The effective dealing with the insurance claims plays a pivotal role to keep organization’s financial health in good shape. Insurance is a very technical subject and should be dealt by the person who has a sound knowledge of insurance. In my 20 years of experience I have seen mostly organizations do not have technical person to deal with insurance portfolio. In absence of proficiency, he is not able to deal with insurance claims effectively, even he is not able to choose a good insurance policy for his organisation. Not having of proper documentation and correspondence, there is extra ordinary delay to recover claim money from the insurance company. And sometimes, they even fail to take a valid claim. At last they ended up by blaming insurance companies for not settling of their claims.
There is a general perception in public that insurance company does not want to settle the claims. But in my long career, I did not see even a single case where insurance company had repudiated a valid claim if insured had furnished them all supported documents. Because of inefficiency of their employees, organisations pay a heavy price. Following are most of the reasons which cause repudiation of claim:
- Misrepresentation or concealment of material fact.
- Fraud
- Non coverage of specific peril
- Excess or Deductible
- Lack of documentation
- Where insured is failed to prove his loss on technical ground.
1. Misrepresentation or concealment of material fact
Sometimes intentionally or unintentionally, people put wrong information or hide some material fact while filling a proposal form. The information you provided at the time of buying policy is inbuilt in policy document. The information and fact which were collected from the insured at the beginning are part and parcel of policy document. In case at the time of claim, if insurance claim department detects this concealment of material fact or misrepresentation, they repudiate the claim under policy. The insurance policy is a legal contract and should be look at very carefully.
- Fraud
Frauds are common in insurance. Some people are involved in selling of fake policy and other are doing this online. They just make a fake website and offer a good discount on premium to attract people. The online fraud is all time high and recently the IRDAI (Insurance Regulatory and Development Authority of India) has also cautioned public in general to take utmost care while buying policy online. Some people also have their mastery in making forge claim. In my long carrier, I have caught many fraudsters who were part of the rackets which had been making fake claims with insurance company for years. So, the person who is handling your insurance department should be capable to purchase policy for your organisation from reliable sources.
- Non coverage of specific peril
At the beginning, you need due diligence to choose right products for your insurance needs. Some perils are inbuilt in policy and other are available as add on covers. If you required the add on covers for your business or personal needs, take utmost care by selecting them. Make proper enquiry about the perils which are covered under the policy. Sometimes, at the time of claim it is seen that the peril to which claim is made, is not covered under the policy. In that case insurance company will not pay you, even if you lodge a genuine claim.
- Excess or deductible
This is a very crucial factor which must be taken into consideration while choosing insurance products. It will put an effect on your claim money directly. If you have chosen higher excess/deductible in your policy, your claim amount will be lowered dramatically. Generally people make mistake by choosing high excess or deductible and pay a heavy price at the time of claim settlement. Some people want to pay premium as low as possible without taking into consideration the consequences at later stage. They do this to save a very nominal amount, sometimes even merely Rs. 100/- or 200/- in individual policies.
- Lack of documentation
Insurance is a business of assurance and you did not receive any physical product in order the premium you pay. Insurance company required certain documents to settle your claim. As a Claim Consultant, I have witnessed many cases in my long carrier where the organisations or individuals had failed to produce the basic documents for their legitimate claim. And in the absence of the documentation, I had no option but to recommend insurance company to repudiate their claim on the ground of lack of documents. In most of the cases, it happened owing to the ignorance about claim documentation or carelessness of the employees of the companies.
- Where insured is failed to prove his loss on technical ground
I have come across hundreds of cases where the insured failed to prove their valid claim on account of incomprehension. They could not procure substantial evidence because of unenlightenment. At the end, their loss proved “mysterious”. These losses could have been recovered if they had a knowledge of insurance claims.
If you want to avoid such kind of loss you should appoint the people who have thorough knowledge of insurance or you can hire a service from the company which deals in insurance claims management. At Active Claims consultant we have a dedicated team to handle all kinds of insurance claims, whether it is liability claims, commercial claims or individual claims. Our team of experts handles all, ranging from selecting of good insurance product, arranging of all documents including claim documents, correspondence with the insurance company and other parties for you.
Following are the key benefits if you avail our services:
- Cut your claim operational cost by 30% to 70%
- Your insurance department is in the hand of experts of industry.
- Fast recovery: our team recovers your claim money faster from insurance company.
- Saving on premium; apart from this our team of experts can explore best competitive rates for you from insurance companies. Our clients enjoy best insurance coverage by paying low premium.
- Dedicated persons to handle your portfolio.
The effective dealing with the insurance claims plays a pivotal role to keep organization’s financial health in good shape. Insurance is a very technical subject and should be dealt by the person who has a sound knowledge of insurance. In my 20 years of experience I have seen mostly organizations do not have technical person to deal with insurance portfolio. In absence of proficiency, he is not able to deal with insurance claims effectively, even he is not able to choose a good insurance policy for his organisation. Not having of proper documentation and correspondence, there is extra ordinary delay to recover claim money from the insurance company. And sometimes, they even fail to take a valid claim. At last they ended up by blaming insurance companies for not settling of their claims.
There is a general perception in public that insurance company does not want to settle the claims. But in my long career, I did not see even a single case where insurance company had repudiated a valid claim if insured had furnished them all supported documents. Because of inefficiency of their employees, organisations pay a heavy price. Following are most of the reasons which cause repudiation of claim:
Misrepresentation or concealment of material fact.
- Fraud
- Non coverage of specific peril
- Excess or Deductible
- Lack of documentation
- Where insured is failed to prove his loss on technical ground
- 1. Misrepresentation or concealment of material fact.
Sometimes intentionally or unintentionally, people put wrong information or hide some material fact while filling a proposal form. The information you provided at the time of buying policy is inbuilt in policy document. The information and fact which were collected from the insured at the beginning are part and parcel of policy document. In case at the time of claim, if insurance claim department detects this concealment of material fact or misrepresentation, they repudiate the claim under policy. The insurance policy is a legal contract and should be look at very carefully.
- Fraud
Frauds are common in insurance. Some people are involved in selling of fake policy and other are doing this online. They just make a fake website and offer a good discount on premium to attract people. The online fraud is all time high and recently the IRDAI (Insurance Regulatory and Development Authority of India) has also cautioned public in general to take utmost care while buying policy online. Some people also have their mastery in making forge claim. In my long carrier, I have caught many fraudsters who were part of the rackets which had been making fake claims with insurance company for years. So, the person who is handling your insurance department should be capable to purchase policy for your organisation from reliable sources.
- Non coverage of specific peril
At the beginning, you need due diligence to choose right products for your insurance needs. Some perils are inbuilt in policy and other are available as add on covers. If you required the add on covers for your business or personal needs, take utmost care by selecting them. Make proper enquiry about the perils which are covered under the policy. Sometimes, at the time of claim it is seen that the peril to which claim is made, is not covered under the policy. In that case insurance company will not pay you, even if you lodge a genuine claim.
- Excess or deductible
This is a very crucial factor which must be taken into consideration while choosing insurance products. It will put an effect on your claim money directly. If you have chosen higher excess/deductible in your policy, your claim amount will be lowered dramatically. Generally people make mistake by choosing high excess or deductible and pay a heavy price at the time of claim settlement. Some people want to pay premium as low as possible without taking into consideration the consequences at later stage. They do this to save a very nominal amount, sometimes even merely Rs. 100/- or 200/- in individual policies.
- Lack of documentation
Insurance is a business of assurance and you did not receive any physical product in order the premium you pay. Insurance company required certain documents to settle your claim. As a Claim Consultant, I have witnessed many cases in my long carrier where the organisations or individuals had failed to produce the basic documents for their legitimate claim. And in the absence of the documentation, I had no option but to recommend insurance company to repudiate their claim on the ground of lack of documents. In most of the cases, it happened owing to the ignorance about claim documentation or carelessness of the employees of the companies.
- Where insured is failed to prove his loss on technical ground
I have come across hundreds of cases where the insured failed to prove their valid claim on account of incomprehension. They could not procure substantial evidence because of unenlightenment. At the end, their loss proved “mysterious”. These losses could have been recovered if they had a knowledge of insurance claims.
If you want to avoid such kind of loss you should appoint the people who have thorough knowledge of insurance or you can hire a service from the company which deals in insurance claims management. At Active Claims consultant we have a dedicated team to handle all kinds of insurance claims, whether it is liability claims, commercial claims or individual claims. Our team of experts handles all, ranging from selecting of good insurance product, arranging of all documents including claim documents, correspondence with the insurance company and other parties for you.
Following are the key benefits if you avail our services:
- Cut your claim operational cost by 30% to 70%
- Your insurance department is in the hand of experts of industry.
- Fast recovery: our team recovers your claim money faster from insurance company.
- Saving on premium; apart from this our team of experts can explore best competitive rates for you from insurance companies. Our clients enjoy best insurance coverage by paying low premium.
- Dedicated persons to handle your portfolio.