Making an Insurance Claim

How to Make a Claim?

An insurance claim is a notification to an insurance company requesting payment of an amount due under the terms of the policy. This is the right of the policy holder. In case of death of the policy holder the claim can be filed by the nominee as agreed upon at the time of issuance of the policy. There are certain guidelines outlined by the company that have to be met while filing a claim.

  • In case of non-death claim, the policyholder has to contact the claims department of the insurance company as soon as the loss is incurred.  In the event of death of the insured, the nominee of the policy has to make claim;
  • If certain time limit for making claims is specified in the insurance policy terms and conditions, the policyholder is bound to make claim within that specified time limit.  Nevertheless, it is in best interest of the policyholder to intimate the insurance claim to the insurance company as soon as possible, as earlier the claim is made, sooner will it be processed;
  • The policyholder is suggested to obtain the contact details of the claims department of the insurance company at the time of the buying the insurance policy;
  • Policyholder ought to make claim in writing if policy terms explicitly require so;
  • The insurance company will require certain documents pertinent to claim processing as mentioned in the policy document.  It is the responsibility of the policyholder to provide all documents as required and mentioned in the insurance policy document;
  • The insurance company will decide on the claim and inform the policyholder or his/her nominee, accordingly after which the claim payment will be made.  It is important to note that only the nominee or beneficiary is entitled to receive the insurance claim amount;
  • If dissatisfied by the insurance company’s decision, the policyholder has the right to follow the complaint lodging procedure.

SECP’s Role in Complaint Handling

In case of any complaint against an insurance company, which SECP deems as legitimate, the same is forwarded to legal department of that company. Constant follow-ups are taken and SECP intervenes to ensure that the matter is resolved as per the terms and conditions between the two parties.

Documents Generally Required for Death Claim:

Following documents are required to be submitted for claiming death insurance:

  • Insurance company’s standard claim form duly filled;
  • Death certificates as may be issued by the National Database Registration Authority (NADRA) or the Union Council or the Hospital;
  • Original insurance policy documents;
  • Copies of the Computerized National Identity Card (CNIC) nominee/ beneficiary and the deceased;
  • Police report and post mortem report, in case the death occurred due to accident;
  • Hospital and medical records, if applicable;
  • Any other document as may be prescribed;

For Disability Claims

Following documents are required to be submitted for claiming disability insurance:

  • Claim forms;
  • Hospital /medical records, X-rays and other treatment records, wherever applicable;
  • Disability certificate from an authorized doctor or as stated in the insurance policy document;
  • Police report and MLO report, wherever applicable;
  • Any other document as may be prescribed under the insurance policy;

It is to be noted that the above mentioned is only a general list of documents and requirements may vary from insurance company to company and insurance policy to policy.