Insurance Blog – What to understand before making an insurance claim
Insurance has major benefits as financial protection, especially when risks occur that can disrupt financial stability. As the famous saying goes, “prepare an umbrella before it rains”, there is a chance that you will get wet if it rains. You don’t want to be bored when you go to work, school or wherever you do your activities, right? If you bring an umbrella, at least you will be protected from raindrops. Likewise in everyday life.
When a person faces health problems (risks) such as critical illness, heart disease or hospitalization due to typhoid, but there is no umbrella in the form of health insurance as protection, then his financial situation is shaken. He should empty the contents of the savings or withdraw the contents of the emergency fund. Even though he can have health insurance with affordable premiums that have benefits based on his and his family’s needs. Therefore, savings and emergency funds need not be disturbed.
In order for your insurance company to know that a risk has occurred to its customers, the policyholder and the insured must report the incident through the insurance claims process. There are documents and information that must be prepared. In order for your claim not to be rejected, you should pay attention to several points. Come on, read on to understand more.
What is an insurance claim?
Instoppedia defines an insurance claim as: the policyholder’s formal request from the insurance company (insurer) to receive coverage or reimbursement for the occurrence of risks incurred in accordance with the rules contained in the insurance policy. The insurance company approves or rejects the claim. If the claim is accepted, the insurance company will compensate the damages to its customers.
Insurance application process
In general, the process of insurance damage is as follows:
1. Report to the insurance company
In order to file a claim, there must be a risk of financial loss. You have paid the premium on time, it is time for the insurance company to fulfill its promise to compensate you for the financial losses you have experienced. Report the incident as soon as possible, do not delay. With the advancement of information technology, claims can be made from anywhere at any time online. Prepare the necessary documents and information. If it is an insurance claim a refund Hospital bills, make sure the original invoice receipt is from the hospital with an official validation indicator.
2. Checking the damage report by the insurance company
After receiving the report along with supporting documents and data by the insurance company, the insurance claims department will review the report. Does the event that carries the risk of financial loss really occur, is it in accordance with the conditions and types of coverage included in the insurance policy, are the attached documents valid? Claims officers can conduct further investigations if there are cases that raise questions or suspicions. If there are still missing documents, the claimant must complete them.
3. Determination of accepted or rejected claims
Then the insurance company will decide to accept or reject the insurance claim submitted by the customer. All these decisions are based on the review and validation processes that have already been carried out. In the next part of this article, we will both understand how to avoid insurance claims being denied.
4. Payment of damages to the insured in case of acceptance of claims
Based on the decision to accept the claim, the insurance company will compensate the financial losses suffered by the policy holder and the insured. Payments are made at specified time intervals and directly to the policyholder’s account. Of course, the amount paid is in accordance with the provisions of the insurance policy.
The reason for rejecting the insurance claim
In fact, the insurance claim process is really easy. However, the claims process can be intimidating for customers who fear or have experienced rejection. Considering the many reasons for the rejection of insurance claims, you can ensure that your future claims will not be rejected again by insurance companies.
Image by tirachardz on Freepik
The reasons for rejecting insurance claims are as follows:
1. The policy is no longer active
The insurance policy remains active until you pay the premium, the amount of which is determined and agreed upon by the parties (the insured and the insurance company). The main reason claims are denied is that the policy is no longer active. If you’re not sure if your policy is still active, remember if you’ve made a payment or call your insurance company’s call center to ask directly.
2. Types of risk events that are claimed are not covered by the insurance policy
Another reason for rejecting your insurance claim is the type of event or risk that is not included in the list covered by the insurance policy. For example, you have health insurance that only covers hospitalization. When you submit a claim for outpatient services, the claim is likely to be denied because your insurance policy does not cover outpatient expenses. Critical illness insurance lists which illnesses are covered and which are not. So, make sure the type of event you’re claiming matches the policy you have. Oh, yes, also make sure you get health care at a partner hospital that works with your insurance company.
3. The risk type is still in the waiting period
The waiting period is the period that the insurance company sets to ensure the health of the insured when buying insurance. The waiting period for health insurance for all diseases is usually 30 days and for some diseases up to 1 year. During the waiting period, you cannot make a claim unless there are special circumstances where the incident is classified as an emergency. Double-check the contents of your insurance policy or call the call center to find out what the waiting period includes and how long.
4. Completeness of alleged documents has not been achieved
Claims officers in insurance companies work with a high level of compliance and accuracy. Therefore, in the process of submitting a claim, you must be able to send all the required documents and information in full. The most important document is the original personal data, such as KTP. The most important information is your policy number. If there is a form that needs to be filled, fill it completely and according to the actual situation.
5. Make sure you don’t violate the principle of good faith (The utmost goodwill)
The principle of good faith is an important foundation in insurance. This means that there is no intent to deceive one party by providing false or incorrect information. The claims officer checks the authenticity and validity of the documents related to the claims submitted by the customer. If a case becomes suspicious, the claims officer will investigate until he confirms that the claim is correct and appropriate.
Online insurance claim
As insurtech, Rojai allows you to submit your claims with a clear process as described on the claim information page on the Rojai Indonesia website. You just need to send the required documents via email. After receiving all the complete documents, we will process the request and then send the confirmed claim amount to your account. Rojai also has a list of partner hospitals that provide the best services with a quick and easy application process using the reimbursement or reimbursement system. No cash.