingent event takes place.

Every type of insurance policy has a specific process for raising a claim, which depends on the policy specifics. This article elaborates on the claim process for different types of general insurance plans.

Motor Insurance Plans

Motor insurance is the only insurance cover that is mandatory as per the Motor Vehicles Act of 1988. This law requires all vehicle owners to have a policy as part of legal compliance. To raise a motor insurance claim, you need to keep in mind the type of insurance plan, i.e., a third-party policy or a comprehensive plan, as the process slightly differs in each case.

All third-party insurance claims begin with the process of informing the insurance company. An FIR is required along with the application form since a third-party plan compensates only a third person for injuries and damages. The Motor Accidents Tribunal is the appellate body that decides the amount of compensation that must be paid, and the insurance company is accordingly directed to compensate the aggrieved person.

Comprehensive plans, on the other hand, cover not just the damage to a third person, but also any damage to the policyholder’s vehicle. Hence, an FIR isn’t always required. In the case of a reimbursement claim, you need to pay for the repairs first, followed by the reimbursement from the insurance company. Here, you are required to submit the invoices for repairs and, only after scrutinizingthem, the insurance company pay the amount of compensation.

For cashless claims, an insurance surveyor is appointed to assess the damage. Only after such an assessment can any repairs be carried out in a network garage. The insurance company directly settles the cost of repairs with the service garage. *Standard T&C Apply

Health insurance plans

Similar to motor insurance policies, the claim process for health insurance plans is dependent on whether the plan offers a cashless facility or not.

Cashless health insurance claims can be made only at a network hospital where the hospital is affiliated with the insurance company’s network. You need to seek authorization from the insurance company in the case of a planned medical procedure, and only then the compensation will be provided.

For reimbursement of health insurance claims, you need to submit all the necessary treatment-related documents to the insurer. Based on the permissible limits in your insurance policy, a payout is provided by the insurer for the admissible treatment costs.

Standard T&C Apply

Remember to read the policy documents thoroughly and understand the claim process, both at purchase and during insurance renewal. Doing so will help avoid any unexpected challenges when raising a claim with your insurance company. Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms and conditions, please read sales brochure/policy wording carefully before concluding a sale.

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