An insurance claim is an official request to the insurance company asking for a payment based on the provisions of the insurance policy. The insurance company reviews and evaluates the claim for its validity and then pays out to the insured or requesting party once approved.
The non-life insurance industry is eye witnessing drastic shifting trends across the two core functions in insurance_ policy administration and claims.
The claims process is the crucial and essential moment in a non-life insurance customer relationship. Insurers are majorly focused on enhancing customers’ claims experience to keep hold of and to grow market share and also to improve customer acquisition and retention rates.
In a vastly competitive insurance market, segregation through new and more effective claims management practices is one of the most vital and effective way to maintain and sustain market share and profitability.
Above all, insurers can convert the claims processing by leveraging modern claims systems that are incorporated with vigorous business intelligence, document and content management systems. This will boost claims processing efficiency and effectiveness. It can operationally and strategically benefit the insurers by permitting them to reduce claims costs to perk up their combined ratio, improve claims processing efficiency, and accelerate customer retention and acquisition.
Nowadays in any insurance office the claim process is built up on:
- Claim document & content management tool
- Mobile and smart phone based technology solutions key
- STP processing to reduce delay
- Modern claim processing platform which is flawless & robust
Normal claim process practiced by General Insurers
- Firstly the insured or the claimant may give notice to the insurer of any loss occurring under contract of insurance as early as possible or within the extended time as may be permitted by the insurer.
- On receiving information of such a notice, a general insurer will respond straight away and give clear indication and instructions to the insured on the procedures that he has to follow.
- In cases where a surveyor has to be prearranged for assessing a loss/ claim, it must be done within 72 hours of the receipt of intimation given.
- Where the insured is not capable to furnish all the particulars required by the surveyor or where the surveyor does not get the full cooperation of the insured, the insurer or the surveyor in either case, shall inform in writing the insured about the delay and hold-up time that may result in the assessment of the claim.
- The surveyor shall be issued /subjected to the code of conduct laid down by the Authority while assessing the loss, and will communicate his findings to the insurer within the period of 30 days of his appointment with a copy of the report being secured to the insured, if he so requests. Where, in special circumstances of special and complicated nature case, the surveyor shall under hint or intimate the insured, and seek an extension from the insurer for submission of his final report.
- In none of the cases shall a surveyor take more than six months from the date of his appointment to hand over the receipt of the survey report or the additional survey report, which ever case may be, an insurer shall within a span of 30 days offer a settlement of the claim to the insured. If the insurer, for any reasons to be proofed in writing and communicated to the insured, decides to decline a claim under the policy, it shall do so within a span of 30 days from the receipt of the survey report or the additional survey report, which ever the case may be.
- The payment amount due shall be made within 7 days from the date of acceptance of the offer by the insured after acceptance of an offer of settlement by the insured. In the cases of delay or hold up in the payment, the insurer shall be legally responsible to pay interest at a rate which is 2% above the bank rate prevailing at the beginning of the financial year in which the claim is reconsider by it.
The Insurance Sector is floating for tremendous growth. Global goliaths in the Insurance Sector are now part of the Indian insurance market. The changing dynamics and trends of the business and regulatory environment stipulate a highly motivated and professional workforce equipped to recognize the nuances of Insurance business to facilitate them to perform more effectively.
In such a state of affairs, there is the need for an Institution, a foundation that shall impart the skill sets that help in empowering insurance professionals everywhere.
With a huge legacy of experience in the domain of Insurance training and processing , AdWISE ASSURE has always made every effort for excellence in General Insurance and Life Insurance training, in addition to Research.