Insurance claims in practice require requirements and procedures that are important for you to know. The reason is, this is to prevent insurance claims from being rejected. So, how do you make a correct insurance claim so you don't get rejected? Check out the following information, come !
How to make an insurance claim so you don't get rejected
1. Make sure your data is correct
The personal data that you fill in when registering for insurance is one of the crucial things during the claim process. This data can include full name, address, contact number, age, health condition, and more. If the insurance company finds that there is data that is different from that stated in the policy, then the company will have the right to reject the claim you submit.
2. Your policy must be active
When submitting a claim, the insurance policy must be in an active state. This means you can't stop paying premiums in arrears. If you do not pay within the specified time, your policy will be declared lapsed or void. In the void position, it is possible that your claim will be rejected. Therefore, don't forget to pay your premium.
3. Already past the insurance waiting period
Some types of insurance have a waiting period, usually for health or critical illness insurance. The waiting period is the period when the insurance is not yet active. This waiting period is useful for reducing cases of pre-existing conditions , or cases of people who are already sick before getting insurance.
Therefore, it's a good idea to double check whether the type of insurance you have has a waiting period. Some other types of insurance, such as Super Safe accident insurance, have no waiting period at all.
4. Find out what cases can be claimed
When buying insurance, you must be thorough and careful in checking the benefits and functions of the insurance provided. Maybe they include medical expense coverage, but what is this medical expense for? Can it be outpatient or only for inpatient? Can it cover medication or lab test results? There are certain conditions in your insurance benefits, so check more carefully!
For example, reimbursement of medical costs. Reimbursement of medical costs due to accidents is not only for Inpatient, but also for Day Surgery. However Treatment or Surgery Discharge Today must be within 24 hours of the Accident. By understanding the specific case, you can understand whether your case has met the existing criteria for filing a claim.
In addition, there is also an exception clause. The cases in this exception are not covered by insurance. For example, if it is proven that the Insured (the person whose life is insured) has died due to suicide, the Insurance Benefits cannot be claimed.
5. Submit a claim on time
Each insurance claim has a certain deadline for submitting a claim application. If you submit a claim late, your claim may be rejected. For example, if in your insurance policy it is stated that the claim application must be submitted within 30 calendar days, then it cannot be later than 30 days.
If you miss it, unfortunately you can't claim the protection benefits that should be yours. Make sure you and your heirs know about this insurance deadline so you don't miss it, OK?
6. Collect Documents Completely
There are various kinds of documents that you must collect when submitting a claim. This document must be complete and filled out correctly. If there is even one incorrect information or incomplete document, then your insurance claim can be rejected.
You can check the required documents on your insurance policy. If you have Super You insurance, you can check it online by looking at the Claim menu, selecting the type of claim you want to submit, and checking the claim procedure and required documents.
7. The incident occurred during the period of protection
The risk that occurs must be within the protection period. If this risk has occurred before the active period of insurance or after the active period of insurance, then a claim cannot be submitted. The way insurance works is only to protect you when the insurance itself is active.
If you get sick before you have insurance, this case is also called a pre-existing condition . If you buy insurance when you are sick, then the possibility of medical costs from illnesses that occurred before the insurance cannot be covered. This is why people say provide insurance while still healthy and young.
8. The incident was not caused by a violation of the law
Cases caused by violations of the law are usually included in the exception. This means that if the Insured has an accident because he is running from a theft case, then the Insured accident insurance cannot be claimed.
9. The incident was not caused by the influence of alcohol or drugs
Just like in cases of breaking the law, the incident must not be caused by the influence of alcohol or drugs. This case falls under the exception as well. If the Insured suffers an accident due to driving under the influence of alcohol and dies because of it, it is unlikely that his life insurance claim can go down.
10. The case was accidental
Intentional cases, such as intentionally self-injury or setting fire to one's own house in order to obtain insurance benefits, will not be able to be claimed. Cases like this can even be considered as insurance crimes or a form of insurance fraud.
If after investigation it is found that an incident was intentional, the insurance company will reject the claim submitted.
11. Make sure the location of the incident is in the insurance service area
Not all insurance services can cover all regions or countries. If you experience a risk outside the coverage area of the insurance service, then you may not be able to submit a claim.
For example, you have health insurance in Indonesia, but you fall ill while in Malaysia. If the health insurance service only covers Indonesia, then you cannot submit an insurance claim.
Therefore, it's a good idea to re-check how wide the coverage area of the insurance service you have.
Causes of Rejected Insurance Claims
There are various reasons that can cause an insurance company to reject our claim. One of these things can happen because we do medical treatment at the non-partner hospital of the insurance concerned. It could also be because we ignore the exception conditions that have been written in the guidebook.
Here are some reasons why your insurance claim was rejected:
1. The Risks Are Not Covered By Insurance
Each insurance product has different benefits, and all of them are listed in the insurance policy.
Let's say there is health insurance that has only inpatient and outpatient coverage benefits, and there are those that have both benefits.
It is very important to understand what the benefits are, as well as the types of risks that are borne by our insurance.
2. Does not comply with the requirements of the policy
Please note, every insurance plan has conditions for the disease covered. Well, it could be, there are some diseases that are not covered by health insurance or critical illnesses that make insurance claims rejected.
There is also a provision for a waiting period or waiting period on a health insurance policy. If the policyholder makes an insurance claim before reaching the waiting period, the insurance claim will be rejected.
Likewise, critical illness insurance for diseases such as stroke generally stipulates a waiting period and also a survival period. Survival period is the period when the Insured survives from being sentenced to a critical illness until he dies, which usually ranges from 7 days, 14 days, or 30 days specifically for health insurance or group life insurance. If the Insured submits an Insurance claim for less than the survival period, the claim will automatically be rejected.
3. The data received by the insurance company does not match
It is very likely that the health data of the customer concerned in the SPAJ (Request for Life Insurance) or SPAK (Request for Health Insurance), is incorrect.
Let's just say, someone has a history of serious illness in a certain period of time or has had surgery. But when filling out the request letter, he was not honest.
Indeed, the contents of the SPAJ and SPAK will greatly affect the value of the premium to be paid. Dishonesty in filling out the form can actually cause the insurance claim to be rejected.
4. Exceeding the Deadline
In a health insurance policy, we are required to apply for reimbursement within a certain period of time in accordance with the policy provisions. If you do not submit within the specified time, the insurance claim can be rejected.
Based on the four reasons above, we must have a good understanding of health insurance policies, ideally from the time of applying for the policy at the beginning. So, when submitting a claim, rejection will not occur.
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