How to File Insurance Claims — Step-by-Step
Cashless and reimbursement claims, death/term claims, required documents, dispute resolution, and tips.
Filing an insurance claim feels stressful, especially during a medical emergency or after a loss. Knowing the exact process beforehand removes uncertainty and speeds up settlement.
Cashless Health Insurance Claim Process
This is the most common claim type. Follow these steps:
Step 1 — Choose a network hospital. Check your insurer's app or website for the list of empanelled hospitals. Only network hospitals offer cashless facility.
Step 2 — Show your health card at admission. The hospital's TPA (Third Party Administrator) desk will collect your policy number and ID proof.
Step 3 — Pre-authorisation request. The hospital sends a pre-auth form to your insurer with diagnosis details, estimated costs, and treatment plan.
Step 4 — Insurer approves or queries. Approval typically comes in 2-4 hours for planned admissions. Emergency cases get faster processing. The insurer may ask for additional documents.
Step 5 — Get treatment. Focus on recovery. The hospital and insurer handle billing directly.
Step 6 — Settlement at discharge. The insurer settles the bill directly with the hospital. You pay only non-covered items (personal consumables, extra meals, etc.).
Save your insurer's 24x7 helpline number in your phone. In emergencies, call them immediately — even before reaching the hospital. They can guide you to the nearest network hospital.
Reimbursement Claim Process
Use this when you visit a non-network hospital or cashless is not available.
Ramesh has surgery at a non-network hospital. Total bill: ₹3,80,000.
- He pays the full amount from his savings
- Within 15 days of discharge, he submits: original bills, discharge summary, doctor's prescriptions, diagnostic reports, and a duly filled claim form
- Insurer processes the claim in 15-30 days
- After deducting ₹12,000 for non-covered items, insurer reimburses ₹3,68,000 to his bank account
Documents needed for reimbursement:
- Claim form (download from insurer's website or app)
- Original hospital bills and receipts
- Discharge summary signed by the treating doctor
- Investigation reports (blood tests, scans, X-rays)
- Doctor's prescription for medicines
- Photo ID proof (Aadhaar/PAN)
- Cancelled cheque or bank details for NEFT transfer
Insurers need ORIGINAL bills and reports for reimbursement. Always ask the hospital for original copies. Photocopies or digital copies are not accepted for claim settlement.
Term Insurance (Death) Claim Process
This is the most important claim your family may ever file. Make sure they know the process.
Step 1 — Inform the insurer. The nominee should call the insurer's helpline or visit the nearest branch within 30 days of death (most companies are lenient on this timeline).
Step 2 — Submit documents:
- Claim form (insurer provides)
- Original death certificate
- Original policy document
- Nominee's ID proof and address proof
- Nominee's cancelled cheque
- FIR copy (if accidental death)
- Hospital records (if death after hospitalisation)
Step 3 — Investigation. The insurer may investigate if the claim is within 3 years of policy issuance (to check for pre-existing condition non-disclosure). Claims after 3 years are less likely to be contested.
Step 4 — Settlement. IRDAI mandates settlement within 30 days of receiving all documents. The sum assured is credited to the nominee's bank account via NEFT.
Anita's husband had a ₹1 crore term policy from HDFC Life. He passes away due to cardiac arrest. Anita:
- Calls HDFC Life helpline the same week
- Submits death certificate, hospital records, and her ID proof
- HDFC Life verifies documents (policy was 5 years old, no investigation needed)
- ₹1,00,00,000 is credited to Anita's bank account in 18 days
What If Your Claim Is Rejected?
Don't give up. You have multiple options:
- Appeal to the insurer — Write a formal grievance letter with supporting documents. The insurer must respond within 15 business days.
- Approach IRDAI — File a complaint on IRDAI's IGMS portal (igms.irda.gov.in). IRDAI intervenes and seeks resolution.
- Insurance Ombudsman — File a complaint with the Insurance Ombudsman for claims up to ₹50 lakh. This is free and faster than courts.
- Consumer Court — For larger amounts, approach the District/State Consumer Disputes Redressal Commission.
Most claim rejections happen due to: non-disclosure of pre-existing conditions, policy lapse (missed premiums), waiting period not covered, or procedures excluded under the policy. Read your policy document carefully at the time of purchase.
Checklist for Your Family
Make sure your family has:
- Policy number and insurer helpline number
- Login credentials for the insurer's portal/app
- Location of original policy documents
- Nominee details updated in the policy
- Know which hospitals are in the cashless network
Key Takeaways
- For cashless claims, always go to network hospitals and request pre-authorisation
- Submit reimbursement claims within 15 days with original documents
- For term insurance claims, the nominee should inform the insurer within 30 days
- If a claim is rejected, escalate to IRDAI or the Insurance Ombudsman
- Keep your family informed about your policies and the claim process
What is the IRDAI-mandated timeline for settling a life insurance claim after receiving all documents?
Learn more about choosing the right policy at our Insurance Guide.
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