It is the feeling of many people that it is easy to apply for insurance but difficult to settle claims. The main reason for this problem is that policyholders lack understanding of the life insurance claim settlement process. Problems of one kind or another arise in the life insurance claim settlement process. Making claims even more difficult. However, if you pay attention to the specific steps of life insurance claims during the process of applying for life insurance claims, it will reduce the difficulty of claims.

First, you must file a claim in time:

< p>The first step in insurance claim settlement is to report the case. According to the provisions of the insurance contract, when the insured subject matter is damaged or an insured accident occurs, the policyholder, the insured, the beneficiary and their authorized agents should notify the insurance company as soon as possible. , otherwise the resulting losses will be borne by the beneficiary. Generally, the policyholder should notify the insurance company within 10 days after the insured event occurs. However, since the claims settlement time limit for each insurance type is different, it must be based on the insurance contract.

If the policyholder reports the accident in a verbal manner, he or she must fill in the formal accident notification form with the following details when reporting the accident. Question: The basic information of the reporter and the insured, the time, place, cause, process and results of the insured accident, etc.

Second, compliance with the scope of liability:

After reporting the incident. , the insurance company or salesperson will inform the customer whether the accident is covered by the insurance coverage. The customer can also re-confirm by reading the insurance terms, consulting the agent, or calling the insurance company's hotline. The insurance company only confirms the accuracy of the insurance coverage. Compensation for losses caused by risks within the scope of liability. The insurance company does not provide coverage for exclusions in the insurance terms, such as suicide, crime and intentional acts of the policy holder and the insured within two years.

Third, prepare all the required documents:

In order to prevent someone from making unfounded or exaggerated claims, insurance companies will definitely require the insured to provide evidence of loss and explain the details within a specified time. Regardless of the type of insurance, the beneficiary must prepare the original insurance policy, the original identity documents of the insured and the beneficiary (ID card, household registration certificate, military ID card, soldier ID card) and the invoice of the latest premium paid. When handling claims, you must also fill in an authorization letter.

Fourth, prepare a medical split form:

If the insured has basic medical insurance and social security has already reimbursed part of it. It is necessary to present to the insurance company in advance the medical expense reimbursement split form issued by social security, and indicate the total medical expenses spent and the fees paid by social security. It should be submitted to the insurance company together with a copy of the original document. The insurance company will use the above materials to Make a claim within the remaining amount of medical expenses.

Fifth, conduct an accident investigation:

After the information is collected, the insurance company’s claims department may initiate an investigation. The customer cooperates with the company in the investigation and provides additional materials and evidence. If the policyholder conceals his or her medical history when applying for insurance, or the insured does not sign for it, it will cause obstacles to the smooth progress of the claim settlement. Finally, the insurance company will review, calculate and determine the compensation amount, and notify the customer to collect the insurance money. [4]

Folding materials

Life insurance claims need to be divided into three different claims situations: health insurance claims, accident insurance claims and death claims. Specific issues should be analyzed in detail, and different claims settlement offices The materials required are also different.

Health insurance claim materials:

Diagnosis certificate issued by the hospital designated or recognized by the insurance company, expense settlement details, outpatient and emergency medical records, original receipts of medical expenses and other medical information; hospitalization If so, a hospitalization summary is required.

Accidental injury claim materials:

(1) If the accident is a work-related injury or the accident involves the work of judicial or administrative agencies such as public security, procuratorates, courts, etc., relevant supporting documents are required;

(2) In case of death, a death certificate issued by the relevant department is still required.

Death claim materials:

(1) Beneficiary’s household registration certificate or identity certificate

(2) Insurance certificate issued by a medical institution or public security department recognized by the insurance company Death certificate of the insured

(3) If the insured is declared dead, the beneficiary shall provide a death judgment issued by the people's court

4) Certificate of cancellation of household registration of the insured, Cremation certificate

(5) Other relevant certificates and information required by the insurance company, such as discharge summaries of hospital deaths, rescue station-related rescue records of deaths in ambulances, outpatient and emergency medical records, etc.

In addition, the following necessary materials are required for total life insurance claims: (1) Insurance benefit payment application form filled in and signed by the insured; (2) Identity certification document of the insured; (3) Insurance Original document, including the last payment receipt.