Insurance Claim Terms - Full Explanation

Insurance is one way that someone does to avoid risks that might occur in the future. In this case, insurance provides financial protection for someone when something unexpected happens, such as illness or accident. Even though insurance provides many benefits, the insurance claim process is often a scourge for many people. How does the insurance claim process actually take place? What are the conditions that must be met in order to claim insurance? Check out the full explanation below.

1. What is an Insurance Claim?

An insurance claim is a process in which a customer or insurance participant submits a request for payment to the insurer in accordance with the agreed insurance policy or contract. The insurance claim process occurs when an insured event occurs and the customer or insurance participant has the right to request compensation from the insurer.

2. Types of Insurance Claims

The types of insurance claims can be divided into several categories, namely:
    • Health Insurance Claims This claim relates to the reimbursement of health costs experienced by the customer, such as hospitalization, surgery and other medical care costs.
    • Life Insurance Claims This claim relates to reimbursement of funds received by heirs or families of insured participants who have died.
    • Car insurance claim This claim relates to reimbursement for the cost of repairing or replacing a car damaged or lost due to an accident or theft.
    • Home Insurance Claims This claim relates to reimbursement for the cost of repairing or replacing a house that is damaged or lost due to natural disasters, fire, theft, or other events.
    • Education Insurance Claims This claim relates to the payment of education funds for children of insurance participants if the customer dies or suffers total permanent disability.
    • Travel Insurance Claims This claim relates to the reimbursement of expenses experienced by the customer when traveling, such as ticket costs, accommodation and medical expenses.
    • Employment Insurance Claims This claim relates to the reimbursement of expenses experienced by the customer when traveling, such as ticket costs, accommodation and medical expenses.

3. Terms of Insurance Claims

Before submitting an insurance claim, there are several conditions that must be met, including:

The completeness of document

In general, the insurer will ask for documents as proof of the claims submitted. Some of the documents that are usually requested are:
    • Claim form
    • Doctor’s certificate (SKD)
    • Police report (for motor vehicle insurance claims)
    • Death certificate (for life insurance claims)
    • Original receipt or invoice (for property insurance claims)

Report to the Insurance Party

After the claim documents are prepared, immediately report them to the insurer. There are several ways you can do to report an insurance claim, including by telephone, email, or coming directly to the insurance office. Make sure you provide honest and accurate information when reporting an insurance claim, including information about the incident that occurred and the type of damage or loss suffered.

Waiting Period

The waiting period is the period of time that must be waited before a claim can be processed by the insurer. The waiting period is usually specified by the insurer in an insurance policy or contract. In general, the waiting period for health insurance claims is 30 days, while for motor vehicle insurance claims it is 14 days. Be sure to find out the waiting period that applies to the type of insurance claim you are submitting.

Not Providing Incorrect Information

Be sure to provide honest and accurate information when filing an insurance claim. Do not provide untrue information or cover up important information, as this can result in rejected insurance claims or lower claim payments than they should.

4. Insurance Claim Process

The insurance claim process usually goes through three stages, namely:

Claim Check

The insurer will examine the claim documents submitted by the customer or insurance participant. Checks are carried out to ensure the correctness of the information and documents provided.

Determination of Claim Size

After the inspection is complete, the insurer will determine the amount of claims that can be accepted by the customer or insurance participant. The amount of the claim determined will be based on the type of incident that occurred and the insurance policy or contract that has been agreed upon.

Payment of claims

After the amount of the claim is determined, the insurer will pay the claim to the customer or insurance participant. Payments can be made directly to the account of the customer or insurance participant, or in the form of a check or giro.

5. How to Submit an Insurance Claim

The following are ways to file an insurance claim:
    • Immediately report the incident to the insurer.
    • Prepare the required claim documents.
    • Make sure the documents submitted are complete and accurate.
    • Follow the claim procedure that has been determined by the insurer.
    • Do not misrepresent or withhold important information.

6. Common Mistakes in Submitting Insurance Claims

Some common mistakes that can occur when filing an insurance claim include:
    • Failure to report incidents or damage in a timely manner.
    • Not reading the insurance policy or contract carefully before filing a claim.
    • Did not collect the required documents completely.
    • Providing incorrect information or covering up important information.
    • File a claim for loss or damage not covered by an insurance policy or contract.

7. Conclusion

An insurance claim is a claim or request for payment for damage or loss experienced by a customer or insurance participant. To submit an insurance claim, it is necessary to prepare complete and accurate claim documents and pay attention to the procedures set by the insurer. Common mistakes in filing insurance claims can result in claims being rejected or claim payments being lower than they should be.
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