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HDFC ERGO General Insurance Claims - Things You Must Know

Whenever you claim your insurance policy, you most likely have suffered some loss or your insured property has sustained some damage that can be caused by a peril that is insured by your insurance plan. So, to understand insurance claims better you must know about an insurance claim, how is it filed, and what are the types of claims.

What is an Insurance Claim?

The insurance policy that you have taken provides you financial compensation and coverage against damages and losses you came across. Some of the common insurance claims that you may file are motor insurance claims, health insurance claims, life insurance claims, home insurance claims, etc. 

How Will Your Claim be paid? Or Types of Claims

HDFC ERGO General Insurance plans offer two types of claims - you can either opt for a cashless claim or go with reimbursement of claim facility.

Cashless Claim

In a cashless claim, your insurance provider settles the claim on your behalf. You do not have to pay anything to the service provider. The facility of cashless claims is generally provided in motor insurance policies and health insurance policies. Under this, if you take the service from the service provider of your insurer’s network, then it will settle the claim directly with the service provider and you will not have to pay anything except for the things that are not covered in your insurance policy.

For example, suppose your car gets damaged in an accident and you want to file a claim for its repair. So, if you get your car repaired from a network garage of HDFC ERGO General Insurance Company (your insurance provider), then the company will settle the claim amount directly with the network garage and you do not have to pay from your pocket.

The same thing happens when you use your health insurance policy for taking treatment from a network hospital of your insurance provider. However, if you take treatment from a non-network hospital or get your vehicle repaired from a non-network garage of your insurer, then you have to pay from your pocket and later claim for reimbursement.

Reimbursement Claim

In reimbursement claim, you have to pay from your pocket first and then claim for reimbursement from your insurance provider, who later settles it. As mentioned above, if the hospital in which you are taking your treatment is not covered in the network list of hospitals of your insurer, then you will not be able to avail of the cashless facility of your insurer. In such a case, you have to pay for your treatment from your pocket and your insurer will later settle it by reimbursing you the amount.

How Will Claim Filing Impact the Premium of Your Insurance Policy?

Whenever you are going to file a claim, think twice especially when you are filing a claim for your vehicle. This is because claim filing impacts your No-Claim Bonus as well as your insurance premium. So, if your car is slightly damaged and its repairing cost is bearable then try to repair it by yourself instead of filing a claim.

Mistakes to Avoid While Filing Claim for Your Insurance Policy:

While filing a claim for your insurance policy, you should avoid the following mistakes:

  • Not lodging FIR in case of travel and motor claim.
  • In case of vehicle claim running away from the spot of the accident.
  • Not informing your insurance provider.
  • Not submitting all the required documents.
  • Not cooperating with your insurance provider.
  • Not reading the documents of your insurance policy carefully.

Process of Filing HDFC ERGO General Insurance Claims:

Follow the below steps to file the insurance claim:

For Health Insurance Policy

You can register your health insurance claim in two ways - cashless claim and reimbursement claim.

Claim Filing Process for Cashless Claim

As mentioned above, you can avail of the facility of cashless claims if you are taking treatment in one of the network hospitals of your insurer. Follow the below-mentioned steps to settle the claim in case of cashless claim settlement:

  • Inform your insurance provider: When you are going to avail the facility of a cashless claim settlement, inform your insurance provider first. For planned hospitalization, inform the insurer in advance and for an emergency, hospitalization inform the insurer within 24 hours of hospitalization. Duly fill and sign the pre-authorization form that will be available at the hospital and submit it for approval.
  • Submit the Following Documents: For availing a cashless facility, you should provide the following documents at the hospital:
    • Policy number
    • Policy documents
    • Aadhar card

Claim Filing Process for Reimbursement Claim

Some insurance providers do not offer the facility of cashless claims. Sometimes when you do not take the service from the network garage or hospital of the insurer, then you have to opt for a reimbursement facility. Steps to file a reimbursement claim are:

  • Step 1: To avail the reimbursement claim inform HDFC Ergo Health Insurance company within 7 days after discharge.
  • Step 2: Download the claim form from the website of the company or visit the nearest branch to get the same. Duly fill and sign this form and attach all the required documents such as - discharge summary, medical bills, consultation sheet, and all other required documents. This form with the documents has to be submitted to the insurance provider (HDFC ERGO General Insurance in this case) or TPA (third-party administrator) of the company.
  • Step 3: Keep all the copies of the documents and bills that you have provided to the company. The claims that you have made based on reimbursement get settled within two to three weeks.

For Travel Insurance Policy

A travel insurance claim is filed when you have lost your belongings while traveling. The first step in filing the claim for your lost baggage is to lodge an FIR by visiting the nearest police station and then inform your insurance provider. If you have lost your checked-in baggage, then you should inform the air-lines and your insurance company. Steps to file a claim in such cases are:

  • Download the claim form from the website of your insurer or ask them to send you via email.
  • With a copy of the FIR that you have lodged with the police, you need to submit the documents like witness statement, claim form, copy of your boarding pass or ticket, your medical reports, etc. As per the type of claim, your insurer may ask you for additional documents, if needed.
  • On your travel insurance documents, you will get the contact details of the administrator of claims who can either be in the destination country where you are traveling or the country that is assigned to get and process your application for the claim.
  • Most of the travel insurance companies have a timeline of filing the claim and after crossing that you will not be able to get any compensation.

For Motor Insurance Claim

You can claim your motor insurance policy under the below-mentioned instances:

  • Damage or injury to third-party.
  • Loss or damage to your vehicle and/ or to you. This can be availed under own damage insurance and you will be eligible to get that only when you have a comprehensive insurance plan.

Steps to File Third-Party Insurance Claim

Follow the below steps to file a third-party insurance claim:

  • File an FIR first
  • Note the names of the people who have witnessed the incident, if they are agreeing to support you.
  • Try to get video or photos of the incident and spot.
  • Note the details of the involved third-party and do not forget to note the details of the insurer as well. Intimate your insurance provider within 48 hours of the incident.
  • Get your case registered in the tribunal court.

Steps to File Own Damage Insurance Claim:

Follow the below steps for the same:

  • Intimate your insurance provider as soon as possible which is at least 48 hours of the incident.
  • If needed inform the police and lodge an FIR.
  • Consult police and your insurance provider before moving your car from the spot of the accident.
  • Your car will be towed to the nearest garage.
  • Your insurer will then send a surveyor to access the damage.
  • If the garage wherein you are getting your car repaired in the network of your insurer then you will get the facility of the cashless claim. Otherwise, you have to file reimbursement.
  • Your claim can be settled as per the cost of repair and coverage that is provided in your insurance policy.

Steps to File Theft Claim:

In case you think that your motor vehicle is stolen, then follow the below steps:

  • File an FIR
  • Inform your insurance provider as soon as possible after filing the FIR. Most of the insurers give a margin of 24 to 48 hours for this.
  • Inform your Regional Transport Office.
  • Submit documents such as original keys of your vehicle, no trace reports, copy of your FIR, claim form, etc.
  • In case your vehicle is not recovered, then your insurance company will give you the claim amount equivalent to the IDV of your vehicle.

Summing It Up!

In this article, we have mentioned almost everything that you may need at the time of filing your insurance claim. However, for more clarity, you should check your policy wording and the terms and conditions of your general insurance plan.

Written By: PolicyBazaar - Updated: 07 October 2020

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