Group personal accident insurance claims processing mechanism

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The process for claims under a group personal accident insurance policy is quite simple.

The process and documents required for processing an Accidental Death benefit claim:

  • The assignee who has been named in the insurance policy should be notifying the issuing office immediately.
  • The claim form has to be given along with the post-mortem report, death certificate, original policy copy and police report.
  • The documents needed are the Photo ID, claim form, post-mortem report, death certificate, HR letter, police report and salary slip.

Here are process and documents required for injury related Insurance claim:

  • The policy issuing office should be immediately notified.
  • Police report should be furnished if it is there.
  • Claim form should be given with the medical certificate which testifies to the disablement of the person insured/injury.
  • Prescription and bills may be furnished in case the policy covers medical expenses as well.
  • Documents required in this case are the Photo ID, claim form, salary slip, HR letter and disablement certificate from a medical practitioner empaneled/approved by the insurance company.

Failure to provide proper documents may lead to claim rejections. There have been umpteen cases where people have not provided the requisite documents and the claim has been rejected.

In fact, in an instance, Subros Construction Limited had sent one of its teams on a group task to a hilly area in Kashmir. The area witnessed huge snowfall which stopped just before the group was to visit and hence they were expecting milder weather conditions. However, snowfall started during the 5-day group trip when the members were trekking. They were stuck at a high altitude in terrible weather. On the very last day, an avalanche hit their camp and two members of the team succumbed to the harsh weather.

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The death certificates were issued and the FIR was made at the local police station yet the group members did not get any copies with themselves. The family members got death certificates along with condolences from Subros Construction Limited which they gave to the group insurance company for receiving the personal accident policy claim for death. The claim was rejected by the insurance company, citing lack of proper documents since the family did not provide a copy of the FIR, post-mortem report and death certificate filed in the FIR and other documents since the trip organizer/members/company had not taken these at the time of the accident. This unfortunate incident should serve as a warning to all those impanelled in a group accident insurance policy and also for companies.

Shailesh Kumar

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