Category: Insurance tips Release Date: 2006-08-01
The compensation of insurance claims handling, is the insurance business in the last one, is the most important aspects. A manifestation of the credibility of claims for insurance companies, but also the ultimate benefit of clients reflects the life insurance policy, it claims to understand the specific operational procedures to protect their own rights and interests of clients of great significance.
1. Applicant accreditation
1. Applicant claims the application, should read, "claims Applicants" and provide proof of identity and proof of the accident Relations.
2. The following persons have the right to claim insurance money paid to the company to apply:
(1) The survival of the beneficiary / insured persons;
(2) the deceased beneficiary of insurance money and their successors;
(3) did not specify the death insurance beneficiaries, the insured person's heirs
3. The following persons have the right to claim the premium application for exemption to the company:
(1) the insured or the insurer;
(2) the insured person's legal representative or guardian.
4. Death insurance money paid or the children's insurance premiums for exemption from the right to bring claims for himself; other matters filed by an agent who claims the right to apply for. If an applicant for an agent, must be submitted to the delegation of authority clear "power of attorney" and the principal / agent both proof of identity.
5. The admissibility of personnel should be immediately delivered to the qualified applicants, "claims Applicants" to inform the corresponding rights and obligations are required to submit the original proof of specified information and corporate advisory Complaint Tel.
2. Fill in the application
1. The applicant claims the application should be made to personally fill out the "application for life insurance claims," commissioned filled, the applicant should be autographed.
2. The application shall set out the circumstances of the accident, claims for items on the ground and its insurance and so on. For the insured person insured more insurance but pay the same insurance, accident led to a number of cases of the application, the applicant can simply fill out a "life insurance claims application." Group insurance applicants claims should be in the "Application for life insurance claims," stamped with official seal policyholders.
3. For Aging
In accordance with "Insurance Act" provides life insurance coverage other than the insured person or beneficiary who requests compensation or insurance payment insurance rights, since its known only from the date of the accident insurance, not to exercise two years to destroy. Life insurance, the insured person or beneficiary of the insured person the right to request payment of insurance, accident insurance, since its only known for five years from the date of exercise of elimination.
4. Application materials
1. The applicant shall be submitted to the policy that corresponds to the agreed terms of settlement of claims application materials. Officers are responsible for receiving regular notification and the initiative to assist the applicant claims claims Prepare all the necessary application materials as soon as possible.
2. Claims shall provide supporting documentation to: In addition to the original submission of policy, we must also submit the following under the responsibility of the respective type of the original document and supporting materials:
(1) death insurance payments for
a. national health departments at the county level or above (including county) hospitals issued by the insured person's death certificate and medical materials;
b. cancellation of the insured person to prove residence;
c. the case of accidental death, but also provides accidental death certificate issued by relevant departments or the courts issued judgments pronounced dead.
(2) The application for disability insurance payments
a. national health departments at the county level or above (including county) Hospital issued a certificate of disability of the insured person and the insured medical materials;
b. the case of an accident, issued by the relevant departments should also provide proof of an accident.
(3) The accident medical or hospital medical care (cost type) insurance premium payment for
a. national health departments at the county level or above (including county level) in public hospitals for medical diagnosis issued by a certificate, a hospital summary of long and short term inpatient care costs of doctor's advice, as well as the original documents, billing schedules;
b. as a result of an accident leading to hospitalization of the insured person should submit proof of accidents issued by the relevant departments;
(4) inpatient care (subsidy type) insurance premium payment for
a. national health departments at the county level or above (including county) Hospital issued a certificate of medical diagnosis, a summary of hospitalization, surgery proved an operation to submit material, and cross-check the original documents hospital expenses, settlement schedules;
b. as a result of an accident leading to hospitalization of the insured person should submit proof of accidents issued by the relevant departments;
(5) critical-illness insurance payments paid for the company designated or approved by medical institutions issued sufficient to establish the insured person suffering from major diseases of the supporting documents, such as pathology reports.
3. Material transfer: the admissibility of claims staff has received the application materials, it should be in the "material transfer certificate claims" in sign, indicating the date the admissibility of evidence after the delivery of the Deputy Joint applicant and real-time claims in the computer operating system registry.
These are the customers insurance claims needed attention, clients are provided below the admissibility of claims insurance companies in the general procedure:
1, fill out the "application claims", this material should be submitted to the rationale to accompany
2, the applicant qualification and fill out the "material transfer claims table";
3, less than the conditions placed on file, issue "does not file a notice";
4, the Summary of cases: placed on file to the closing time of 3 days;
5, non-specific cases: placed on file to the closing time of 10 days;
6, special cases: In case one of the following circumstances, the filing to the closed period of up to 60 days, such as ultra-60 days, must be reported to head office:
a. The applicant did not timely notice or burden of proof;
b. Identification of relevant authorities in the book, legal instruments, undetermined;
c. there is an applicable exemption clause cases.
