Of all the questions that are asked by family members and friends, the most one tend to be this: how do I submit a claim request from my insurer/how to DIY? This is especially common given the poor (or lack of) service provided by the agent once the sale is completed. (Read our guide on getting the right financial advisors). Contrary to popular beliefs, it’s important to note that the agent who sold you the insurance policy may not be legally bound to assist you in your claims. It is hence imperative to understand the claims process and do it yourself, if necessary.
After just helping to complete yet another claim procedure, we decided to write this article to help you get through the process, if ever you need to do it yourself. That said, each insurer has its own requirements and procedure. We detail the general steps and perspectives of underwriters when processing such claims. The intention is to demystify the process and assure you that it is not as complicated as it is made out to be.
Importance of the underwriter/claim executive
An insurance underwriter is a financial professional that evaluates the risks of insuring a particular person or asset, uses that information to set premium pricing for insurance policies and reviews claims applications. This is the one of the most important roles in the insurance company and to you, the most important stakeholder when applying for claims.
The underwriter’s role is to work for the insurer, where he/she processes the claims based the terms and conditions of the insurance. There are some priorities which the underwriter look at:
- Ensure that the claim result is made objectively as per the insurance contract
- Ensure that there is no fraud in claims
- Ensure that the necessary procedure and steps are followed with the required documentation
With this perspective and given their importance in approving claims, ultimately as a claimant, we need to make their job as easy as possible to process the claims. It is worthwhile to do their job easier and expedite the claims process.
Some ways to do that:
- Review the insurance contract and in particular, read the exclusions. If the claim event is in the exclusion, it is unlikely your claim will be approved. i.e., if you have a pre-condition of a heart attack, your health insurance will exclude heart attack and in the event of the heart attack, your insurance will not pay out.
- Properly keep and organise all documents chronologically
- Review the insurer’s website and check if there are any additional forms/documents required for claims submission. There tends to be a checklist to help the agents and insured. Example below:
What is the process of claiming?
Here is simplified chart for the claiming process. We used a typical process of claiming medical bills. Comparing this to generic auto claims, the steps will vary slightly but the general intention of the process is the same. When an event happens (i.e. an accident for auto claims) where the insurance coverage can be used to indemnify, you have to take the necessary steps to inform the insurer and the necessary parties, get the documentations and submit them timely.
Alerting the relevant stakeholders
This entirely depends on the insurance type and claim you are submitting. For example, when dealing with auto claims and auto accidents, the first step is to alert the police. In health related claims, the first step is hence to simply inform and arrange for a doctor visit.
Do not underestimate this step. When you inform the stakeholder will set an important precedent of whether your claims can be processed. A typical example to illustrate the point is handling health claims. If you visit the doctor prior to your insurance coverage period, your insurer has the right to deny any of these claims. This is because the illness was informed and discovered prior to the coverage period.
Collecting and organising the necessary documentation chronologically
As mentioned above, it is likely that your insurer has provided a checklist for the various type of claims. Please retrieve that and use it to submit to the insurer.
Beyond stating the obvious for this step, which includes collecting every documentations and organising them chronologically, we will also share some tips and lessons learnt.
- Scour the insurer website in advance. Prepare or keep in handy any claim form in advance so that you can bring and have the relevant stakeholders sign. More often than not, you will need to pay for a separate visit or request to just sign. Save yourself that trouble and fees.
- Always request for physical or digital written copies of anything that you do. If you went for a doctor appointment, request for a receipt and consultation document that details the findings of the doctor. Again, if they do not provide you during the visit, it will often cost you more to get it.
- Take pictures and supplement as evidence, even if it is not required. Pictures are usually objective evidence and can help the underwriter/claim executive in processing the claims.
- Initiate the claims process as early as you can and within the time limit. Usually claims are required to be filed with 30-60 days. Even though the bills might not be finalised, you can still initiate and claim any expenses that come. However, once the period is missed, there will be no recourse for your claims.
This step is also non-trivial. 1 key point to note: make sure to submit the documents via the insurer’s mentioned channel. This can be via email or through a dedicated platform where you need to upload the documents.
Await claims result
Here comes the most important part: the results. Depending on whether the results are satisfactory, you may then choose to appeal. That said, from our experiences, the chances are often slim and may require further legal pursuit – which may then not justify the costs. It ultimately depends on the interpretation of the contractual wordings. Unless something is blatantly wrong, it is difficult to pursue further. Hence, it is important to note the terms and conditions of the insurance.
The above is something we experienced after helping family members and friends claim their insurances. Even with good understanding of the procedures, the claim process still wears people down as it is usually time-consuming and requires coordination with different stakeholders. Not to mention, it is also done at a bad timing (either because of an accident, health issue or etc.).
All these is to say that, fret not: the end results will usually be positive if everything is done accordingly and in good faith.
Our guides on getting started with insurance also embeds a simple checklist. Downloads are free for first few folks.