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How Do Claims Work?

From paperwork to phone calls to long queues at government buildings. The many things you sometimes have to do before you can even make a claim, can make an already bad situation feel so much worse. Luckily, there are some things you can do now that’ll make it easier later.

Nobody likes admin, but sometimes it’s unavoidable. This is especially the case when claiming on your insurance. That’s not because insurers are trying to make it difficult. They need to verify that it’s a legit claim (because, not everyone is as honest as you). So what can you do now that’ll reduce the strain on future you or your beneficiaries for when the bad thing happens? 

It goes without saying...

...if you're not honest when you take out your policy, you’re not going to enjoy the claims process very much. Why not? Because you best believe your insurer is going to check if what you said is true. If you didn't disclose accurately or were dishonest, the insurer may either reduce the payout or not make the payout at all. This will depend on your contract terms and conditions.

Before the bad thing happens

Want to know the secret? Come a little closer. That’s it. Closer… The secret is to be organised. 


As uncool as that may sound, you’ll be looking cucumber-cool down the line if you’ve:


  • read through the fine print in your policy document, 
  • saved relevant contact numbers and email addresses, and 
  • found out what’s involved in the insurer’s claims process. 


Look out for things like waiting periods and exclusions (stuff not covered). If there are any documents you can make copies of and get certified ahead of time, do that now, and put them in a safe place. 


The other cool thing you can do is to tell your beneficiaries that you have insurance. If they don’t know, and it’s something like life insurance, they may not know they can claim. Also, make sure they have copies of all those documents we mentioned.

After the bad thing happens

If you're prepared, when it comes time to claim, the process ought to be pretty simple and quick. 


If it’s you submitting the claim, refer to your policy document to confirm whether you’ve got a valid claim. But, if you took your policy out with a broker, they can help with the admin.


For short-term insurance claims, check to see if you’ll need to pay an excess fee. 


If you’re going to claim, now’s the time to whip out your insurer’s contact info (you so cleverly saved) and let them know.


Depending on the type of claim, the documentation may include:


  • police reports, 
  • doctor’s reports, or 
  • death certificates. 


Ask the consultant if there are any other documents required. This will speed up the process and avoid a lot of back and forth.


Once you’ve submitted your claim, the insurer reviews it. They’ll check that the information you gave when you took out the policy is true. They'll also check that the documents you’ve submitted are in order. If everything checks out, they'll approve the claim and make payment.

What if my claim is rejected?

If your claim is unsuccessful, find out why. If you disagree with the reasons given, there are a few options available to you:


  • Escalate the matter with the insurer
  • Refer the matter to a short-term or long-term insurance Ombudsman to investigate
  • Get legal advice (this can get very expensive, very quickly)
  • Refer the matter to an arbitrator
  • Get an independent assessment done (short-term insurance only)


If the outcome changes, the insurer will review the claim again. 


But, hopefully, it won’t come to that, and you’ll get paid out quickly so things can get sorted.


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