What do I need to pay attention to when making a claim? What to pay attention to when making insuran

It is important to note that the doctor confirms that the medical record is correct when prescribing it.

1. Determine the scope of responsibility After an accident occurs, the scope of responsibility for the accident should be determined first. For example, if the insured person falls and is injured, see if they have accident insurance, or medical insurance, etc. If an accident occurs, but it is not covered by the insurance, you will not be able to receive compensation.

If you can't judge the scope of liability, you can call ** to consult the insurance company personnel for professional answers.

2. Report the case in time and ask for the required claim information After the occurrence of an insurance accident, you should call the customer service of the insurance company to report the case in time. Ask what information should be prepared for the claim, and make corresponding records, so as to avoid incomplete claims in the later stage and unable to get the claim in time. How long is "timely"?

Each insurance company has a time limit between the occurrence of an insured accident and the reporting of the incident, after which the claim may cause unnecessary trouble. Therefore, after buying insurance, you must see clearly how the contract stipulates this time, for example, report the case within ten days, etc.

3. Keep the documents The documents must be kept, especially the life insurance and other medical receipts, which should be classified and the original documents should be retained. It will be handed over to the insurance company's claims adjuster at the time of claim. If you lose important documents, it may affect the progress of your claim.

4. The beneficiary fills in clearly The insurance company will strictly review the beneficiary's information before paying the claim to avoid payment errors. Therefore, it is recommended that the policyholder or the insured fill in the clear beneficiary when signing the contract. For example, it is not advisable to fill in "legal heirs", but to be clear about who, who, and so on.

Buying insurance is buying protection, how to quickly recover losses after an accident, and getting compensation from the insurance company is the wish of every policyholder, but what do you need to pay attention to when making insurance claims? In this article, we summarize the precautions as follows, hoping to help those who need help, quickly settle claims, and recover losses as soon as possible.

First, it is necessary to report the case in a timely manner: the first step in the insurance claim is to report the crime. According to the provisions of the insurance contract, when the insured object is damaged or an insured accident occurs, the policyholder, the insured, the beneficiary and their entrusting person shall notify the insurance company as soon as possible, otherwise the loss caused by this shall be borne by the beneficiary.

Under normal circumstances, the policyholder should notify the insurance company within 10 days after the occurrence of the insured event, but because the timeliness of claims for each type of insurance is different, it is necessary to report the case in time according to the provisions of the insurance contract to prevent the loss of their interests.

If the policyholder reports the accident in the form of an oral report, the official notice of accident must be completed afterwards. When reporting a case, the following issues should be explained in detail: the basic information of the informant and the insured, the time, place, cause, process and result of the occurrence of the insured accident, etc.

Second, meet the scope of responsibility:

After reporting the accident, the insurance company or salesman will inform the customer whether the accident occurred is covered by the insurance liability. Customers can also reconfirm by reading the terms of the insurance, consulting with the **person, or calling the **** of the insurance company. The insurance company only compensates the insured for losses that are actually caused by risks within the scope of liability, and does not cover exclusions in the insurance terms, such as suicide, crime, and intentional acts of the policyholder and the insured.

Third, prepare the required documents:

In order to prevent unfounded or exaggerated claims, the insurance company will definitely require the insured to provide evidence of the loss and explain the details of the circumstances within a specified period of time. Regardless of the type of insurance, the beneficiary needs to prepare the original insurance policy, the original ID card of the insured and the beneficiary (ID card, household registration book, military ID, soldier ID card are acceptable) and the invoice for the latest premium paid.

Fourth, prepare a medical split sheet:

If the insured has publicly-funded medical treatment and the employer and social security have already reimbursed a part, then it is necessary to present the medical expense division bill issued by the employer to the insurance company in advance, and indicate the total amount of medical expenses incurred and the expenses paid by the unit, and submit it to the insurance company together with a copy of the original document, and the insurance company will make a claim within the remaining amount of medical expenses according to the above materials.

Fifth, conduct an accident investigation:

Once the information was collected, the insurance company's claims department began to investigate. The insurance company may require the customer to cooperate with the company in conducting research and provide additional materials and evidence. If the policyholder conceals his medical history when applying for insurance, or the insured does not have a personal signature, etc., it will bring obstacles to the smooth progress of the claim process.

Finally, the insurance company will review, calculate, and determine the amount of the claim, and notify the customer to go and collect the insurance benefit.

After the policyholder is out of insurance, he needs to submit a claim and reason for compensation to the insurance company according to the actual accident situation and the consequences caused by it, so as to share the risk, which is what people usually call a claim claim. For claims, policyholders should grasp the following basic elements.

1. There are two types of claims: compensation and payment. Compensation corresponds, and because life insurance is based on a person's life or body as the subject matter of insurance, life and body cannot be measured in money, so in the event of an accident, the insurance company can only pay insurance money to the beneficiary or the insured within the amount agreed in the policy.

II. Claim Procedures.

1. Case filing and inspection;

2. Review documents and audit responsibilities; 3.accounting for losses;

4. Residual treatment;

5. The insurance company pays the compensation;

6. The insurance company exercises the right of subrogation.

3. The insurance claim must be made within the limitation period of the claim, and if the insured or beneficiary does not file a claim with the insurance company, does not provide the necessary documents and does not receive the insurance money, it shall be deemed to have waived its rights. The statute of limitations for claims is generally 5 years, and the statute of limitations for other insurance is generally 2 years. The statute of limitations for claims shall be calculated from the date on which the insured or beneficiary knows of the occurrence of the accident, and after the occurrence of the accident, the policyholder, the insured and the beneficiary shall first stop reporting the accident and then file a claim for compensation.

Fourth, the principle of claim settlement.

1. Abide by contracts and keep promises.

2. Insist on seeking truth from facts.

3. Active, rapid, accurate and reasonable.

5. The documents to be provided when applying for a claim include: the original of the insurance policy or insurance certificate, the certificate of the insurance premium paid, the original text that can prove the identity of the insurance subject or the party, the claim list, the certificate of the insurance inspection, and other documents that should be provided in accordance with the provisions of the insurance contract.

VI. Dispute ResolutionIn the course of the performance of the insurance contract, if the two parties have a dispute over the ownership of the insurance liability and the amount of compensation, they shall be handled in an appropriate manner and in a fair and reasonable manner. According to the usual practice, disputes arising in the insurance business can be handled by negotiation and settlement, arbitration and judicial litigation.

There are generally two methods of negotiated settlement: self-settlement and third-party mediation. Arbitration is an agreement made by the parties to a contract before or after the dispute to be decided by a third party who agrees to submit their dispute to a mutually agreeable third party, and the arbitrator decides the dispute between the parties in the capacity of the referee rather than as a mediator.

Element 1: Clarify insurance liability.

Element 2: Clarify the types of insurance.

Element 3: Master the insurance agreement.

Element 4: Understand the compensation procedures.

It is important to note that the doctor confirms that the medical record is correct when prescribing it.