A Guide to Ensure that your Claims are Successful!

Smartchoice Editorial
February 20, 2020

Insurance in Pakistan is still a sector that is not known much or people are not very familiar with the benefits and importance of it. Even the people neck-deep into the business and management are somewhat reluctant to acquire insurance be it car, travel, home, health etc.

Insurance is still considered to be an illusion that one person is kept in and to create a make-belief world where when buying insurance they would be protected against all the financial losses and risks that are unforeseen.

In a country like Pakistan whenever someone buys any such policy the one thing that is kept in mind while getting insured is to foresee any kind of financial loss that may occur and the loss is bared or the risk is tolerated by the insurance provider.

There are certain do’s and don’ts that need to be kept in mind while procuring insurance and also at the time of making claim, as of everything in life even at the time of claim “honesty is the best policy”.

Few of the things that need to be kept in mind whenever you are in need to file your claim, not only file it successfully but also can get reimbursement for your claim.

What is the claim?

When you claim your insurance plan, you are formally notifying and alerting the insurance company that you have suffered a loss or damage against the same that has been insured and that you believe is covered by the policy you have purchased and are requesting an action.

The insurer will review your said claim and see if the event or circumstances are risks or things happened are covered by the policy. You will need to provide relevant proof it that it is a genuine claim and the insurer will need to be certain the claim satisfies the terms and conditions of your procured insurance policy.
If your claim is recognized, the replacement or repair of your belongings or any payment by the insurer is called the benefit or payout. The insurer will work out the value of the claim and provide the appropriate and accurate benefit specified in your insurance contract.

Is it worth claiming?

Claiming even the smallest damage is not an intelligent move, as the more you claim in your insured tenure at the time of renewal you don’t get to enjoy much of a discount or a better price on your premium because of your previous record.

For example: If you have only had a brake light smashed, then it probably isn’t worth claiming for the damage, as it would add in your claim history and shall affect your future claims and policy procurement as well. It would be wise if you spent some money to get a new brake light from your pocket.

Claims handling standards

Although each insurance company has its procedures for handling claims, general insurance companies that are members of the Insurance Association of Pakistan or SECP are required to meet or exceed the standards for claims handling laid down in the General Insurance Code of Practice.

The Code describes how insurers must handle their customers, including the time it takes to handle and make decisions on claims. Compliance is monitored by the SECP; the current mandate of the SECP includes the following

• Regulation of corporate sector and capital market
• Supervision and regulation of insurance companies
• Supervision and regulation non-banking finance companies and private pension’s schemes
• Oversight of various external service providers to the corporate and financial sectors, including chartered accountants, credit rating agencies, corporate secretaries, brokers, surveyors etc.

Paying claims

Insurance companies are expected to promptly assess all of the claims that are made, and to pay out all claims that are covered by the wording in their policies. Under the obligation of SECP ( Securities and exchange commission of Pakistan), insurance companies promise to respond to your claim within the due stipulated time and tell you whether they will accept or deny your claim based on the information you have provided.

When you make a claim, you need to keep yourself equipped with all the evidence and proof that needs to be presented concerning your claims. This may include ownership documents, medical reports and invoices, receipts of the goods and any other relevant details for your lodging and acceptance of the claim.

After providing the proofs initially, if the insurance provider needs any more evidence they would let you know and inform you after their initial probing. If an indemnification claim is denied, the company must/should provide you with written details for the decision to deny the claim and information about its complaints handling procedures.

It starts right at the beginning which is…. Buys the right policy – focuses on the cover, not just price

Don’t be tempted for the cheapest policy available in the market, you may think that as long as you are getting covered in the bare minimum you should opt for it, but remember that the policy you should be considering should ensure that the cover provided is a per needs and requirements.

It should not be the case that when God forbid something occurs and it’s time to make a claim, at the time of filing your claim you are informed that your claim shall not be processed as due to the policy bought and the coverage provided against it that certain XYZ is not covered.

The Association of British Insurers (ABI) said the main reasons household claims failed were because the claim value was below the policy excess or the policyholder did not have the right cover.

So make sure that you have the right and appropriate cover for your belongings or yourself, whether it is your car or your health make sure you buy the right plan which a proper fit for you and can come in handy w Successful Claims Begin At The Point Of Purchasing the Policy

When applying for an insurance policy cover, it is important to make all disclosures honestly.

As charity begins at home, it’s the same when buying insurance as you expect your provider to tell and inform you regarding all the inclusions and exclusions of the policy you should keep in mind that you should not be hiding some “unpleasant” habits or facts from your provider.

For example, if you hide any pre-existing disease and buy a cover and at the time of claim is it unearthed that the disease already existed before the coverage started, the insurance provider will and shall refuse to pay the claim, it may also be an effort in vain to procure a policy and not be able to claim it due to it not being falling in the due criteria. So make sure that you are honest and come clean if not then you should also remember not to expect coverage for anything that has not been mentioned in your stated policy.

At the occurrence of a Death or Hospitalization

In the event of death or reimbursement due to hospitalization file or send/alert your insurance provider as soon as possible. The delays in filing the claims are considered to fishy and arouse suspicion that may make the insurance provider probe deeper and investigate more that may delay your claim process and you may face difficulty and delays in reimbursements.

Comprehensive Information Should Be Given to the Insurance Company Accurately
All the relevant information provided to the insurance provider at the time of filing claim on the claim application including the name of the policyholder, date, location, and reason of death/reason of damage (in case of car) and any other appropriate information required by the insurance firm, error/blunders or inconsistencies can cause apprehensions in the insurance company when processing your claim. So under any of these circumstances make sure to take care of the details and check and recheck all the Nitti gritty.

Read the small print – take care not to nullify your policy

It is said that the main “meat” or the main “message” is in the small prints, same is with the policy, when you get cover for anything always remember to read the fine print and what is being offered and it is against what terms and conditions.

You need to ensure that whatever you are being offered has “no conditions attach” if there are any such conditions attached you should be informed before your purchasing of policy. As a consumer everything for you should lie in the black and white and you should try and eliminate all the grey areas.

For example: when you buy a health policy, no hospitalization claim can be made in the first thirty days except for accidental coverage, there are 30 days waiting period that you should be informed about.

In travel insurance the baggage delay claims, they delay coverage promised if is $200, the amount paid shall be after the remaining has been paid by the airline, for instance, if the airline pays $75 for the delayed baggage the insurance provider will only pay you remaining $125 not the full $200.

So the “KEY” is to read the fine print…Failure to meet your insurer’s policy terms and conditions could invalidate your insurance and leave you with the cost of picking-up the claim. (Go Compare) 

The policy document will also outline the excesses the amount you’ll have to contribute towards any claims made on your insurance (usually deducted from the amount paid out to you).

Act quickly and follow the procedures

Act swiftly and follow all the steps to successful claim so that you don’t miss out on anything, be sure to the details and take care of all the details.

The policy which you receive after making the payment of your desired plan has two important numbers, the first is your very own policy number and the second is your insurer’s claim’s helpline number which you shall need to call and register your claim and discuss what should be the nest step to be followed.

For instance, if your car has had an accident, first things to consult your policy and call the insurer claim helpline, if it’s bigger you need to file a police report and then as per the complaint number pass on that detail to your insurance provider to have a complete record of your claim.

If your home has been burgled the first thing you should do is to call the police. They will need to investigate the incident and will give you a crime reference number which you will need to pass on to your insurer.

Don’t do anything like going to a mechanic or anything before consulting your insurer until it’s an emergency, don’t dispose of any of the damaged parts, the insurance provider may want to analyze and assess the damage themselves.

Importance of Collecting evidence

One thing that stands important in case of any policy is to keep substantiate evidence to support your claims, such as photographs of the damage, or receipts for items that have been broken, it will be immensely helpful and would facilitate your claim process smooth.

Be Honest and Truthful

Don’t exaggerate or lie regarding the damage that you have incurred, when making or filing a claim always remember honesty is the best policy. If by any chance or way your insurer finds that you had been fabricating even the tiniest part of the claim, and then they are legally and officially entitled to decline the whole claim and not pay even the part that you can claim rightfully.

So make sure that you don’t file any claim that has no flavour of truth.

Get some evidence!

You will always want to ensure that you have the evidence for your losses which shall enable you to claim the money back from the insurer.

For example: when travelling, you lose your baggage and to claim the baggage you should exactly remember the things present in your baggage and their cost.
When your car gets into an accident with another car, make sure to click the pictures from the mobile phone at that very moment and don’t forget to rightly capture the damage to your and the other person car as well.

The evidence you have will make your claiming process swift and comparatively easier as the insurer would have more reasons to accept your due claim.

Review your Product Disclosure Statement (The Inclusion and Exclusions)

You should and you should review the Product Disclosure Statement (PDS) that what are inclusions and exclusions are being offered by your provider on what occasions and circumstances. Also see your policy schedule for your insurance policy to see if you have a valid entitlement and claim, also make sure that the event you want to claim for is not on the exclusions.

For example, your policy may have death benefit but under what circumstances you can claim that benefit is mentioned in the policy fine print. Your insurer will also be checking all such details once you lodge a claim. Checking this product disclosure would also help you to oversee how much money you need to mint in to ensure the damage is completely covered.

Conclusion

When you have all the tools to file/lodge your claim, you need to be truthful and completely honest. You need to understand that there is no “shortcut” to making your claim. You can get your legitimate claim if you follow all the aforementioned steps and also remember to renew your policy each year for continued coverage for your car, travel, health and many other insurances.

Like it, share
  •  
  •  
  •  
  •  
  •  
  •