Services
Claims Management
Risk
Management
Claims Management
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Claims Management
In the event of any loss or damage, our experienced claims department will assist
you with lodgment, negotiation and settlement.
The following process should be adopted if an accident or loss occurs:
Advice police if it is a crime or a motor accident or a major accident/loss (obtain
a copy of first information report)
Do not make any statements or admit liability
Advice insuranzone.com immediately
Complete incident report/claim form, if available
Make sure the area is safe and no further claims can occur
Await instructions from us.
What we do when you report a claim
Our claim service processes
Receive your claim Intimation
Collect more details from you with regard to the insurance policy and about the
accident
Verify your information with policy details
Register the claim and Create Claim Intimation Slip
Forward the claim slip to the Insurer by mail / Fax and then send Hard copy also
Organize surveyor for immediate survey by the insurer (For health related claims
TPAs are intimated for immediate attention)
We forward you a claim form either soft or hard copy for completion and return and
procedures to be followed and carried out by you are explained in How to get quick
action on your claim.
Create claim Docket with claim intimation slip, policy copy, other written communications
and then copy of the duly filled claim form, estimates, survey reports etc.
Inform the surveyor about his appointment for loss assessment by the insurance company
and also inform you, the Surveyors name and telephone number and Advice you how
to cooperate with the surveyor for assessment.
We assist you in filling claim forms if so required and to provide documents to
the surveyor.
Closely follow with the surveyor for effective progress of the claim process and
have continuous interaction with you, your insurer wherever necessary for completion
of assessment.
Ensure faster delivery of survey report by the surveyor to the insurer
Follow up with the insurer/TPAs for speedy processing
Any queries from the Surveyor/insurer attended immediately by collecting required
information.
Collect the Claim approval from the insurer and forward the same to you for your
approval
If you agree, we collect the cheque from the insurer and deliver it to you
If you do not agree, we organize for a re-negotiation. A re engineering process.
If your claim is denied /delayed / not satisfied, we help to file claims with Ombudsman
or organize dispute resolution process or Advice a suitable legal Adviser for filing
a civil dispute with the court.
How To Get Quick Action On Your Claim
Complete the claim form and return to our office.
Advice the Police immediately in the event of loss by burglary, housebreaking, theft,
suspected malicious damage. Also make sure the premises are secure to avoid further
incidents. If an FIR could not be obtained from Police, at least you can obtain
the acknowledgement of your complaint from them or take note of the report number.
If an assessor is appointed by that time, supply the claim form to the assessor.
Attach all original quotations obtained for replacement of, or repair to, the damaged
or missing property. Photocopies are not always accepted.
Attach original valuations and receipt of purchases whenever possible.
Attach any letter of demand and any other correspondence that you may receive from
a Third Party.
Do not make any admission of liability for loss or damage caused by you to Third
Parties.
Documents required in case of a motor accident:
RC book in original along with a photo copy
DL in original along with a photo copy of the driver who was driving at the time
of accident (DL is not required for theft).
Policy copy
Estimate of repairs from an authorized dealer or repairer
FC (fitness certificate) in original along with a photo copy for commercial vehicle
Permit in original along with a photo copy for commercial vehicles
Police FIR for major accidents or acknowledgement of complaint
Non-traceable Certificate (NTC) in case of theft loss
Accident Spot Photographs if taken
Details of TP vehicles such as RC book copy, DL copy and insurance policy/certificate
copy if involved
Documents required in case of a personal accident
In case of road accident, file an FIR directly or thro' the hospital where you are
admitted.
Discharge summary in original along with investigation reports, Scan reports, X-ray
reports, MRI reports, Doctors prescription with medicine purchase bills, Bill for
the hospital stay and break-up cost of hospital bill and the break up cost of medicine
bills if they form part of the discharge summary.
Employer's certificate for absence if employed or FC from the attending doctor if
not employed.
Post mortem certificate in case of death
Police inquest (final investigation report) report in case of death.
Documents required in case of an health insurance
Discharge summary in original along with investigation reports, Scan reports, X-ray
reports, MRI reports, Doctors prescription with medicine purchase bills, Bill for
the hospital stay and break-up cost of hospital bill and the break up cost of medicine
bills if they form part of the discharge summary.
Any medical reports, bills and receipts available prior to the hospitalization
Any medical reports, bills and receipts available after the discharge from hospital
Policy copies of earlier years
Documents required in case of a house hold insurance
In case of theft loss, FIR or acknowledgement of complaint from police.
List of items lost with description and their value
Proof of purchase if required by the insurer
Non-traceable Certificate (NTC)
In case of Fire Loss, Fire brigade report and police report if given
Repair / replacement estimate from dealers / manufacturers / repairers
In case of natural calamities like Flood, cyclone etc, weather report if caused
by AOG peril
Estimates as in 6 above
In case of appliances Breakdown loss, estimates as in 6 above
What is the role of a loss assessor:-
An assessor is an independent licensed person who is appointed by the Insurer for
their impartiality and expertise in assessing the loss.
They will interview and obtain details of a loss, and assess the loss based on the
estimates provided by you.
Cause of loss as stated by you is required to be certified by the loss assessor
The assessor is your contact point during the process of the assessment
The assessor will write a report to the Insurer recommending a course of action.
If required you can obtain a copy of the report.
The surveyor is expected to issue report within 30 days but normally it takes time
depending on their work load, speed of receiving documents from you and the complexity
of your claim.
The Insurer will not act until these reports are received and although not bound
by the assessor's recommendations, the Insurers usually accept these reports.
If you are unhappy or not satisfied with any aspect of the claim or with the Assessors'
responses, advise us to take over the process of negotiation.