Kathmandu. The best advertisement that any insurance company can make is probably “We don’t advertise, we pay claims!”. The best way to show the excellence of an insurer is to settle a claim as soon as possible when the insured has filed a claim in accordance with the terms of the insurance policy.
Paying a claim means paying the customer as per the terms of the insurance policy issued, which provides financial relief to the insured in the event of any unexpected loss and enables them to continue living and running their business in the same condition.
The only objective behind any insured taking out insurance is to ensure that the insurance company pays the claim immediately in the event of any unexpected event covered by the insurance policy. Getting a claim paid quickly, easily and in a reasonable amount is the best service an insurance company can provide.
A large business customer may approach an insurance company through a broker or directly with the company for insurance. This broker may then be the one who, in fact, has the main business with the insurance company. However, the insurance broker will certainly inform the customer about any dissatisfaction with the insurance company, thus
The reputation of the insurance company is more relevant than that of the customer.
When an insured person suffers a disaster for the first time, he may not know what to do or where to go to file a claim. When a disaster occurs, he may read the insurance policy documents before making a claim to the insurer. Perhaps this is the first time he has read the terms of his insurance policy carefully. The terms and conditions set out in the policy under the heading “What to do in the event of a claim” may be the beginning of compensation for the loss suffered by the insured or, if the loss is due to a risk not included in the terms, may add to the suffering already suffered by the insured.
What is claims management?
Claims management refers to the processes and controls in place to provide an efficient and cost-effective solution to dealing with claims arising from various types of risks borne by the company.
Claims management begins with answering the question “What to do in the event of a claim”. It is ensured that the insured can easily contact the company for necessary information regarding the insurance claim with the insurer. Appropriate advice is given by the responsible staff to reassure them and inform them about the claim process. They are informed about the claims process in detail, the measures required to mitigate the damage and obtain the remaining compensation under the insurance policy.
The company’s claims management needs to ensure that there is an appropriate infrastructure in place with qualified personnel to process the claims that have entered the process.
The claims department needs to coordinate with the risk assessment department, which has knowledge of the customer, the accounting department to ensure that the insurance premium is paid, and the higher management that needs to make procedural decisions.
Whether it is in the insurer’s claims department or in the branch office, the information regarding the insurance claim must have been formally received. And then the insured must have filed an application with the necessary documentary evidence for the claim. The insurer should have collected the initial details related to the claim. The date on which this was done should be specified when the customer first contacted the insurer for a claim or when the insurance documents were opened and viewed.
1. Has sufficient information been provided? Has the claim form already been completed?
2. Are medical or police reports or surveyor’s reports required?
3. Can the insurance claim involve fraud and/or restrictions?
4. What is the risk and sum insured under the policy?
5. What is the current estimated amount of the claim?
6. Will a damage inspection be required?
7. Will outside experts/adjusters be required?
8. What is the procedure for arranging repairs, reconstruction or transportation for the insured?
9. Are there third parties involved in the subject matter of the claim?
10. Where does the liability for the damage lie – with the insured or the third party?
11. Is there a possibility of subrogation, i.e. the insurer’s right to recover compensation from a third party?
12. Will outside legal assistance be required?
