What are the procedures for making an insurance claim?

What are the claim process is actually not complicated, generally speaking, after the accident, the claim is these four steps: report; Preparation of claim documents; Submit the claim information to the insurance company, and the insurance company will review it; The insurance company notifies you of the outcome of the claim.

1. Case filing and investigation: After receiving the notice of the accident, the insurer shall immediately send someone to conduct an on-site investigation to understand the loss and its causes, check the insurance policy, and register the case.

2. Review of certificates and materials: The insurer shall review the relevant certificates and materials provided by the policyholder, the insured or the beneficiary to determine whether the insurance contract is valid, whether the insurance period has expired, whether the loss is the insured property, whether the claimant has the right to claim compensation, and whether the place where the accident occurred is within the scope of insurance.

3. Verification of insurance liability: After receiving the request for compensation or payment of insurance money from the insured or beneficiary, the insurer shall, after checking the facts and reviewing the documents, make a timely assessment of whether it should bear the insurance liability and how much responsibility it should bear, and notify the insured or beneficiary of the verification result.

4. Fulfillment of compensation obligations: On the basis of the verification of liability, the insurer shall perform the obligation of compensation or payment of insurance money within 10 days after reaching an agreement with the insured or beneficiary on compensation or payment of insurance amount. If the insurance contract stipulates the insured amount and the period of compensation or payment, the insurer shall perform the obligation of compensation or payment of insurance money in accordance with the provisions of the insurance contract. ‍‍

Legal analysis: 1. Report the accident: The insured should notify the insurance company immediately after the occurrence of an insured accident.

2. Fill in the application: The insured or beneficiary shall fill in the "claim application" for rock trapping. The application form must be filled out truthfully to avoid prolonging the investigation of the case.

3. Issuance of certificates: Submit the insurance policy, claim application, the latest payment voucher and relevant certificates to the insurance company for verification. In case of death or disability, it is necessary to provide the date verification next to the death certificate and the disability appraisal certificate; For outpatient clinics, outpatient prescriptions and medical records are required; In case of traffic accidents, the accident ruling or certificate issued by the traffic management department shall be provided.

4. Investigation and verification: After receiving the above documents, the insurance company shall investigate and verify whether it is an insurance liability.

5. Receiving insurance money: After the insurance company verifies and agrees to the claim, the insured or beneficiary will be notified to receive the insurance money.

Legal basis: Insurance Law of the People's Republic of China Article 22 After the occurrence of an insured event, when the insurer is requested to compensate or pay insurance money in accordance with the insurance contract, the policyholder, the insured or the beneficiary shall provide the insurer with the relevant certificates and materials that it can provide to confirm the nature, cause and extent of loss of the insured accident.

If the insurer finds that the relevant certificates and materials are incomplete in accordance with the provisions of the contract, it shall promptly notify the policyholder, the insured or the beneficiary to provide supplementary information in a one-time manner.

Procedures for insurance claims: The insured or the victim shall notify the insurance company to apply for compensation and provide proof and materials, and the insurance company shall verify whether it is an insurance liability and notify the insured of the result; If it does not belong to the insurance liability, the reasons shall be explained in writing; For those who are liable for insurance, the insurance money shall be compensated within 10 days after reaching an agreement with the insured to compensate the insurance money.

1. How long is the compensation period of traffic accident insurance?

1. The statute of limitations for claims is generally 2 years, and the statute of limitations for personal injury is 3 years.

2. Within 5 days from the date of receipt of the certificate and information provided by the insured, the insurance company shall verify whether it is an insurance liability and notify the insured of the result.

3. For those who are liable for insurance, the insurance money shall be compensated within 10 days after reaching an agreement with the insured to compensate the insurance money. If it does not belong to the insurance liability, the reasons shall be explained in writing;

4. If the insurance company does not accept the application, it can file a lawsuit with the court if it provides relevant information.

5. The court will conduct the hearing within 7 working days.

2. How to deal with the insured vehicle in the accident and how to report the accident?

Insured vehicle accident process: After the accident of the insured limb shouting accident, the insured or the victim notifies the insurance company and applies for compensation for the insurance money, and the insurance company shall verify whether it is an insurance liability and notify the insured; If it does not belong to the insurance liability, the reasons shall be explained in writing; For those who are liable for insurance, the insurance money shall be compensated within 10 days after reaching an agreement with the insured to compensate the insurance money.

3. Can I apply for insurance without an accident certificate from the traffic police force?

If you do not have an accident certificate from the traffic police force, you can also apply for insurance. After receiving the compensation application, the insurance company shall inform the insured in writing of the certificates and materials related to the compensation that the insurance company needs to provide to the insurance company, and after the insurance company receives the certificates and materials, it is the insurance liability and shall make compensation, and it is not the insurance liability, and the reasons shall be explained in writing. Therefore, as long as the insured can prove that the traffic accident is covered by the insurance, even if there is no accident certificate from the traffic police, the insurance company will compensate for it.

Article 27 of the Regulations on Compulsory Insurance of Motor Vehicle Traffic Accident Liability.

If a road traffic accident occurs in an insured motor vehicle and the insured or victim notifies the insurance company, the insurance company shall immediately give a reply and inform the insured or victim of the specific compensation procedures and other relevant matters.

Article 28.

If the insured motor vehicle is involved in a road traffic accident, the insured shall apply to the insurance company for compensation for insurance benefits. The insurance company shall, within one day from the date of receipt of the compensation application, inform the insured in writing of the proof and materials related to the compensation that need to be provided to the insurance company.

Article 29.

The insurance company shall, within 5 days from the date of receipt of the certificate and materials provided by the insured, verify whether it is an insurance liability and notify the hidden insurer of the result; If it does not belong to the insurance liability, the reasons shall be explained in writing; For those who are liable for insurance, the insurance money shall be compensated within 10 days after reaching an agreement with the insured to compensate the insurance money.

1.Acceptance of the reportAcceptance of the report means that the insured must report to the insurance company in a timely manner when an insured accident occurs, and the insurance company shall register the accident for the record. Generally speaking, reporting an accident is an important part of the insurance company's claim settlement process, which helps the insurance company to understand the accident situation in a timely manner, and if necessary, it can intervene in the investigation and verify the nature of the accident as soon as possible. At the same time, the insurance company can inform or remind the applicant of the materials to be prepared according to the requirements of the insurance contract and the circumstances of the accident, and give guidance on the methods and ways of collecting the relevant materials.

2.Acceptance of materials, case filing, acceptance and filing is a process in which the insurance company reviews the claim application materials provided by the applicant to determine whether the materials are complete, whether supplementary materials are required, or whether the insurance company determines whether Sun Huairan accepts the application. In the case filing process, if the applicant of the insurance company submits incomplete and unclear supporting materials, he will immediately tell the applicant to submit the relevant materials; If the materials are complete and clear, the applicant shall be immediately informed of the approximate time required to handle the case, and the method of receiving the insurance money.

3.Review and review refers to the process in which the case handler determines the objective facts based on relevant evidence, determines the insurance liability, accurately calculates the payment amount, and makes a claim conclusion.

4.After the notification and payment case has passed the approval process, the insurance company can notify the beneficiary to bring the relevant identity certificate and relationship certificate to go through the payment procedures.

The specific procedures for insurance claims are as follows:

1. During the insurance period of the insurance contract, the insurer shall bear the responsibility for the payment of insurance money in accordance with the contract;

2. The insured, the insured or the beneficiary of the insurance money shall notify the insurer in a timely manner after knowing the occurrence of the insured event;

3. If the insurer considers that the claim certificate and materials provided by the insured are incomplete, it shall promptly notify the insured at one time and the insured shall supplement it;

4. After receiving the insured's request to pay the insurance money, the insurer shall promptly verify whether it is an insurance liability, and if the situation is complicated, it shall verify within 30 days, unless otherwise agreed in the insurance contract;

5. The insurer shall notify the insured of the verification result, and if it is an insurance liability, it shall perform the obligation of insurance compensation within 10 days after reaching an agreement with the insured on the payment of insurance money, and if the insurer does not belong to the insurance liability after verification in accordance with the previous agreement, it shall issue a notice of refusal to pay the insurance money to the insured within three days from the date of verification, and explain the reasons;

6. If the insurer is unable to determine the payment amount within 60 days from the date of receipt of the insurance payment request and relevant certificates, it shall pay the amount determined in advance according to the existing certificates and data, and the insurer shall pay the corresponding difference after the insurer finally determines the payment amount.

Insurance Law of the People's Republic of China Article 23 After receiving the request for compensation or payment of insurance money from the insured or beneficiary, the insurer shall make an assessment in a timely manner; Where the circumstances are complicated, an approval shall be made within 30 days, unless otherwise agreed in the contract. The insurer shall notify the insured or beneficiary of the verification results; For those who are liable for insurance, the obligation to compensate or pay insurance money shall be fulfilled within 10 days after reaching an agreement with the insured or beneficiary to compensate or pay insurance money. If the insurance contract stipulates the time limit for compensation or payment of insurance money, the insurer shall perform the obligation of compensation or payment of insurance money in accordance with the agreement.

If the insurer fails to perform the obligations provided for in the preceding paragraph in a timely manner, it shall compensate the insured or the beneficiary for the losses suffered thereby, in addition to paying the insurance money.

No unit or individual may illegally interfere with the insurer's performance of the insurer's obligation to compensate or pay insurance money, nor shall it restrict the right of the insured or beneficiary to obtain insurance money.