The Ins and Outs of Your Insurance Claim
Whose responsibility is it to process your insurance claim?
- Ultimately the consumer. The consumer must comply with all terms and conditions of the policy
- Ignorance isn’t bliss, and consumers must inform themselves about their insurance policies
- Insured people need to read correspondence from their brokers to avoid repudiations
- Make sure insurance premiums are always up to date – missing a payment can mean a denied claim
- With car insurance for instance, policy holders need to ensure that their insured vehicles are fitted with the anti-theft features requested by the insurance company before their insurance claim.
There are Do’s and Don’ts with Claiming
The insurance claim process must run correctly if you want any money back. Yes, most claims processes go without a glitch but there are times when you’ll encounter problems. Every insured person who who puts in an insurance claim after medical treatment, damage to their home or car has to wonder if their claim will be successfully processed.
Y car insurance or other insurer is responsible for paying benefits covered under your policy. But most people with insurance haven’t done research on their insurance – they don’t understand how the claims process works.
You have to read your policy thoroughly so you know exactly what cover you have. This is important because there are some events or medical treatments for which you won’t have cover in your policy. And you therefore can’t claim.
Check that your Insurance Claim has Landed in the Right Box
Once you’ve paid your doctor’s bill for instance, it will go to the claim’s processing centre, or so you think. How many times don’t you email or fax your medical aid claims and hear nothing from the medical aid?
You can’t just assume that your claim forms arrived in the right place. Who knows, they could have landed up in spam. You have to take full responsibility for your claim forms and ensure that they do in fact land up where they should.
A wise move would be to email or fax them and then phone the claims department to check whether they got the forms. Remember too, that you need all the right documentation for a claim to be successful.
Always Keep Documentation Related to Claims
Your insurer will have a standard set of claim forms for completion. Some insurers in South Africa will assign a claims representative to you. This person will work with you to get all the documents to finalise the claim.
Always keep all documents relating to your claim, and if you want to know how your claim is proceeding, always have your policy number on hand when phoning to query.
Remember too, that with insurance, there is always some form of fraud and in the case of damage to your car, an assessment will be necessary to prevent insurance fraud. After validation and assessment, with a valid claim your insurer will repair the insured item.
Claim processing and expecting to be paid out isn’t automatic. There’s a lot to claiming the right way. You need all the right information, and if a third party is involved, you’ll have to provide their details too. You have to submit a claim within 60 days from the date of the event that prompted the claim or it won’t be paid out.
Help is at Hand
Putting in a claim isn’t necessarily a pleasant experience – there is always the fear of your claim being denied. Handling your claims correctly can spare you a lot of anguish and bad luck with your claim.
If you require it, a consultant from your insurance company will explain the process of claiming and provide you with the information you need to process the claim and get a positive result.
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