Can the insurance company check the outpatient records when making claims?

I will. If insurance companies have questions about claims, they will go to hospitals and social security centers to get medical records.

Insurance claim settlement refers to the behavior of the insurance company to perform the compensation or payment responsibility according to the contract when the property or personal life of the insured is damaged due to an insurance accident, or when other insurance accidents agreed in the policy require payment of insurance money, which directly embodies the insurance function and fulfills the insurance responsibility.

Claim procedure

1, initiate an investigation

After receiving the notice of danger, the insurer shall immediately send someone to conduct on-site investigation, understand the situation and reasons of the loss, check the insurance policy and register for the record.

2, audit certificates and materials

The insurer examines the relevant certificates and materials provided by the applicant, the insured or the beneficiary to determine whether the insurance contract is valid, whether the insurance period expires, whether the loss belongs to the insured property, whether the claimant has the right to claim compensation, and whether the place where the accident occurred is within the scope of insurance liability.

3, approved insurance liability

After receiving the request for compensation or payment of insurance money from the insured or beneficiary, the insurer shall, after checking the facts and reviewing various documents, verify in time whether it should bear the insurance liability and how much insurance liability it should bear, and notify the insured or beneficiary of the verification result.

4. Fulfill the obligation of compensation

On the basis of verifying the liability, the insurer shall perform the obligation of compensation or payment of insurance benefits within ten days after reaching an agreement with the insured or beneficiary. If the insurance contract stipulates the amount of insurance and the time limit for compensation or payment, the insurer shall perform the obligation of compensation or payment of insurance benefits in accordance with the insurance contract.

Extended data;

Limitation of insurance claims;

1. Insurance claims must be filed within the limitation period. If the insured or beneficiary fails to file a claim with the insurer after the limitation period, providing the necessary documents and collecting the insurance money will be regarded as a waiver of rights. Different types of insurance have different time limits. The limitation of life insurance claims is generally 5 years; The limitation of other insurance claims is generally 2 years.

2. The limitation of claim shall be calculated from the date when the insured or beneficiary knows the occurrence of the insured accident. After the occurrence of an insurance accident, the applicant, insurer or beneficiary shall immediately stop the insurance and report the case, and then make claims.

Three, after the insured claims, if the insurance company thinks it is necessary to pay the relevant documents and materials, it shall promptly notify the other party in one lump sum; After the materials are complete, the insurance company shall conduct verification in time, and if the situation is complicated, it shall conduct verification within 30 days and notify the other party of the verification results in writing; For the insured, the insurance company shall pay the compensation within 10 days after reaching the compensation agreement; For those who do not belong to the insurance liability, a notice of refusal to pay compensation shall be issued within 3 days from the date of approval and the reasons shall be explained.

Four, the insurer claims review time should not exceed 30 days, unless otherwise agreed in the contract. However, within 10 days after reaching an agreement on compensation or payment of insurance benefits, the insurance company shall fulfill its obligation of compensation or payment of insurance benefits. In addition, if it is verified that it does not belong to the insurance liability, it shall issue a notice of refusal to pay compensation within 3 days from the date of verification and explain the reasons.

Reference materials; Baidu encyclopedia-insurance settlement of claims