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What is an Insurance Claim, and How Do They Work?

Understanding what is insurance claim is essential for every policyholder. Simply put, an insurance claim is a formal request made to the insurer for compensation as per the policy’s terms. Once the insurer verifies the details and confirms its validity, the approved amount is disbursed to the policyholder. To put it clearly, the insurance claim meaning lies in securing financial support during covered emergencies or losses.

  • 9,566 Views | Updated on: Jul 11, 2025

What is an Insurance Claim?

An insurance claim is a formal request made by the policyholder to their insurer to receive monetary compensation for a covered loss or event. It’s the point at which the insurer must fulfill their contractual obligation. Filing a claim starts the process of assessing and validating the event, and, if eligible, providing financial support to the insured.

It is the practical application of the promise made by the insurer, turning a policy contract into tangible support when you need it the most.​​​​ At its core, filing a claim sets in motion the process for your insurer to assess the situation and, if valid and covered, provide the financial relief or benefit outlined in your policy document​​​​.

Types of Insurance Claims in India

There are as many insurance claims as Types of insurance plans . These claims depend upon the type of insurance one has chosen. However, there are the following types of insurance claims that are popular among people:

Health Insurance

Health insurance claims cover medical expenses like doctor visits, hospital stays, surgeries, and prescriptions incurred due to illness, injury, or ongoing medical conditions. Claims can be submitted for specific treatments or reimbursement for already incurred expenses.

Life Insurance

​​​Life insurance claims provide a financial payout to your beneficiaries upon death. Different types, like term life, whole life, and universal life insurance, offer varying payouts and benefits. These claims involve submitting death certificates and completing beneficiary forms.

Travel Insurance

Travel insurance covers unexpected expenses during your trip, such as medical emergencies, trip cancellations, lost luggage, and travel delays. Claims vary depending on the specific event and coverage you purchased.

How Does an Insurance Claim Work?

The insurer evaluates the claim, checks documentation, and if approved, disburses the amount. It helps cover costs such as hospital bills, lost income, or living expenses during emergencies.

For families dependent on a primary earner, claim settlements can be vital in ensuring financial continuity. Overall, the claim process helps individuals and families manage the economic burden during difficult times, providing stability when it is needed the most.

How to Report or Submit a Claim Request?

Policyholders can usually initiate an insurance claim through several convenient channels offered by their insurer, such as:

  • Online via the insurer’s website: Most insurance companies have a dedicated ‘Claims’ section on their official website where you can start the process.
  • Phone or email support: For assistance with your claim, you can also contact the insurer’s customer service team via a helpline number or email address.
  • In-person: Visiting the nearest branch of your insurance company is also an option for offline claim support and guidance.
  • Self-service portal: Many insurers provide a secure online portal or mobile app where policyholders can log in to manage their policy and submit claims digitally.

Regardless of how you initiate contact, the claim submission process often involves the following stages:

  • Document submission: Fill out the claim form and upload all necessary supporting documents.
  • Claim registration: Once documents are verified, your claim is officially registered.
  • Processing: Your claim will be reviewed and processed as per IRDAI’s PPHI Regulations.

What Documents are Required to Intimate a Claim?

When reporting a claim, the documents you need depend on the type of claim being submitted. Below is a general overview:

1. Death Claim Documents

  • Claimant Statement Form
  • Claimant’s recent photo
  • Death Certificate
  • Photo and address ID proof
  • PAN or Form 60
  • Cancelled cheque/bank statement
  • Payout mandate form

2. Health and Critical Illness Claim Documents

  • Claim form
  • Doctor’s certificate
  • Medical records and discharge summary
  • Cancelled cheque
  • Pre-authorization form (for cashless)
  • Original bills and payment receipts

Note: Specific documents may vary depending on the exact policy and claim type. Always refer to your insurer’s official claim assistance portal or customer care for precise requirements.

How to Claim Your Insurance?

Claiming insurance involves notifying your insurance company that you have experienced a covered loss or event and requesting compensation or coverage for the incurred expenses. The process can vary based on the insurance type and the claim’s nature. Here are some general steps that can be taken:

Immediate Action

  • Report loss to insurer immediately
  • File an FIR (if needed)

Gather Documents

  • Download or request claim form
  • Collect supporting bills, reports, etc.

Submit Your Claim

  • Fill and submit form with documents

The Investigation

  • Surveyor may assess the claim

Claim Settlement

  • Approved claims receive payout
  • Denied claims receive explanation

Final Thoughts

Insurance is more than just compensation—it’s peace of mind. A clear understanding of the claim process ensures you’re financially protected when it matters most.

FAQs on Insurance Claims


1

How do I file an insurance claim?

You can file an insurance claim by notifying your insurer through their website, phone, or branch. Submit the required claim form along with supporting documents. The insurer will then review and guide you through the next steps.



2

What documents are required for an insurance claim?

Documents depend on the claim type but usually include a filled claim form, proof of loss, identity proof, and bank details. Check with your insurer for specific requirements. Complete documents help avoid delays.



3

How long does it take to process an insurance claim?

Processing time varies based on claim complexity and document completeness. Simple claims may settle within days, while complex ones can take weeks. Insurers generally follow regulatory timelines to decide claims.


4

What happens after I file a claim?

The insurer reviews your documents and may ask for more information. After verification, they approve or reject the claim. You will be updated on the claim status throughout the process.


5

Can an insurance claim be rejected?

Yes, claims can be rejected if they don’t meet policy terms or have incomplete documentation. Claims may also be denied if the event isn’t covered or if there’s fraud. Always provide accurate information to avoid rejection.



5

What are the common reasons for claim rejection?

Common reasons include missing documents, late filing, or claims outside policy coverage. Fraud or nondisclosure of facts can also lead to rejection. Timely and honest communication reduces rejection risk.

Amit Raje
Written By :
Amit Raje

Amit Raje is an experienced marketer who has worked in various Fintechs and leading Financial companies in India. With focused experience in Digital, Amit has pioneered multiple digital commerce in India. Now, close to two decades later, he is the vice president and head of the D2C business department. He masters the skill of strategic management, also being certified in it from IIMA. He has challenged his challenges and contributed his efforts in this journey of digital transformation.

Amit Raje
Reviewed By :
Prasad Pimple

Prasad Pimple has a decade-long experience in the Life insurance sector and as EVP, Kotak Life heads Digital Business. He is responsible for developing user friendly product journeys, creating consumer awareness and helping consumers in identifying need for life insurance solutions. He has 20+ years of experience in creating and building business verticals across Insurance, Telecom and Banking sectors

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