Liga Asuransi – Dear readers, how are you? Let’s continue our lesson. This time is about how to take care of insurance claims to be smooth, quickly paid and get the maximum amount.
Frankly, the issue of insurance claims is the most critical thing in an insurance transaction. Although the insurance company used is a good and well-known company, the premium costs are expensive and offered by the known agent of broker. If payment of claims is not smooth, it becomes a big problem.
We know that everyone’s goal to buy insurance is to get financial reimbursement in the event of an accident, illness, death, loss or damage to their assets and property because of unexpected and sudden risks.
Therefore, before you experience disappointment with the payment of insurance claims you should know in advance the things that can help you when handling insurance claims better and faster.
In this article we want to fully outline the things that can help you in taking care of insurance claims.
If you are interested in this article, please share it with your colleagues so that they also understand like you.
Every person or company has the risk of various unwanted events such as to get sick, damage, lose of asset.
One of the efforts that can be done to minimize the impact of risk is to have an insurance coverage. With the insurance coverage, the losses that occur can be replaced by the insurance company.
What is an insurance claim?
Insurance claim is a claim from the insured party (you) to the insurance company (insurer) in connection with the contents of the insurance agreement contract stated in the insurance policy. Provided that each party has fulfilled its obligations, for example you if have paid insurance premiums.
Insurance Claims Function
All insurance programs, both life insurance and general insurance, are long-term protection and investment programs that benefit you. Insurance claims become your right as an insured and the obligation of the insurance company as an insurer.
What are the benefits of insurance?
Insurance claims are the main and most important goal for every insurance transaction. Risk transfer means that you as an insured are aware of the threat of danger in the short or long term to your life or property. When the threat turns into reality, you will suffer losses and will feel the burden that can occur at any time.
This is actual the function of insurance for you and your family so there is no need to bother to shoulder the burden of that risk. Insurance takes your risk by paying premiums. If you have paid the premium, the risk will transfer to the insurance company.
How to Pay Claims?
The next function of insurance claims is for the payment of compensation. When you experience an event that causes losses such as a fire in the house, the insurance will compensate the loss in accordance with the coverage and the premium you choose.
Insurance is also useful to pay compensation for customers for example on life insurance. Life insurance is made based on an agreement between the customer and the insurance. In addition, the law governing insurance that has mandatory properties such as BPJS health. This social insurance aims to protect the public from health threats that can result in death and others.
The Procedure Insurance Claims
Each insurance policy generally has the same way of claiming procedure according to the type of insurance you use.
Property insurance
Property Insurance can minimize customer financial losses when there is an unexpected situation such as damage due to an accident or theft. So, insurance users do not pay the total cost of repairs for property damage because it has been covered by insurance. In general, property insurance has two types, namely:
All-risks Property Insurance provides protection for all possible risk of loss, ranging from minor to large damages. Sometimes as a replacement the term All Risks is also used the term Comprehensive.
Total loss only Property Insurance (TLO) is protection that only covers losses that are worth more than 75 percent of the price of property or loss due to crimes, such as theft. When there is a loss below 75% of the value of property, the insurance company does not cover it.
After knowing the types of Property insurance, you should also know the steps to make the claim. Here’s how to claim property insurance that you can try.
First, you can report the incident to your insurance broker agent about the accident that happened to the Property by explaining the accident that occurred then attach a photo of the property damage.
Next, complete documents such as STNK, driver’s license, and certificate from the police if the damage to property is more than 70 percent, as well as a property insurance policy. Document requirements are very important so that the submission process runs smoothly
You can fill out reports offline or online in the insurance application and then come to the nearest branch. The insurance will check the completeness of the data and send a surveyor to see the damage to property.
After the survey is completed and approved, the Property will be delivered to the workshop and then taken back to your chosen location.
Health insurance can help customers in getting treatment, especially those that cost big amount such as surgery. The best insurance companies usually have a variety of health insurance products. For example, health insurance product insurance in the form of reimbursement of inpatient costs, outpatient, and a combination of hospitalization and outpatient. For the procedure of filing a health insurance claim can follow the steps below:
Make sure the health insurance policy is active by regularly paying health insurance premiums.
Make sure the disease you want to claim is not excluded in the insurance policy. Because health insurance policies apply exceptions, namely types of diseases or conditions that are not included in the coverage. For example, HIV/AIDS disease, costs for items outside of medical devices such as tissues, and non-drug costs such as supplements and vitamins
If you already understand the above, you can contact a broker or insurance agent by informing that you are being treated. Next the insurance broker will tell you what steps you need to do. Some insurance companies also provide representatives at the hospital who can help you in terms of the claims process.
You need to keep all proof of payment of treatment transactions for reimbursement purposes.
When you are allowed to go home from the hospital, you can immediately file a claim by filling out a claim form. You can get this form by downloading it from the insurance company’s website.
Do not delay the claims process as most insurance companies only accept claims for health coverage no later than 30 days after the event.
Follow the claims procedure that you can usually take in three ways: 1. Manually submit the original claim form and supporting documents to the health insurance company’s office; 2. Upload claim forms and claim documents online through the website; 3. Upload claim forms and documents
After submitting the claim form and supporting documents, the insurance company will check the completeness of the documents to be confirmed to the customer.
When complete documents and claims are received, the insurance company will pay your medical funds according to the protection benefits stated in the policy.
How to claim life insurance
Life insurance products are most widely used by the people of Indonesia. This insurance protects the family from financial losses due to the death of the insured who is the backbone of the family. Insurance companies usually have four types of the best life insurance products, namely:
Term Life Insurance: This type of life insurance provides protection to customers within a certain period ranging from 5, 10, to 20 years
Whole Life Insurance: This type of life insurance provides lifelong protection for customers and the average insurance company sets a coverage age limit of only 100 years.
Dwiguna Life Insurance (Endowment Insurance): This type of insurance offers two benefits, namely as term life insurance as well as savings.
Unit Link Life Insurance: Unit link life insurance is a type of insurance that offers self-protection products as well as investments that promise future profits
After knowing the types of life insurance, you should also know how to file a life insurance claim.
Curious? Here’s how you can do it:
First, you or your heirs can contact the insurance to report that the insured has died. Prepare documents such as death certificates and insurance policy documents to support reports
Furthermore, the insurance will make sure & contact the heirs to conduct several interviews. For example, about the truth of the news of the death of the insured and make sure the documents related to the insurance policy are in the hands of the heirs. Some insurance companies provide claims processes online.
The insurance company will send a claim form for life protection due to the death of the insured. You / heirs can prepare documents and fill out the entire claim form and send it back to the insurance. Some of the supporting documents requested include policy and endorsement (Original), photocopy of all laboratory and radiology examination results, photocopy of ID card or identity of the beneficiary, Certificate of Death from the local government, Certificate of Death from the Doctor / Hospital containing the cause of death of the insured, the original police certificate (BAP) if the insured died due to an accident.
The insurance will verify the documents and analyze until the data is complete.
If the document is approved, the insurance will contact the heirs with the insurance agent intermediary about the rejection or acceptance of the claim application process.
How to claim health insurance
What Causes Customers to File Insurance Claims?
Claim becomes a test for insurance users. Many also make this reason to refuse to use insurance services, whether it’s life insurance, property, to travel insurance.
If all the provisions are already fulfilled, insurance claims are easy and simple, because everything is stated in the agreement between the parties and is bound by law. So, the insurance should not carelessly reject the claim.
Here are some of the causes that make the insurance claim become problems:
- The insurance policy is not active (lapse) so the insurance will not be liable for the losses suffered. So, you must pay insurance premiums on time or at least not until the end of the grace period.
- Claims filed are not covered by the insurance dependents clause. Examples of TLO Property insurance claims for property damages of at least 70%, 75%, even 80%. If your property is only scratched or does not suffer damage according to the percentage above, of course the insurance will not accept claims.
- Filing a claim exceeds the specified deadline. For example, property insurance claims must be taken care of immediately because the time limit is about 3 x 24 hours. As for life insurance claims, the time limit is 30-60 days. Submissions beyond that time, of course, will be rejected.
- Incomplete claim documents may be due to less than one document, the insurance will reject the claim. For example, for life insurance, you must include a certificate from a doctor.
- It is still in a waiting period so that the insured as the buyer of the insurance policy will not be able to file a claim. The waiting period for critical illness is usually about 30 to 365 days.
- The policy owner hides the existing disease so that the insurance will reject it, even though the waiting period has been passed. Make sure you are in good health when buying insurance.
- Claims that are advocated include exceptions. In life insurance, there are some insurance exceptions, namely death by suicide, court sentences, to crimes.
- Policyholders break the law. For example, even though it has all-risk Property insurance, the insurance will not cover the claim if the property policyholder is in an accident due to recklessness or violating traffic.
- Committing insurance crimes such as acts of lies or sabotage committed intentionally by the policy owner or his heirs for insurance claims to be paid. For example, an insurance policy owner may intentionally cause an accident in order to get compensation from insurance. Of course, the insurance will reject it if the event is done intentionally.
Why should you always use the services of an insurance broker?
From the explanation above you can see that insurance claims are not a simple thing. Many things must be known, executed, and obeyed so that you can make a claim smoothly.
It must be admitted that it is not easy to understand all the contents of an insurance policy, it needs special education and years of experience in resolving insurance claims. The problem is that not all of you have both requirements.
It is best to use the services of an insurance brokerage company. Insurance brokers are insurance experts recognized by OJK and registered with the National Professional Certification Agency (BNSP) whose job is to assist you in designing insurance policies, negotiating with insurance companies, and assisting in resolving claims. Insurance broker is your insurance expert.
Insurance brokers defend your interests, not those of insurance companies. The insurance broker is on your side.
Therefore, you must be disappointed because of your insurance claim is not paid, to avoid such situation then always use the services of an insurance company for all your insurance needs.
One of the leading insurance brokerage companies in Indonesia is L&G Insurance Broker. L&G is a smart insurance broker that can be accessed online through its website.
For all insurance needs you contact L&G right now!
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