Types of Insurance Claims, from Health to Property

The following types of insurance claims are important to know so that you are not mistaken in submitting an insurance claim.

The definition of an insurance claim is a submission from a customer to an insurance company to pay their rights in the form of benefits from the agreement in the policy.

In fact, it is not uncommon for people to make mistakes about the claim process so that their application is rejected. So, to understand more about this insurance claim and its types, take a look at the following review.

Some Causes of Rejected Insurance Claims

So that the claim process can run smoothly, you should first consider the following 14 possibilities:

  • The policy is not active or lapsed.
  • The risk of claims is not included in the clause.
  • The risk of claims is included in the exception.
  • Claims beyond the specified time.
  • Incomplete claim documents.
  • The insurance policy is still in the waiting period.
  • Claims are included in pre-existing conditions (diseases that existed before registering for insurance).
  • Police holders are breaking the law.
  • Policyholders commit insurance crimes.
  • The area where the risk occurs is not covered by insurance.
  • No longer guaranteed by the company.
  • Already exceeded the limit covered.
  • Insurance does not accept double claim benefits.
  • Not in a partner workshop/hospital.

The following is a review of the types of insurance claims:

Types of Insurance Claims

Of course, the method of claiming each insurance will be different and adjusted to the policy you have. Well, here are the types of insurance claims that you need to know.

1. Health insurance claim

There are two claim methods to choose from, namely cashless and reimbursement. Cashless is a non-cash claim method, while reimbursement requires customers to pay hospital bills with personal funds first. This is the insurance claim procedure.

Cashless:

  • You need to bring your personal identity and membership card when you visit the insurance partner hospital (RS).
  • The hospital will verify your data and ask for a letter of guarantee from the insurance company.
  • You will be asked to fill out a claim form.
  • After the administration is done, you are welcome to undergo treatment.
  • When you want to go home, the hospital will check your data and if there is an excess cost that exceeds the claim, you need to pay it.
  • Cashless claims can only be used at insurance partner hospitals.

Cashless health insurance claim requirements:

  • Original insurance participant card.
  • Card Without Resident (KTP).

Reimbursement:

  • You need to come to the hospital and undergo medical treatment.
  • Pay hospital fees and don’t forget to ask for documents such as lab results, payment receipts, diagnosis letters from doctors, and others.
  • Submit the required documents to the company.
  • The insurance company will process your claim and refund the cost of medical treatment.
  • Reimbursement claims can be used at hospitals outside the company’s partners.

Reimbursement health insurance claim requirements:

  • The original police
  • Claim form which can be downloaded on the company’s official website
  • Proof of general check-up
  • Original doctor’s certificate
  • Original laboratory and/or radiology results
  • Original hospital receipt
  • If treated due to an accident, please include a police certificate

2. Life insurance claims

In this type of life insurance claim, death insurance claims will be given in the form of cash compensation. That means, if there is a risk of death, compensation will be given according to the general policy agreement via bank transfer. The following is the insurance claim procedure:

  • To file a claim, first report to the insurance provider that the insured has died, not later than 7 days after the incident. It depends on the policy, yes.
  • Then the heirs send the necessary documents, such as claim forms, identity cards and policy cards.
  • After receiving the file, the insurance company will verify the correctness of the data and match it with the policy provisions.
  • If the documents are in accordance with the provisions, the insurer will disburse the sum insured to the account of the heirs.

Life insurance claim requirements:

  • Claim form on life insurance which can be downloaded on the company’s official website
  • Identity Card (KTP) in the form of a photocopy
  • Original family certificate and photocopy
  • Original birth certificate and photocopy
  • Proof of first premium payment

3. Claim car insurance

The way to claim on car or vehicle insurance is divided into two categories, namely all risk and TLO. All risk itself means to bear damage ranging from mild to severe damage so that the way to claim car insurance is scuffed into all risk.

Meanwhile, for the risk of loss such as due to theft or falling, you can file a TLO claim. This is the insurance claim procedure.

All risk:

  • Photos of damaged car parts as evidence. This proof of insurance claim will help you so that the claim submitted can be approved by the insurance company.
  • Create a chronology of car damage due to accidents.
  • Visit partner workshop.
  • Fill out the claim form at the workshop and include other supporting documents.
  • The workshop will confirm your data to the company and if approved then they will repair your car.

How to claim on TLO car insurance:

  • Report the case of lost car to the police station.
  • Make a written chronology of cases of lost cars.
  • Include a claim form, identity card, and other supporting documents and send it to the company.

Car insurance claim requirements:

  • Insurance policy
  • Driver’s License (SIM)
  • Vehicle Registration Certificate (STNK)
  • BPKB for car vehicles
  • Insured Identity Card (KTP)
  • LKKB (Motor Vehicle Accident Report)
  • Accident chronology letter
  • Certificate of loss of car if as a result of theft

4. Claim travel insurance

For this type of travel insurance, the claim is divided into two methods, namely cashless and reimbursement. Cashless can be used if there is a health risk during the trip, while reimbursement is used if there is a risk of discomfort during the trip, such as delays, lost luggage, and the like. This is the procedure for claiming travel insurance benefits.

Cashless:

  • Bring the required claim documents
  • Show the document to the hospital
  • The hospital will verify the data
  • Then, fill in the claim form provided by the hospital
  • Welcome to treatment
  • After that, the hospital will check the data and if there is an excess fee that exceeds the limit then you need to pay the bill
  • Cashless claims can only be used at partner hospitals (both at home and abroad)

Cashless travel insurance claim requirements:

  • Original insurance participant card
  • Identity Card (KTP)

Reimbursement:

  • Fill in the claim form which can be downloaded on the company website
  • Submit a claim
  • If approved and in accordance with the policy, the insurance company will provide compensation for the cost of the loss.

Reimbursement insurance claim requirements:

  • Claim submission form
  • Identity Card (KTP)
  • Flight ticket
  • Airline certificate
  • Medical certificate
  • Police certificate
  • If there is a flight cancellation, make sure the documents provided are valid or have letterhead, signature, stamp, and so on

5. Claims on property insurance

To note, property insurance has a way of claiming that is more complicated than other insurances. The reason is, there is a loss adjuster appointment if the claim is complicated and the amount is large.

For example, there was a factory fire and the losses reached billions so that the best fire insurance company would appoint a loss adjuster for further questioning. Here is the claim procedure:

  • Include the required claim documents
  • Make a report and explain the cause of the loss
  • Stages of policy research by the insurance company
  • Stages of claim research by the insurance company
  • If the loss is large, the insurance company will show a loss adjuster to conduct further research
  • If approved, the claim process will generally be disbursed within 14 working days

Claim terms:

  • Insurance claim form
  • Letter of claim for damages
  • Police report or village head
  • Quotation from contractor for repair costs
  • Certificate and other evidence requested by the insurance company

What If Insurance Claim Is Denied?

Well, after making sure that you have met the requirements above, but in fact the claim is still rejected, then you can try the following solutions:

  • Check insurance policy
  • Contact insurance company
  • Contact insurance broker

Thus a review of the types of insurance claims that need to be understood. Want to file an insurance claim? Understand again yes the types above. Good luck!

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