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Ramalingam

Ramalingam Kalirajan  |6240 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Jul 12, 2024

Ramalingam Kalirajan has over 23 years of experience in mutual funds and financial planning.
He has an MBA in finance from the University of Madras and is a certified financial planner.
He is the director and chief financial planner at Holistic Investment, a Chennai-based firm that offers financial planning and wealth management advice.... more
Raj Question by Raj on Jun 18, 2024Hindi
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my car met an accident with a person 3 month ago. my car had collied with a boy and boy get minor injury. we did not log any police complaint at that time, but call insurance compnay. later i paid expanse of the treatment of the boys injury. i have 3rd party insurance also. now please let me know how can i claim of the treatment expanse from insurance company. if they will pay to the injured person, i am ok to it.

Ans: I’m sorry to hear about the accident and hope the boy is recovering well. It’s great that you took responsibility for his medical expenses. Since you have third-party insurance, you can potentially claim the treatment expenses from your insurance company. Here’s how you can proceed:

Steps to Claim Treatment Expenses from Third-Party Insurance
1. Gather Necessary Documents
Ensure you have all the necessary documents ready, including:

Insurance Policy Details: Your third-party insurance policy
Accident Details: Date, time, and location of the accident.
Medical Bills and Receipts: Copies of all the treatment expenses you paid for the injured boy.
Medical Reports: Any medical reports or discharge summaries from the hospital.
Witness Statements: If possible, get statements from any witnesses of the accident.
2. Inform Your Insurance Company
Contact your insurance company as soon as possible. Provide them with the details of the accident and the treatment expenses incurred. Inform them that you wish to claim these expenses under your third-party insurance.

3. Submit a Claim Form
The insurance company will provide you with a claim form. Fill out the form accurately, providing all necessary details. Attach the gathered documents, including medical bills and reports, with the claim form.

4. Cooperate with the Investigation
The insurance company may conduct an investigation to verify the details of the accident and the incurred expenses. Cooperate with their inquiries and provide any additional information or documents they may request.

5. Follow Up
Keep in regular contact with the insurance company to follow up on your claim status. This will ensure that your claim is processed promptly.

6. Payment to the Injured Person
If the insurance company agrees to cover the expenses, they may pay the amount directly to the injured person or reimburse you for the amount you have already paid. Confirm this with your insurance company and provide the injured person’s contact and bank details if needed.

Points to Remember
Document Everything: Keep copies of all communications with the insurance company, including emails, letters, and phone call records.
Legal Advice: If you face any difficulties in the claim process, consider seeking legal advice to ensure your claim is processed smoothly.
Possible Outcomes
Reimbursement to You: The insurance company reimburses you for the medical expenses you have already paid.
Direct Payment: The insurance company pays the medical expenses directly to the injured person or their family.
By following these steps, you can navigate the claim process with your third-party insurance company and ensure that the medical expenses are covered. Your proactive approach in taking responsibility for the injured boy’s treatment is commendable and should help in facilitating a smooth claim process.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in
DISCLAIMER: The content of this post by the expert is the personal view of the rediffGURU. Users are advised to pursue the information provided by the rediffGURU only as a source of information to be as a point of reference and to rely on their own judgement when making a decision.
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How do I make a claim in case of an insurance event? I have a cashless mediclaim from United India but somehow I am not able to understand how I should initiate a claim settlement in case of hospitalisation. Could you please give me step-by-step procedure for filing claims and reimbursements?
Ans: Certainly! The process for filing a claim for cashless mediclaim with United India Assurance may vary slightly based on the specific policy and the nature of the medical event, but here is a general step-by-step guide that you can follow:

1. Inform the Insurance Company:

In case of planned hospitalisation, inform United India Assurance in advance. For emergencies, inform them as soon as possible.

2. Verify Network Hospitals:

Ensure that you are admitted to a hospital that is within the network of hospitals affiliated with United India Assurance for cashless claims.

3. Pre-Authorisation Process:

For planned hospitalisation, you need to obtain pre-authorisation from the insurance company. This involves submitting relevant documents such as the doctor's recommendation, estimated medical expenses, and other required information.

In an emergency, if pre-authorisation cannot be obtained in advance, inform the insurance company at the earliest opportunity.

4. Collect Necessary Documents:

Gather all relevant documents, including the policy document, ID proof, claim form, medical records, hospital bills, diagnostic reports, and any other documents required by the insurance company.

5. Submit Claim Form:

Fill out the claim form accurately. You can obtain this form from the hospital, the insurance company's website, or their customer service.

6. Submit Documents to the Hospital:

Provide the necessary documents to the hospital's insurance desk. The hospital will then submit the claim form and documents to the insurance company for processing.

7. Approval/Rejection of Claim:

The insurance company will review the submitted documents and decide whether to approve or reject the claim. If approved, the insurer will directly settle the bills with the hospital.

8. Paying Non-Covered Expenses:

If there are any expenses not covered by the insurance policy or if the claim is rejected, you may need to settle those directly with the hospital.

Reimbursement Claims:

• If you paid the medical expenses out of pocket, you can file for reimbursement
• Obtain all original bills, receipts, and medical reports
• Fill out the reimbursement claim form
• Submit the form along with the supporting documents directly to the insurance company within the stipulated time frame.

Follow-Up:

• Keep track of your claim's status by following up with the insurance company if necessary.
• Retain copies of all documents submitted for your records.

Always refer to the specific terms and conditions of your insurance policy and contact United India Assurance's customer service for any policy-specific details or clarifications. The contact information for United India Assurance can typically be found on their official website or in your policy documents.

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Ramalingam

Ramalingam Kalirajan  |6240 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on May 11, 2024

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I have bought a Health Insurance for My family 2+1 on Aug 23 with a 25Lacs covering from Reliance General Insurance Co. This Policy is port from Niva Bhupa which i had taken in 2021. I come to know some one from my surrounding is that the Reliance is not settling claims Properly and full. This policy is taken for 2year. Can u Suggest me
Ans: I understand you're concerned about Reliance General settling claims properly. It's good to be aware! Here's how we can approach this:

Claim Settlement Ratio (CSR) Check: Every insurance company has a CSR, a public record showing the percentage of claims they settle. You can check Reliance General's CSR online to see their historical performance.

Policy Review: Review your policy documents carefully. Understand the terms and exclusions related to claim settlements. If something seems unclear, reach out to Reliance General for clarification.

Network Hospitals: Using network hospitals within your policy can streamline the claim settlement process.

Remember, a single experience doesn't represent the entire picture. However, your concern is valid. Let's not worry, we can assess further!

You did well porting your policy! Health insurance is crucial, and you've taken a great step for your family.

Moving forward: If you'd like a more in-depth analysis of your health insurance options, consider consulting a Certified Financial Planner (CFP). They can assess your specific needs and recommend the best plan based on your family's requirements.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

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