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Step-by-step guidance for health, life and motor claims. Know exactly what documents to submit, what to expect, and how to avoid rejection. PolicyRaj is with you every step of the way.

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Claims by Type

Select Your Claim Type

Each insurance type has different steps and documents. Pick yours below for a tailored guide.

Cashless Claim

You get treated at a network hospital and the insurer pays the hospital directly. No upfront payment needed. Requires pre-authorisation from the insurer or TPA.

Reimbursement Claim

You pay the hospital bills yourself (at a non-network hospital), collect all original documents, submit them to the insurer, and receive the money back in your bank account.

1
Hospital Admission
Inform your insurer or TPA within 24 hrs for emergencies, or 3 days before for planned procedures. Go to an empanelled network hospital.
2
Pre-Authorisation
The hospital's insurance desk sends a pre-auth form to the insurer/TPA. This is mandatory for cashless processing.
3
Approval Received
TPA approves the treatment and room category. Approval covers the estimated treatment cost as per your policy limits.
4
Treatment
Get treated without worrying about payments. The insurer settles bills directly with the hospital on your behalf.
5
Discharge
Sign the discharge form. Collect a copy of the discharge summary and all bills. Pay only non-covered items (like cosmetic procedures).
1
Get Treatment
Pay hospital bills upfront. Keep every original receipt, prescription, and lab report. Do not lose any paperwork.
2
Collect Documents
Gather discharge summary, all original bills, prescriptions, investigation reports, and your claim form from the insurer's website or office.
3
Submit Within 30 Days
Send the complete document set to the insurer or TPA within 30 days of discharge — by post, courier, online portal, or the insurer's app.
4
Claim Processing
Insurer verifies documents and may contact the hospital directly. Processing typically takes 15–30 days from the date of complete submission.
5
Amount Credited
Settlement is transferred directly to your bank account (via NEFT). You receive an intimation SMS/email confirming the payment.

Health Claim — Document Checklist

Submit all originals. Photocopies are acceptable only where marked. Missing documents are the #1 reason for claim delays.

Duly filled claim form — signed by attending doctor & patient
Hospital discharge summary (original)
All original bills, receipts and payment proof
Doctor's prescription and treatment / operation notes
Investigation reports — X-ray, blood reports, scans, etc.
KYC documents — Aadhaar card & PAN card (self-attested copy)
Cancelled cheque (for reimbursement bank transfer)
Insurance policy document copy
Pre-authorisation approval letter (for cashless claims)
FIR copy (for accident-related hospitalisations)
Never hand over originals to an agent. Submit directly to the insurer or TPA.

Death Claim

Filed by the nominee after the policyholder's death. The sum assured is paid to the nominee. Requires death certificate and nominee KYC as primary documents.

Maturity Claim

Filed by the policyholder when the policy term ends and they are alive. The maturity amount (sum assured + bonus) is paid directly to the policyholder's bank account.

Rider Claim

Filed under add-on riders like Critical Illness, Accidental Death Benefit, or Permanent Disability Rider. Each rider has specific documentation requirements.

1
Notify the Insurer
Contact the insurance company within 30 days of the policyholder's death. Early intimation is not mandatory but significantly speeds up the process.
2
Collect Documents
Obtain the death certificate from the Municipal Corporation or Gram Panchayat. Gather the original policy bond and nominee's KYC documents.
3
Submit Claim Form
Fill the nominee's claim form (available on insurer's website or branch). Attach all supporting documents and submit at the nearest branch or online.
4
Investigation (if applicable)
For policies under 2 years old, the insurer may investigate the cause of death. A surveyor may visit or request additional medical records.
5
Settlement
Once verified, payment is made to the nominee within 30 days of complete document submission. IRDAI mandates interest for delays beyond 30 days.
1
Receive Intimation
Insurers typically send a maturity intimation letter 1–3 months before policy end date. Check your registered email and address well in advance.
2
Verify Bank Details
Ensure your registered bank account and IFSC are correct with the insurer. Update if there have been any changes using a KYC update form.
3
Submit Maturity Form
Fill and submit the maturity discharge form along with original policy bond, KYC documents, and cancelled cheque to the insurer.
4
Document Verification
The insurer verifies the submitted documents against their policy records. This usually takes 7–15 working days.
5
Maturity Paid
Maturity amount (sum assured + accumulated bonus) is credited to your bank account via NEFT on or before the policy maturity date.

Life Claim — Document Checklist

Requirements vary by claim type. Items marked are for death claims; maturity claims need fewer documents.

Original death certificate issued by Municipal Corporation / Gram Panchayat
Original policy bond / policy document
Claim form — filled and signed by nominee (death) or policyholder (maturity)
Claimant's KYC — Aadhaar card & PAN card (self-attested copy)
Nominee's bank account proof — cancelled cheque with name printed
Medical certificate stating the cause of death (from treating doctor)
Hospital treatment records (if death occurred in hospital)
FIR report & post-mortem report (for accidental death)
Income / employment proof of deceased (required by some insurers)
NEFT mandate form with claimant's bank details
For policies under 2 years, expect closer scrutiny. Keep all documents ready.

Own Damage (OD) Claim

Covers damage to your own vehicle due to accidents, fire, natural calamities, or vandalism. Available only under Comprehensive or OD-only policies. Not covered by Third-Party only plans.

Third-Party Claim

Covers legal liability for damage or injury caused to a third party (another vehicle, property, or person). Mandatory by law under the Motor Vehicles Act. Settled via MACT court if disputed.

1
Inform the Insurer
Call the insurer's claim helpline immediately after the accident — or within 24 hours. Take photos of the damage from multiple angles before moving the vehicle.
2
Surveyor Arranged
The insurer arranges a licensed surveyor within 48 hours. The surveyor inspects and photographs the damaged vehicle to assess the loss.
3
Vehicle to Garage
Take your vehicle to an authorised network cashless garage. The surveyor assesses repair requirements and approves the repair estimate.
4
Repairs Begin
Insurer approves the estimate and repairs commence. You may be asked to pay a compulsory deductible (typically ₹1,000–₹2,000 or depreciation amount).
5
Collect Vehicle
Once repairs are complete, the insurer pays the garage directly. You pay only non-covered items. Sign the satisfaction voucher and collect your vehicle.

When is FIR required? An FIR is mandatory for theft, third-party injury/death, and major accidents involving damage to public property. For minor fender-benders with no third-party involvement, an FIR is generally not required — but always safer to file one.

1
File an FIR
File an FIR at the nearest police station immediately. This is mandatory for all third-party claims involving injury, death, or property damage.
2
Inform Your Insurer
Notify your insurance company within 24 hours with the FIR number, accident details, and third-party contact information.
3
MACT Court Petition
If the third party files a claim at the Motor Accident Claims Tribunal (MACT), the insurer handles legal representation on your behalf.
4
Surveyor Assessment
A surveyor assesses third-party property damage. For injury / death claims, medical records and legal documents are reviewed by the insurer.
5
Award & Settlement
The MACT or insurer determines the compensation. The insurer pays the award directly to the third party. You have no out-of-pocket expense under TP cover.

Motor Claim — Document Checklist

Have these documents ready when you call the insurer. The faster you submit, the faster your claim is processed.

Duly filled motor claim form (from insurer's website)
RC (Registration Certificate) — self-attested copy
Valid driving licence of the driver at the time of accident
Insurance policy copy (front page with policy number)
FIR copy — for theft, TP claims, and major accidents
Original repair bills and labour charges (for reimbursement)
Photographs of damage — taken before repair begins
Panchnama or police spot report (for theft or major damage)
Both sets of keys (for total loss or theft claims)
NOC from financer / bank (for loan-funded vehicles)
Do not repair the vehicle before the surveyor has assessed it — this can void your claim.
Know Before You Claim

Top Reasons Claims Get Rejected

Avoid these common mistakes that cause insurers to deny or partially settle claims.

1

Non-Disclosure of Pre-Existing Conditions

Failing to declare a pre-existing illness (diabetes, hypertension, etc.) at the time of buying is the most common reason for claim rejection, especially in health and life policies.

2

Waiting Period Not Completed

Most health policies have a waiting period of 2–4 years for pre-existing diseases and 30 days for general illnesses. Claims filed during this window will be denied.

3

Procedure Not Covered Under Policy

Cosmetic surgery, dental treatments, self-inflicted injuries, and experimental treatments are commonly excluded. Always check the policy exclusions list before admission.

4

Incomplete or Incorrect Documents

Missing documents, mismatched names, unsigned claim forms, or illegible reports all cause delays and rejections. Double-check every item in the checklist above.

5

Policy Was Lapsed at Time of Claim

If you missed your premium renewal and the policy lapsed, you have no coverage. Always pay premiums before the due date and check your policy's grace period (usually 15–30 days).

6

Claim Filed After Time Limit

Each insurer has a strict timeline — typically 24 hrs (motor), 30 days post-discharge (health), or 30 days from death (life). Missing the deadline gives the insurer grounds to reject.

Expert Tips

Pro Tips for Faster Claims

Sachin Kathuria's 20 years of claims experience distilled into 6 actionable tips.

Read Exclusions Before You Buy

Most people skip the exclusions page. It contains the list of situations where the insurer will NOT pay. Reading it upfront prevents nasty surprises at claim time.

Inform the Insurer Immediately

Do not wait. Call the insurer or TPA within 24 hours of an accident or hospital admission. Early notification prevents procedural rejection on time-limit grounds.

Keep All Originals Safe

Never hand originals to an agent, hospital liaison, or third party. Submit documents directly to the insurer or TPA. Keep a scanned copy of everything you send.

Use the Insurer's App or Portal

Most insurers now have mobile apps for claim intimation and tracking. Digital submission is faster, trackable, and time-stamped — reducing processing time significantly.

Contact PolicyRaj for Claim Disputes

If your claim is unfairly rejected or partially settled, call Sachin Kathuria on 9013976999. He mediates with insurers on your behalf — at no charge to PolicyRaj clients.

File with the Insurance Ombudsman

If the insurer ignores your grievance for 30 days, escalate to the IRDAI Insurance Ombudsman. It's a free, quasi-judicial body with power to direct settlement. Visit bimabharosa.irdai.gov.in.

Claim Helplines

Emergency Claim Contacts

Save these numbers before you need them. Call us first — we'll guide you through the right number.

HDFC ERGO

Health & Motor Claims

ICICI Lombard

Health & Motor Claims

Bajaj Allianz

All Claims

Niva Bupa

Health Claims

HDFC Life

Life & Rider Claims

LIC of India

Life Claims

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