How to File a Claim & What Is the Process?

By Rahul Narang
How to File a Claim & What Is the Process?

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How to File a Claim & What Is the Process?

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How to File a Claim & What Is the Process?

By Rahul Narang
How to File a Claim & What Is the Process?

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Get Expert Advice

By Rahul Narang
How to File a Claim & What Is the Process?

Get Expert Advice

By Rahul Narang
How to File a Claim & What Is the Process?

Get Expert Advice

There are many queries about the claim process in the country, such as how to apply for a claim. Who should we approach? What is the claim process?

Here are all of your responses:

So there are two types of claim processes. I.e_._ cashless and reimbursement

Cashless:

As the name implies cashless means that no cash is required for the claim (Although the policyholder must pay File charges, etc. and the claim is paid up to SI).

An insurance company has affiliations with hospitals. A policyholder can go to the nearest network hospital for cashless treatment. The list of network hospitals is updated on the insurance company’s website.

Let’s break it down: Hospitals have agreements with insurance companies. A policyholder can seek cashless care at the nearest network hospital; the list of network hospitals is updated on the insurance company’s website. The hospital is paid directly by the insurance company for treatment costs and medical expenses. Always choose cashless care at your preferred network hospital, and always consult the network hospital list for the best and quickest treatment by your doctor.

Documents Related to the Cashless Claim Process​

While claiming treatment at your nearest network hospital, there are T.P.A desks (Third Party Administrators, whose job is to coordinate with the customer, hospital, and company. all at the same time).

 Documents for further process.

Like,

i_) Health Insurance policy / Health Cards._

ii) I.D Proof related Document.

iii) Date of Birth proof Document.

iv) Doctor’s prescription.

Pre-Authorization:​

Another method for starting the patient’s treatment through the claim

So, how exactly does it work?

You already know what treatment or surgery will be performed! In this case, your first step is to notify the insurance company about the treatment and the doctor at the policy company’s network hospital. After reviewing the medical documents, the claim is generated. The doctor will provide the policy company with a detailed prescription for the treatment as well as the estimated cost of the treatment, and the policy company will approve the pre-authorization claim after cross-checking the related documents

Reimbursement

Reimbursement means, the policyholder is paying for the treatment by himself/herself and then files a claim with the help of bills of the treatment which was paid during the treatment.

Documents for the Reimbursement Claim Process​

When filing a claim, you must provide certain supporting documentation. There are two methods for filing a claim offline and online.

Nowadays, most companies work digitally, and to apply online, simply visit the company’s website or application and follow their guidelines, while to apply offline, you have to submit documents physically, and simply organize a file with the necessary documents. Like

i) Original Documents

You should carry all the original documents which were used for the treatment like diagnosis reports, discharge Summary, bills/receipts, and medical reports/tests.

ii) KYC document.

iii) Identity card

iv) Cancel cheque

Pre & Post Hospitalization Claim

There are two important terms, you should understand before getting your insurance, pre-hospitalization expenses and post-hospitalization expenses. If you have been admitted to the hospital for a medical illness following which, you file a claim which was approved by the insurer then all the diagnostics and medical expenses done by the patient before being hospitalized are called pre-hospitalization expenses.

Further, when you get finally discharged from the hospital the cost of medicine, test, and doctor fees for follow-up treatments are termed post-hospitalization expenses. When you file a claim for medical expenses most health insurers will cover the pre-hospitalization and post-hospitalization expenses in the claim, however, these expenses are covered for a certain number of days only, which is mentioned in the policy document

IRDAI Guidelines for the Better Cashless Claims​

IRDAI has always been working for policyholders and companies to help them in giving better and easy services. IRDAI has better a step ahead for the policyholders in their new guidelines on 20th July 2022. It was termed as cashless hospitalization through a preferred partner network. What all does IRDAI’s new guidelines covers?

Scope of Coverage Will Increase:​

The scope of coverage of policies has been increased across the length and breadth of the country. It has been stated that the list of cashless network hospitals will increase and following the quality control of the same will be better for the claim process and treatment. Here insurance company must set up some quality checklist criteria so it will also help in tying up with more hospitals that provide a better quality experience and services to the policyholder.

Some benchmark setup by IRDAI that every network hospital should follow like

  • Minimum Manpower
  • Minimum Infrastructure Requirement

Hence it all will provide better and hassle-free cashless claims and ease for the policyholder!

Instructions for an Easy and Quick Pre-Authorization Medical Claim:​

In India, the cashless claim process is used to pay for various services at hospitals, and once the patient arrives at the hospital and requests assistance, the hospital is required by policy to begin treatment as soon as possible. {Although, the Policy Company will approve or reject the claim and provide a pre-authorization letter (if approved) for the patient}.

But first, the Customer must submit his/her/patient’s details for approval. As you are aware, there are two types of claim processes: cashless and reimbursement claims. We’ll go over every step of the claim process here.

Step 1: Locate the Closest Network Hospital

The process begins when the customer arrives at the network hospital for cashless treatment of the patient to provide better care and treatment (although the hospital could be a network hospital or another hospital that is not listed in the policy company).

The customer must complete a claim form and provide all necessary documents before proceeding with the procedure. The following documents are required for the claim:

i) Health Insurance policy / Health Cards.

ii) Identification Proof Document. (Aadhar card/Voter ID card)

iii) Proof of Date of Birth Document. (Aadhar card*)

iv) Doctor’s prescription.

Step 2: Verification​

Once you have submitted the necessary documents for the claim, you must wait for approval from the insurance company. 

The hospital will check the customer’s information and send the duly completed pre-authorization form to the insurance company. Once verified with policy benefits, the insurance company sends an authorization letter back to the network hospital. (Depending on the terms and conditions of the individual company, the pre-authorized request may take up to 2 to 4 hours.)

Step 3: Approval Received​

Once the pre-authorization is authorized and received by the network hospital, the hospital begins treating the patient without any expense until discharge, it may alter depending on the terms and conditions of the insurance or the different companies. The policyholder is mandated to pay File charges, and the claim is paid up to SI. Treatment charges and medical expenditures are paid directly by the insurance company to the hospital (try to pick cashless treatment in your closest or preferred hospital for a hassle-free claim)

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FAQs

How Do I File a Cashless Claim for Medical Treatment?

To file a cashless claim, visit a network hospital affiliated with your insurance company. Submit the required documents, including your health insurance policy, ID proof, date of birth proof, and doctor’s prescription. The hospital will coordinate with the insurance company to generate a pre-authorization claim. Once approved, the insurance company will directly cover the treatment costs at the network hospital.

What Documents Are Necessary When Filing a Cashless Claim at a Network Hospital?

To file a cashless claim, you need to provide documents such as your health insurance policy/health card, ID proof, date of birth proof, and the doctor’s prescription. These documents help facilitate the pre-authorization process for your treatment.

How to File a Reimbursement Claim?

To file a reimbursement claim, you pay for the medical treatment yourself and collect bills and receipts. You can submit the claim either online through the insurance company’s website or offline by physically submitting the necessary documents. Required documents include original documents related to the treatment, KYC documents, identity card, and a canceled cheque.

What Are Pre and Post Hospitalization Claims?

Pre-hospitalization expenses are the costs incurred by the patient before being hospitalized for a medical condition, and post-hospitalization expenses cover medical expenses, such as medicine, tests, and doctor’s fees, after discharge from the hospital. Most health insurers include coverage for these expenses, but there is usually a limit on the number of days for which they are covered, as mentioned in the policy document.

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To file a cashless claim, visit a network hospital affiliated with your insurance company. Submit the required documents, including your health insurance policy, ID proof, date of birth proof, and doctor’s prescription. The hospital will coordinate with the insurance company to generate a pre-authorization claim. Once approved, the insurance company will directly cover the treatment costs at the network hospital.<\/p>"}},{"@type":"Question","name":"What Documents Are Necessary When Filing a Cashless Claim at a Network Hospital?","acceptedAnswer":{"@type":"Answer","text":"

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To file a reimbursement claim, you pay for the medical treatment yourself and collect bills and receipts. You can submit the claim either online through the insurance company’s website or offline by physically submitting the necessary documents. Required documents include original documents related to the treatment, KYC documents, identity card, and a canceled cheque.<\/p>"}},{"@type":"Question","name":"What Are Pre and Post Hospitalization Claims?","acceptedAnswer":{"@type":"Answer","text":"

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Introduction You have waited so long to finally purchase that car, saved for it and checked all those reviews. And now that you have it, would you really take the risk of driving it without proper car insurance? Just one accident, a scratch or major repair work can cost you so much. This is why the right car insurance policy is as important as the right vehicle. But the problem is that a lot of people buy the cheapest insurance for car. They think that it’s enough for complete protection, when actually, these basic policies often offer only partial protection. For full-on protection, you need add-ons like bumper to bumper insurance along with proper understanding of how the claim process actually works. Let’s learn about it all! What Is a Car Insurance Policy? In simple terms, a car insurance policy is an agreement between you and your insurance provider. In this, you pay a set premium and in return, you will get financial protection during events like: Accidents Theft Fire Natural disasters Injury or property damage to third party In India, it’s compulsory to get a third-party insurance. However, it only covers the damage that you have caused to someone else and not your own car. That is the reason most car owners want comprehensive car insurance. Types of Car Insurance Policies in India Third-Party Car Insurance As per the law, it’s a mandatory requirement for all car owners. It covers damage caused to another person, vehicle or property Your own car is not covered in it It’s usually the cheapest insurance for car but not ideal fin terms of protection Comprehensive Car Insurance This one is recommended for all car owners because: It covers your car as well as third-party damage Provides protection against accidents, theft, fire and natural disasters Bumper to bumper insurance add-on makes it even more beneficial What All Does Comprehensive Car Insurance Cover? All car owners must ideally choose a comprehensive plan. It gives peace of mind and helps avoid hassles. This is what it usually includes: Damage that happened because of an accident Fire and explosion Floods, storms, earthquakes etc Theft Vandalism / riots Cover for personal accident Third-party liabilities What Is Not Covered? These are the exclusions that you must know of because this will help you avoid claim rejections. Accidents because of drunk driving Driving without a licence Mechanical breakdown Normal wear and tear Electrical failure Damage happened outside of the policy period Using a private car but for commercial use Add-Ons For Better Protection Add-ons are the extra yet optional covers that you can include to enhance your car insurance policy. Below are the most useful ones to consider: Bumper to Bumper Insurance (Zero Dep): This one is definitely the most popular add-on because it ensures no depreciation deduction during claims. Here, your insurer takes care of the full repair amount. It’s perfect for: New cars High-end cars Driving in cities with heavy traffic Engine Protect: It covers the damages that arise because of the entry of water, oil leakage or maybe a hydrostatic lock. Roadside Assistance: Helps with towing, jump start, battery help etc. Gives huge support during breakdowns. Return to Invoice (RTI): In case your car gets stolen or is totally damaged, you will get the original invoice amount and not the depreciated amount. Key Replacement Cover: Covers for the lost or stolen keys and is highly useful for high-tech keys. Consumables Cover: Items like nuts, bolts, engine oil and AC gas, that are usually excluded, are covered in this add-on. While add-ons like bumper to bumper insurance charge a little much, you also get to save a lot of money during repairs How to Choose the Right Car Insurance Plan? The aim is to balance protection and price. Here’s how you do it: Don’t just go on and pick the cheapest insurance that you get • Compare coverage and claim settlement ratio of multiple options • Always choose the correct IDV (Insured Declared Value) • Add zero depreciation cover for newer cars • Check the number of network garages listed with the insurer • Always read exclusions carefully If you compare smartly, you can totally ensure maximum protection without overspending. Steps in Car Insurance Claim Process If you follow these steps, it’s actually very easy to file a claim: Step 1: Immediately Inform the Insurer: Most insurers need you to notify them within 24–48 hours. Step 2: Take Photos of the Damage: When you have clear pictures, it helps in fast approval. Step 3: File an FIR: This is normally required for theft or major third-party damage. Step 4: Visit a Network Garage: The repairs are cashless. No upfront payment needed. Step 5: Surveyor Inspection: A surveyor checks the damage caused and gives approval for the repair estimate. Step 6: Repairs Begin: Garage starts working on your after getting approval. Step 7: Settlement: For cashless claims, the insurer pays directly to the garage. If applicable, you need to pay only for the deductibles. How to Lower Your Premium Without Losing Coverage These tips will help you enjoy good protection without have to spend more than required: Always renew on time • Don’t set a very low IDV • Make wise use of No-Claim Bonus • Install anti-theft devices in the car • Before renewal, compare different plans • Drive safely so that there are no frequent claims. Conclusion A car insurance policy is not just a legal compulsion but a financial protection against unexpected expenses of repairs. While cheapest insurance for car may seem more attractive but it often offers limited coverage. The smart thing to do is opting for a comprehensive plan with the right add-ons. This will give the most benefits. Understand the coverages, exclusions and the claim process and you can secure the most suitable policy. If you want easy comparison and expert guidance, Policywings can help you make the right decision!

Written byRahul NarangPublished onDecember 17, 2025