Speak from those who have experience in insurance claims

What materials are required for life insurance claims

(1) The insurance benefit payment application form must be filled in and signed by the insured;

(2) The insured Identity document;

(3) Original insurance policy, including the last payment receipt. How to handle life insurance claims? What is the claims process?

Normally, life insurance claims go through the following processes: seven steps: case acceptance, case filing, preliminary review, investigation, adjustment, review and approval, and case closure and filing.

The specific claims process is as follows:

1. Case acceptance: Case acceptance refers to the process in which the insurance accepts the customer's report and claim application after an insured accident occurs. The contents of the report include the time, place, cause, process and related circumstances of the insured accident, the name of the insured (party), ID number, insurance policy number, insurance type and date, the name and contact information of the reporter, etc.

2. Case filing: Case filing refers to the process in which the claims department of the insurance company accepts the customer's claim application and registers and numbers the claim case according to the company's relevant rules, so that the case enters the formal processing stage.

3. Preliminary review: Preliminary review is a process in which claims adjusters conduct a preliminary review of the nature of the claim application case, the validity of the contract, the claim materials, etc.

4. Investigation: Investigation refers to the process of verifying and verifying insurance accidents, which has a decisive impact on the outcome of claims settlement. The principles of investigation include the principle of seeking truth from facts, the principle of promptness, accuracy and comprehensiveness, the principle of double investigation, the principle of avoidance, the principle of prohibiting making any commitment during the investigation process, etc.

5. Adjustment: refers to the process by which adjusters make payment, refusal to pay, accommodation payment, exemption processing and calculation of the amount of insurance benefits for claim cases. The adjuster calculates the claim based on the insurance contract and category and prepares the "Claim Settlement Calculation Book" and "Claim Settlement Case Handling Report Form".

6. Case closing and archiving: Case closing personnel conduct different processing according to the instructions on the claim file submitted by the review personnel:

1) Processing of payment cases. For contracts that continue to be valid, make two copies of the "Approval Form", attach one copy to the contract, return it to the customer for clear indication, and file the other copy; at the same time, make a "Claim Settlement and Collection Notice" and send it to the applicant and The contract is treated as "closed and the contract continues to be valid". For a terminated insurance contract, a "Claim Settlement and Collection Notice" will be prepared and sent to the applicant and indicate the reason for the termination of the insurance contract. At the same time, the insurance contract will be treated as "Case Closed and Contract Termination".

2) Handling of refusal cases. For contracts that continue to be valid, a "Notice of Denial of Claims" will be prepared and sent to the applicant, indicating the reasons for the rejection of claims and prompting the applicant to retrieve relevant materials. At the same time, the insurance contract will be treated as "Closed and the contract continues to be valid." For a contract that has been terminated, a "Notice of Rejection of Compensation" shall be prepared and sent to the applicant, indicating the reasons for the refusal of compensation and the reason for the termination of the contract. If there is any refund, the items that should be refunded shall also be noted in the notice and shall be The insurance contract is treated as "closed and contract terminated".

3) Handling of exemption cases. For premium exemption cases, a "Premium Exemption Notice" will be prepared and sent to the applicant, and the contract will be treated as "Closed and the contract is exempt from premiums."

(2) Archive. Archiving is when the closing personnel arrange and bind all the materials of the closed claims cases in a prescribed order, and archive them according to the requirements of business file management for future reference and use. In order to facilitate your later claims settlement, it is recommended that you purchase life insurance through formal insurance channels as much as possible. If an insurance accident unfortunately occurs by purchasing life insurance, our professional claims team will assist you throughout the entire process to settle your claim.

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