It is the feeling of many people that it is easy to insure and difficult to settle claims, and the main reason for this problem is that the insured lacks understanding of life insurance claims procedures. There are some problems in life insurance claims, which makes claims more difficult. However, if you pay attention to the specific steps of life insurance claims in the process of applying for life insurance claims again, it will reduce the difficulty of claims.
First, we must report the case in time:
The first step in insurance claims is to report the case. According to the provisions of the insurance contract, when the subject matter insured is damaged or an insurance accident occurs, the applicant, the insured, the beneficiary and their entrusted agents shall notify the insurance company as soon as possible, otherwise the losses caused thereby shall be borne by the beneficiary himself. Under normal circumstances, the insured shall notify the insurance company within 10 days after the occurrence of the insurance accident, but due to the different claims limits of various types of insurance, it is necessary to report the case in time according to the provisions of the insurance contract to prevent their own interests from being lost.
If the applicant reports the case by oral notice, he must fill in a formal danger notice afterwards. When reporting a case, the following issues should be explained in detail: the basic information of the informant and the insured, the time, place, cause, process and result of the insured accident, etc.
Second, in line with the scope of responsibilities:
After reporting the case, the insurance company or salesman will inform the customer whether the accident falls within the scope of insurance liability. Customers can also reconfirm by reading the insurance clauses, consulting an agent or calling the insurance company hotline. Insurance companies only compensate the insured for the losses caused by the risks within the scope of responsibility, and do not provide protection for the exclusions in the insurance clauses, such as suicide within two years, the insured and the insured's crimes and intentional acts.
Third, prepare the required documents:
In order to prevent people from making unfounded or exaggerated claims, insurance companies will definitely ask the insured to provide evidence of loss and explain the details within the specified time. No matter what kind of insurance, the beneficiary must prepare the original insurance policy, the original identity documents of the insured and the beneficiary (ID card, household registration officer's card, soldier's card) and the invoice for the latest premium payment. If you entrust others to handle claims, you must also fill in the power of attorney.
Fourth, prepare the list of medical practitioners:
If the insured has basic medical insurance and part of the social security has been reimbursed, it is necessary to show the insurance company the medical expense reimbursement split form issued by the social security in advance, and indicate the total medical expenses paid and the expenses paid by the social security, and hand it over to the insurance company together with the original copy of the document, and the insurance company will make claims within the remaining medical expenses according to the above materials.
Fifth, carry out accident investigation:
After all the data were collected, the claims department of the insurance company began to investigate. The insurance company may require customers to cooperate with the company in the investigation and provide additional materials and evidence. If the insured conceals the medical history when applying for insurance, or the insured does not have his own signature, it will bring obstacles to the smooth progress of claims. Finally, the insurance company will review, calculate and determine the compensation amount, and notify the customer to receive the insurance money. [4]
Folding material
Life insurance claims need to be divided into three different ways: health insurance claims, accident insurance claims and death claims.
Health insurance claim materials:
Medical information such as diagnosis certificate, expense settlement list, emergency medical records, original medical expense receipts issued by hospitals designated or recognized by insurance companies; If you are hospitalized, you need to summarize your hospitalization.
Accidental injury claim materials:
(1) If the accident is a work-related injury or involves the work of public security, procuratorial organs, courts and other judicial administrative organs, relevant supporting documents shall be provided;
(2) In case of death, a death certificate issued by the relevant department is required.
Death claim materials:
(1) beneficiary's household registration certificate or identity certificate
(2) The death certificate of the insured issued by the medical institution or public security department recognized by the insurance company.
(3) If the insured is declared dead, the beneficiary shall provide the death judgment issued by the people's court.
4) Certificate of cancellation and cremation of the insured's household registration.
(5) Other relevant certificates and materials required by the insurance company, such as hospital death discharge summary, relevant rescue records of the rescue station where the rescue vehicle died, emergency medical records, etc.
In addition, general life insurance claims need to provide the following necessary materials: (1) Application for Insurance Payment filled out and signed by the insured; (2) the identity certificate of the insured; (3) The original insurance policy, including the receipt of the last payment.
Precautions for folding
It is precisely because risks are everywhere that instead of waiting for risks in fear, it is better to buy yourself a guarantee to prevent unexpected risks. In fact, this is why many people choose to buy insurance. Claim settlement can be said to be the most important link in the whole insurance process, and it is the obligation of the insurance company to perform economic compensation for the personal and property losses within the scope of the insured's contractual responsibility. So what are the precautions for life insurance claims?
1, hazard notice:
The applicant, the insured or the beneficiary shall notify the insurance company in time after knowing the insured accident.
In the process of claim, the implementation of the principle of timely notification is very important. Timely notification can enable the insurance company to investigate the insurance accident immediately, and any delay will slow down the progress of the investigation and lead to the delay in the time limit for claim settlement.
Related tips:
The right of the insured or beneficiary of life insurance to claim compensation from the insurer shall not be extinguished within five years from the date of its famous insurance accident.
2. Requirements
The occurrence of the claim is directly caused by the claim. Claim and settlement are two sides of the same problem. Claim refers to the claim made by the insured to the insurance company, and it is also the concrete embodiment of the insured's realization of its insurance interests.
After the occurrence of an insurance accident, the applicant, the insured or the beneficiary shall notify the insurance company of the place, time, reason and other relevant information of the accident in the fastest way and file a claim.
After receiving the claim, the insurance company starts the claim settlement procedure.
Related tips:
After receiving the request for compensation or payment of insurance money from the insured or beneficiary, the insurer shall verify it in time and notify the insured or beneficiary of the verification result; The insured shall perform the obligation of compensation or payment of insurance benefits within ten days after reaching an agreement with the insured or beneficiary on compensation or payment of insurance benefits. If the insurance contract stipulates the amount of insurance and the time limit for compensation or payment, the insurer shall perform the obligation of compensation or payment of insurance benefits in accordance with the insurance contract.
If the insurer cannot determine the amount of compensation or payment of insurance benefits within 60 days from the date of receiving the request for compensation or payment of insurance benefits and relevant certificates and materials, it shall pay according to the minimum amount that can be determined by the existing certificates and materials; After the insurer finally determines the amount of compensation or insurance payment, it shall pay the corresponding difference.
3. Insurance liability and liability exemption
When buying insurance, you must first determine what kind of protection you want to buy for yourself.
4. The principle of proximate cause of creditor's rights.
The principle of proximate cause is the principle that the insurance parties follow when handling insurance cases or when the court hears litigation cases related to insurance compensation, when investigating the cause of the incident and determining the attribution of the responsibility for the incident.
According to the principle of proximate cause, when the risk accident insured by the insurer is the proximate cause of the loss of the subject matter insured, the insurer shall be liable for compensation.
The principle of proximate cause has become an important criterion to judge whether an insurance company bears insurance liability.
For losses caused by a single cause, the single cause is the proximate cause.
For the losses caused by various reasons, proximate cause is the reason that continues to play a decisive or effective role. If the proximate cause falls within the scope of insurance liability, the insurer shall bear the insurance liability.