Claim assistance

What we do — and what we cannot

Being straight about this matters more here than anywhere else on the site.

What we do: help you intimate the claim correctly and on time, tell you which documents the insurer will want and in what form, keep the file moving, chase the surveyor or the third-party administrator, translate what the insurer is asking for, and stay reachable while it is open.

What we do not do: decide the claim. The insurer assesses it against the policy terms and their decision is theirs. Any adviser who tells you they can guarantee approval is telling you something that is not true. What good preparation does is remove the avoidable reasons for a delay or a rejection — and in our experience those account for most of them.

Motor claim: the first hour

1. People first. Attend to injuries and safety before anything else. If anyone is hurt, or a third party is involved, the police need to be informed.
2. Tell the insurer promptly. Intimation is time-sensitive and most policies require it without unreasonable delay. Do this before repairs are arranged — not after.
3. Record the scene. Photographs of the damage, the position of the vehicles, the registration numbers and the surroundings. It takes two minutes and it settles arguments later.
4. Do not start repairs yet. The insurer will usually want the damage surveyed first. Repairs begun before that are a common reason a claim is reduced.
5. Call us. We will tell you what happens next and what the insurer will ask for.

Health claim: cashless and reimbursement

Planned admission. Tell the insurer or TPA in advance — most policies expect notice several days before. Confirm the hospital is in the cashless network and get the pre-authorisation started before you are admitted rather than at the counter.

Emergency admission. Get treatment first. Intimation still needs to happen quickly afterwards, usually within a short window specified in the policy.

Reimbursement. If the hospital is outside the network, or cashless is declined, you pay and claim afterwards. Keep every original — discharge summary, itemised bills, payment receipts, prescriptions, diagnostic reports and the treating doctor's notes. Missing originals are the most common cause of a stalled reimbursement.

IRDAI has published timelines for cashless authorisation. Our guide to how those timelines work explains what they cover and what still depends on the policy terms.

Why claims get delayed

Very few claims fail dramatically. They stall, and usually for one of these reasons:

• Late intimation. The most avoidable one, and the most common.
• Something not disclosed at proposal stage. A health condition, a previous claim, a modification to the vehicle. This surfaces at claim stage and it is difficult to fix then.
• Documents that do not match. A name spelled differently, an address that was never updated, a registration detail that is wrong on the policy.
• A gap in cover. A policy that lapsed, or a vehicle that was sold and never transferred — see transfers and hypothecation.
• Assuming something was covered. A waiting period still running, a sub-limit, a deductible, an excluded cause. Usually discoverable in advance, which is why we would rather read your policy before you need it.

What to have ready

• The policy number and a copy of the policy schedule.
• For motor: registration certificate, driving licence, photographs, the police report where one exists, and repair estimates once the insurer asks for them.
• For health: discharge summary, itemised hospital bills, payment receipts, prescriptions, diagnostic and investigation reports, and the treating doctor's notes.
• Your own contact details as they appear on the policy — if they have changed, tell us.

If we did not arrange your policy

We would still rather you called than struggled with it alone. There are limits to what we can do on a policy we do not service — we cannot act on your behalf with an insurer we have no relationship on — but we can usually tell you what the insurer is asking for and why, and what your next step should be.

Common questions