Motor Claim
Third Party Claim
If your vehicle is insured and has a third party liability cover, the compensation sought by the third party for damages in case of an accident will be fully paid by your insurance company.
Report to the Police
Where your vehicle is involved in an accident, it is mandatory to report the incident to the police and file the first information report quoting the details such as registration number of the vehicle, license number of the driver, and the names/contact details of witnesses, if any and in case of third party claim claim it is mandate to lodge FIR.
Inform your insurer
Intimate your insurer immediately along with the basic details of the Policy, Driver, and Place of the accident. If other's vehicle is involved i.e. if you are a victim, you must obtain the insurance details of that vehicle and intimate the insurer about that vehicle.
Submit documents to your insurer
Submit the following documents to the insurance company for processing your claim:
- Claim form
- Policy copy
- Registration Certificate
- Driving License
- First Information Report
- Any other documents/information as required by the Insurer
Theft Claim
If you have Comprehensive coverage on your insurance policy, you will be covered for the stolen car as well and eligible to get a claim for the theft of your car.
Lodge an FIR
You must report to the police and obtain the First Information Report.
Inform your insurer
If your vehicle is not found within 90 days, then you need to obtain Non-traceable report from Police and submit the same to your insurance company.
Submit claim form and other documents
You should fill claim form giving information like Policy number, Vehicle details, Date, time and description of the incident. You need to submit the duly signed Claim Form along with the following documents:-
- Registration certificate (RC) of the vehicle
- Driving license
- Policy copy
- FIR
- Final Non-traceable report by police
- Letter of Subrogation
- All sets of keys
- Letter addressed to the RTO intimating theft
Inform your Regional Transport Officer (RTO)
The next important step to do is to notify the Regional Transport Officer (RTO). It is also a mandatory step as per The Motor Vehicle Act 1988.
Claim Settlement
If you have taken a car loan to purchase your car, the insurer will settle the amount directly to the financier. The settlement amount is on the Insured Declared Value (IDV) which might however differ based on usage and market value.
Own damage claim
Claim for damage to your own insured vehicle is called an own damage claim and you are eligible for this if you are holding what is known as a package or a comprehensive policy.
Inform Insurer and police
Where your vehicle is damaged due to accident, you must immediately inform insurance company and police, wherever required, to enable them to depute a surveyor to assess the loss.
Send your vehicle to the garage
You should send your vehicle to the garage or authorized workshop where you can also report your claim. Your workshop or garage will prepare an estimated cost of repairs and liaise with insurance company.
Surveyor Inspection Report
Surveyor will inspect the vehicle and submit the inspection documents to your insurance company. Insurance company will review the documents and on the basis of the inspection will authorize the garage or workshop for the repairs.
Payment of Expenses
If your policy provides for cashless service, which means you do not have to pay out of your pocket for covered damages, the insurance company will pay the workshop directly. In case of reimbursement service, the approved claim amount will be intimated to the garage and you will be paid by insurer within 7 days of submission of final documents.
Reimbursement documents to be submitted to the Insurer
Reimbursement documents to be submitted to the Insurer
- Copy of the Insurance certificate cum Policy Schedule
- Claim form
- Copy of Registration Certificate
- Copy of Driving License
- First Information Report
- Estimate of cost
- Final repair invoice and receipt / Satisfaction voucher for cashless payment
Health Claim
On Cashless Basis
Cashless hospitalization is a facility provided by the Insurance Company wherein the policyholder can get admitted and undergo the required treatment without paying directly for the medical expenditure. The eligible medical expense, thus incurred, shall be settled by the respective Insurance Company directly with the hospital as per policy terems and conditions. The Cashless claim facility can be obtained only for the treatment done at the network hospital listed by the respective Insurance Company.To know the network hospital, check your policy document or call the toll-free number mentioned therein.
Inform your Insurer
Hospitalization can be under two circumstances - planned or in case emergency
- Planned: Once your doctor has recommended hospitalization, contact your insurer immediately and inform them about the hospitalization.
- Emergency: In case of emergency hospitalization, you must inform your insurer within 24 hours of hospitalization.
Process of Admission in the hospital
To avail the cashless benefits kindly show your health ID card or policy number for identification purposes.post which the Hospital TPA Support Desk will providea pre-authorization form in which personal details need to be filled by insured/patient and the restof the details need to be filled by the treating doctor and hospital staff. Insured/Patient needs to optfor the room as per their policy eligibility only. The preauthorization form needs to be signed by the patient or his family member.
Documents to be sent to the Insurance Company along with the pre-authorization form
Collate the documents to be sent along with the pre-authorization form:
- Policy Copy/ Health Card
- ID proof with address
- Investigation Test reports from Pathologist
- Medico Legal Certificate (MLO)- in accident cases
Confirmation of insurer to proceed with services
Hospital will submit duly filledthe pre-authorization form to the Insurer. The Insurer will review the documents and provide confirmation to the hospital to proceed with the cashless services. Normally, TPA issues a letter of confirmation within 3-6 hours, provided all relevant documents are submitted.
Hospital sends the bill to the insurer during discharge
Hospital shares all the bills, treatment papers, and discharge summariesto the respective Insurance Company. It is advisable that the Insured/patient also obtain a copy of the same for record-keeping.
Denial Of Cashless
If admissibility of the claim cannot be established based upon the documents provided at the time of cashless request, the cashless facility shall be denied by the Insurer/TPA. However please note that denial of authorization for cashless benefit does not mean denial of claim or denial of treatment and does not in any way prevent you from seeking necessary medical attention or hospitalization. The insured/patient can submit the claim documents for reconsideration in reimbursement along with duly completed claim form within 7 days from date of discharge from the hospital.
Cashless Settlement
At the time of discharge, the hospital would send all hospitalization related documents along with discharge summary, final bill, reports, medicine details etc. & claim would be processed as per consideration of hospital tariff, package or schedule of charges, mutually agreed upon with either TPA or Insurance Companies, whichever is applicable as per policy. Insured should note that the policy may contain certain exclusions &/or restrictions which will be applied at the time of initial & final authorization. Non-medical expenses (NME) are not payable and will be deducted.
Claims on Reimbursement Basis
Reimbursement claims are how you can claim expenses incurred at an out-of-network hospital or claims rejected for cashless benefit.
In case of a reimbursement claim, the policy holder pays the expenses himself with the hospital and then claims for a reimbursement of those expenses from the Insurance Company by providing necessary documentation.
Inform your Insurer
Hospitalization can be under two circumstances - planned or in case of emergency
- Planned: Once your doctor has recommended for the hospitalization, contact your insurer immediately and inform about the hospitalization.
- Emergency: In case of emergency hospitalization, you must inform your insurer within 24 hours of hospitalization.
Get the treatment done
Avail the treatment as prescribed. Intimate your insurer in case of the treatment done outside the network hospital. In the meantime, you can proceed with your treatment and pay the bill.Ensure to get your all original case related papers, medical bills, medicalreports,discharge summary and any other documents given by the hospital from the hospital.
Submit the documents to your insurer
Submit the following documents to your insurer for scrutinizing the same as per policy terms and conditions:
- Complete and signed Claim form with attending doctor's prescription
- First prescription of the present illness, for which treatment has been undergone in hospital/nursing home
- Medical advice for hospitalization
- Discharge summary of hospital
- Original Final bill of the hospital
- Medical fitness certificate
- All test reports supported by medical prescription (pre & post hospitalization)
- All vouchers/bills/receipts pertaining to the tests mentioned above
- All medicines purchased from outside the hospital at any point in time to be supported by original prescription
Claim documents review by Insurer
Your insurer will review the claim documents received and effect the payment within 7 days of receiving documents. If the treatment claimed is not covered under your plan, a rejection letter will be sent to you stating the reason for the same.
Hospital sends the bill to insurer during discharge
Ready with you the below documents to be sent along with the pre-authorization form:
Direct payment
Once the bill is confirmed, insurer makes payment directly to the hospital.
Submit a Claim Ticket
Please enter your policy details. We will assist you with your claim.
Here we help you to guide through the various claim process which you might go through with insurance companies. If in case you need further assistance, you may simply email us at info@walnnut.com