How do you help your client to expedite the claim settlement process?

How do you help your client to expedite the claim settlement process?

They say that a trustworthy agent is the one who assists his customers at the time of claim. Maintaining a relationship with the client is also very important.

So, how can you ensure a quick claim settlement of your client’s health/car insurance?

The process is easy as Turtlemint helps you in expediting the whole claim process. You just have to follow some simple steps, to make the claim settlement process easy for your client. Let’s see how –

For health insurance claims

Inform Turtlemint when your client is hospitalized for planned or emergency treatments. The client can also directly call Turtlemint, the insurance company or the TPA.

If Turtlemint is contacted, the company’s claim expert verifies the name of the patient and insurer, hospitalization date, name and address of the hospital and the reason for hospitalization. This information is then shared with the concerned insurer or its TPA and claim is intimated. The customer can directly contact the insurer and furnish these details too.

For cashless claim settlement, your client is required to fill a Pre-authorization form. This form is available at the hospital’s insurance/TPA counter. If it is a planned hospitalization, the form should be filled and submitted before actual hospitalization. However, in case of emergency cases, the form is to be submitted after hospitalization.

The Pre-authorization form is essential for approval of cashless claim.

The medical bills are then shared with the insurance company which, after checking the bills, settles the bills directly with the hospital.

In case of reimbursement claims, your client should follow the same intimation process as in case of cashless one.

The client is then required to pay the hospital bills himself. After being discharged from the hospital, the client has to collect all the relevant documents like –

Bills, receipts and prescriptions of all payments done with respect to hospitalization.

Bills and bar code of any equipment or implants used

Discharge card of the hospital

Cancelled cheque

The claim would then be settled in a similar manner as in case of cashless one.

Points to Remember:-

  1. Submit a completely filled Claim form and all the documents to Insurance company / TPA within 7 days from the date of discharge in case of Re-imbursement claims
  2. Mandatory documents Required for Hospitalization:

Policy copy

E-cards

ID proof

  1. Intimation TAT — 24Hours to 48Hours
  2. Cashless service is available only at the network hospitals.
  3. If the request for cashless settlement is denied, you can still pay for the expenses at the hospital from your pocket and then request for reimbursement claim
  4. If the total cost of treatment exceeds the initial approved amount, the hospital can request the TPA or the insurance company to enhance this amount as per the expenses.
  5. All the necessary documentation, prescriptions and doctor’s reports should be furnished, if required by the insurance company/TPA.

For Motor Insurance claims

There are two types of Settlement

  1. Cashless Settlement — under this the insurance company settles the bills directly with the workshop
  2. Reimbursement Settlement — under reimbursement, your client has to pay the bills from his pockets. Later, the insurance company reimburses the approved amount to client

Here is the process for both –

For cashless claims –

In case of an accident, the policyholder should inform Turtlemint or the insurance company directly.

Turtlemint then processes the claim after verifying the name of the policyholder and the insurance company, policy number, date and type of loss and the name and address of the workshop.

The customer would then be told about the nearest workshop tied with the insurance company. The vehicle should be taken to the specified workshop for cashless claims.

Once the client register the claim in Insurance Co either by himself of by taking the assistance by turtlemint claim expert (Our turtlemint claim expert takes the insurance company on conference call and help the client to registered the claim) and surveyor is appointed by the insurance company to assess the damages.

Turtlemint shares the details of the surveyor with the client if the client seeks help from Turtlemint.

The surveyor assesses the damages and the cost of repairs and approves the repair.

Once approved, the vehicle is repaired. The surveyor visits the workshop to assess the repair and the costs incurred.

The workshop mails the surveyor about the repair cost. The surveyor calculates the company’s liability and mails the workshop of the company’s proportion of claim. The company pays the bills directly for its share. For Example: if the Total Bill is RS 10,000/- and if the Insurance company’s share is Rs 8,000/- then the Insurance Company will drop a mail to Workshop stating that their liability/ Share is Rs 8000/-.

The workshop will take the remaining Rs 2000/- from the policyholder and release the liability and the insurance company will pay the liability amount to the workshop.

For reimbursement claims –

In Case of Reimbursement Settlement insured can take his vehicle to any of his nearby workshop and confirm the broker (Turtlemint) regarding the workshop details

After registration of claim the surveyor will visit the workshop check all the required documents, assess the loss and give the necessary approval to the workshop to start the repair work.

After repairs, the surveyor visits the workshop to assess the repairs. The client would have to pay the bill for the repairs. The original bills and the payment receipts are submitted to the surveyor for reimbursement.

After receiving the original bills and documents the claim is settled and the approved amount is transferred to the Client’s account via NEFT in 8 to 10 Working Days.

A list of documents is required in a motor insurance claim some of which are as follows –

  • Completely filled and signed Claim Form
  • RC book’s copy
  • Driving License copy of the person driving the vehicle at the time of accident
  • Policy copy
  • FIR for theft or third party claims

Points to Remember:-

  1. Submit a completely filled Claim form and the documents to Insurance company within 7 days from the date of Claim Registration
  2. In Case of Reimbursement claim instruct the workshop not to start the vehicle repair prior to survey
  3. In Case of Reimbursement claim instruct the workshop to purchase the damaged parts which are approved by surveyor from authorized Dealer and to present the original part’s bill whenever the surveyor demands
  4. Cashless service is available only at the Cashless Workshop.
  5. In case of Comprehensive policy there is depreciation of 50% in Plastic and As per Vehicle Age on Metal and even client has to bear compulsory policy excess, consumable, Taxes and Salvage Deduction
  6. In Case of Zero Deprecation policy there is no depreciation on parts but client has to bear compulsory policy excess, consumable, Taxes and Salvage Deduction

Turtlemint is always around to provide their assistance at the time of claim. You, as the middleman, should also inform your clients of the claim process to ensure speedy settlement of claims.

If you have any other queries you can always contact Turtlemint team on 1800 266 0101 or email us on: pospsupport@turtlemint.com

 

Read more about motor claim settlement process

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