Critical Illness Claims: Documentation Checklist

What is meant by critical illness claims? 

Critical illness insurance is a special secured health insurance protection cover that allows enhanced financial security in the event of treating several complicated ailments. Not all CI plans allow coverage for all sorts of critical ailments. The types of diseases covered remain mentioned in the policy documents.  

Once the insured individual is diagnosed with any of the listed critical ailments, the insurer will offer a lump sum, depending on the sum insured amount, provided he/she outlives the designated survival period as per the plan terms.  

Once this claim is settled, the plan automatically gets cancelled and becomes null and void.  

When to file a critical illness insurance claim settlement? 

The importance of CI insurance can never be exaggerated. However, you need to understand the claim settlement procedure to enjoy its complete benefits: 

1. Waiting period: You need to serve the waiting period first before raising any claim. This tenure varies from one insurer to another and types of ailments. You must clarify the details with your chosen insurer before finalising the plan.  
    
2. Details required: Once you get diagnosed with any of the listed critical ailments, you need to approach your respective insurance provider and submit all the relevant details, including the policy number, the name of the insured/policyholder for whom the claim settlement is required, name and type of the ailment, details of the hospital and doctor, details of the medical procedures, etc. Once all these details are submitted, the insurer will guide you further accordingly, following the plan terms.  

How do you file a critical illness insurance claim? 

The critical illness claims settlement procedure is simple and user-friendly. You simply need to follow these few steps to complete the process: 

1. Intimation: This is the primary step to initiate the claim settlement procedure. Once the concerned individual gets diagnosed with any of the listed critical ailments, you need to approach the respective insurance provider at the earliest to inform them regarding the development. It is best to contact them within the first 7 days after diagnosis. It is best to follow the exact tenure for intimation according to your chosen plan and insurer.  
    
2. Claim form fill-up: After this, you need to fill up the claim form, providing all the necessary details. You can either visit the nearest office of your insurer to get the form or easily download it from their official website. Enter the necessary details like the policy number, ailment details, doctors’ findings, etc.  
    
3. Supporting documents: To ensure a smooth claim settlement, you need to submit all the necessary documents, like prescriptions, investigation reports, etc., to support your claim.  
    
4. Submit: Once you have duly filled in and signed the claim form and attached all the supporting documents with it, you can submit it to the insurer. However, never fail to keep a photocopied backup of all the documents submitted. The insurer will review all the documents and investigate the matter before claim settlement. If everything is correct, they will transfer the designated claim amount to the registered bank account shortly.  

List of documents needed 

To ensure smooth critical illness claims, you need to submit the following documents to your respective insurance provider: 

1. Photocopies of valid identity proof of the insured person, like an AADHAAR card, passport, etc. 
2. Address details and proof 
3. Critical illness policy paper 
4. A duly filled-in and signed claim form 
5. Medical prescriptions and certificates from the treating physician 
6. Investigation and lab test reports like X-rays, blood reports, scans, etc. 
7. Bills and invoices for medical consultation 
8. Medicine bills 
9. Discharge summary in the case of hospitalisation  
10. Bank account details of the policyholder. 

Negating the possibility of claim rejection 

While applying for critical illness claims settlement, you need to consider these aspects to negate the possibilities of claim rejection: 

1. Policy coverage: On being diagnosed with any critical ailment, first ensure that that particular health condition is covered under your chosen CI plan. This is required as all CI plans do not cover all sorts of critical ailments.  
    
2. Waiting period: Usually, CI plans to maintain a waiting period. Clarify it beforehand to avoid any last-minute surprises or misunderstandings during claim settlement. Each insurer maintains a different waiting period for different ailments. Proceed accordingly after proper clarification.  
    
3. Correct filling: Ensure that all the details mentioned in the claim submission application are correct. Any false information may lead to claim rejection. 
    
4. Submitting all documents: Submit all the necessary documents issued during the entire diagnostic and treatment procedure to support your claim. Co-operate with your insurance provider if they require any additional documents.  
    
5. Punctual premium payments: Try not to fail your premium dues ever. This will keep your CI plan uninterrupted and active.