A policyholder makes an insurance claim by formally requesting compensation from the insurer for a covered loss or event. By filing a claim, you’re asking the insurer to honour the policy and cover your financial loss according to the agreed terms.

In Preeti’s case, she asked the insurer to cover her car repair costs under “own damage”, a valid and covered claim category.

Event	Preeti's Case
Policy Type	Car Insurance
Incident	Accident (skid)
Damage Estimated	₹45000
Claim Type	Own Damage Claim
Deductible (Paid by Preeti)	₹1000
Amount Paid by Insurer	₹44000

So, an insurance claim bridges the gap between damage and financial recovery.

Types of Insurance Claims

Not all claims are the same. Depending on the type of insurance and the situation, the nature of the claim will differ. Let’s explore the most common types:

1. Health Insurance Claim

When a person is hospitalised or undergoes a medical procedure, they can raise a claim to get reimbursement or a cashless service from the insurance provider.

2. Life Insurance Claim

When the insured person passes away, their nominee can file a death claim to receive the sum assured.

3. Motor Insurance Claim

This is for vehicle-related damage or loss due to accident, theft, fire, etc.

4. Travel Insurance Claim

Used for trip cancellations, lost baggage, and emergency medical needs during travel.

5. Property Insurance Claim

Applicable when property or home is damaged due to natural disasters, fire, burglary, etc.

Different Claim Types with Examples

Insurance Type	Example	Claim Trigger
Health Insurance	Appendicitis surgery costing ₹90,000	Hospitalisation
Life Insurance	Death of a policyholder in a road accident	Nominee claims ₹25,00,000 sum assured
Car Insurance	Collision during monsoon	Car body repair worth ₹45,000
Travel Insurance	Flight cancelled due to weather	Airline cancellation refund ₹20,000
Home Insurance	Fire due to a short circuit	Home repair worth ₹3,00,000

Who Can File an Insurance Claim?

Preeti asked, “Can anyone in the family raise a claim, ya sirf main?”

That depends on the type of insurance. In most cases, the policyholder, or their nominee, is allowed to file the claim.

Eligibility Based on Insurance Type:

Insurance Type	Eligible Claimant(s)
Health Insurance	The policyholder or insured family member
Life Insurance	The nominee mentioned in the policy
Car Insurance	Registered owner or authorised driver
Property Insurance	Owner or policyholder

Example:

Preeti is the car’s registered owner, so only she can raise the car insurance claim, not her friend who was driving it at the time.

Step-by-Step Process to File an Insurance Claim

After the accident, Preeti downloaded her insurer’s app and followed these steps, which can apply to most insurance types.

Claim Filing Steps:

Intimate the Insurer
Inform the insurance company immediately. For car accidents, you must report within 24-48 hours. For health emergencies, it’s best to inform before admission or within 24 hours.
Submit Required Documents
Upload scanned documents or visit a branch. Documents differ per insurance type.
Survey or Investigation
In Preeti’s case, a surveyor from the insurance company visited the garage to inspect the damage.
Approval & Claim Settlement
After verification, the insurer either gives cashless approval or reimburses the expenses within a few days.
Pay Deductible and Receive Balance
The deductible is the small portion that the policyholder pays; the rest is paid by the insurer.

Car Insurance Claim

Action Step	Time Taken	Notes
Intimate Insurer	Within 24 hrs	Through the app or toll-free
Submit Documents	Same Day	Driving license, RC, FIR if needed
Surveyor Visit	Within 1 day	Assess vehicle damage
Claim Approved	2–3 days	Approval was sent to the garage
Repair & Final Payment	3–5 days	The insurer pays directly or reimburses

Required Documents for Insurance Claims

Documents are very important. Any missing document can delay or even cancel your claim.

Document Checklist (Based on Insurance Type):

Insurance Type	Required Documents
Health Insurance	Hospital bills, discharge summary, doctor’s note
Life Insurance	Death certificate, policy document, ID proof, and nominee details
Car Insurance	RC copy, license, repair estimate, photos, FIR (if applicable)
Travel Insurance	Airline ticket, cancellation proof, receipts
Property Insurance	Photos of damage, repair estimate, and ownership proof

Numerical Example:

In Preeti’s case, she submitted 6 documents, including:

Insurance policy copy
RC
Driving license
Accident photos
Garage estimate
ID proof

Common Reasons Why Claims Get Rejected

When her neighbour heard about her accident, he said:
“Yaar mera bhi ek baar claim reject ho gaya tha. Bohot strict hote hain ye log.”

That’s true. Insurance companies follow strict rules. Claims can be rejected due to:

Top 5 Claim Rejection Reasons:

Reason	Description
Delay in Claim Notification	The claim was filed after the allowable time frame
Missing/Inaccurate Documents	Incorrect RC, no hospital bills, or wrong nominee info
Policy Lapse	Premium not paid, hence no active policy
Non-Disclosure of Facts	Hiding pre-existing disease or damage history
Fraud or Misuse	Exaggerated or fake claims filed by policyholders

Example:

If Preeti had repaired the car privately and then claimed the cost with a fake bill, the insurer would have denied the claim.

Claim Settlement Ratio: Why It Matters

Preeti’s father always said, “Claim settlement ratio dekho before buying insurance.” But what is it?

The Claim Settlement Ratio (CSR) is the percentage of claims an insurance company settles vs. the total number received.

Table of Health Insurers – Claim Settlement (FY 2023)

Insurer	Claim Settlement Ratio	Average Settlement Time
Star Health	82.31%	2–3 days
HDFC ERGO	99.39%	3–4 days
Niva Bupa	92.02%	2 days
ICICI Lombard	97.16%	4–5 days
Care Health Insurance	92.77%	3 days

Always go for insurers with a CSR above 90% and a low average settlement time.

RTO Approval in Motor Claims

For serious accidents, especially third-party claims, the insurer might need a report from the Regional Transport Office (RTO). This can extend claim processing time.

In Preeti’s case, this wasn’t needed because it was a self-accident and didn’t involve third-party damage.

Conclusion

An insurance claim is your right as a policyholder. Whether it’s a car accident, medical emergency, travel problem, or death, your claim helps you move from crisis to recovery.

Preeti used her health insurance during an emergency and saved ₹45,000. She knew how to file the claim, so she didn’t have to pay from her own pocket. This made a big difference.

Don’t wait for trouble to learn about claims. Keep your documents ready, understand your policy, and make sure it stays active. Being prepared can save you time, stress, and money.

FAQs on Insurance Claims

What is the difference between reimbursement and a cashless claim?

In a reimbursement claim, you pay the expense first, and the insurer pays you later. In a cashless claim, the insurer directly pays the hospital or garage.

Can a claim be filed online?

Yes, almost all insurers now allow online claim filing through apps or websites.

What is a deductible in insurance claims?

A deductible is the amount you agree to pay from your pocket. The insurer pays the rest.

What happens if I miss the deadline for filing a claim?

Your claim may get rejected. Always file within the allowed time, usually 24–48 hours for motor/health claims.

Can I withdraw a claim once filed?

Yes, but only before settlement approval. Once processed, claims can't be withdrawn.

Other Informative Pages
What is TDS	What is Tax	What is Direct Tax	What is Indirect Tax
What is Capital Gains Tax	What is Inheritance Tax	What is Angel Tax in India	What is Excise Duty
What is The New Tax Regime	What is Life Insurance	What is General Insurance	What is an Insurance Claim
What is NCB in Insurance	What is IDV in Bike Insurance	What is SEBI	What is E-Invoicing