INSURANCE CLAIMS GUIDE FOR POLICYHOLDERS
Insurance claims are a key feature of a company's services, particularly those focused on insurance.
Insurance claims are a key feature of a company's services, particularly those focused on insurance. This is crucial because it provides mutual benefits to policyholders.
However, many insurance companies offer their products to prospective customers, but the claims process is often difficult.
To avoid the recurring issue of difficult insurance claims, I will briefly outline the claims procedure to avoid company rejection.
As a financial product, insurance is a target of oversight by the Financial Services Authority (FSA). This oversight aims to protect consumer rights.
For companies, it serves as a guideline for carrying out their obligations transparently and fairly.
What is an insurance claim?
A policyholder requests an insurance company to pay or compensate for losses as guaranteed in the insurance policy.
When an event occurs that results in a loss for the customer, they report the incident to the company.
Based on the policyholder's report, the company conducts a field inspection to determine the eligibility for the compensation requested.
A concrete example: a car accident damages the policyholder's car. Because the policyholder is covered by a company's car insurance program, they can file a claim for the damage.
Insurance Company Obligations
According to Financial Services Authority (OJK) Regulation No. 1/POJK.07/2013 concerning consumer protection in the financial services sector, insurance companies' obligations include:
1. Transparency in providing information
2. Complaint management
If an insurance company violates this OJK regulation, it will result in sanctions, including the revocation of its business license.
According to the official OJK website, it was revealed that by 2023, 82% of insurance companies in Indonesia had complied with good governance
Types of Insurance Claims
Currently, there are many types of insurance available and frequently offered by companies. The most common and easily encountered are:
1. Life
2. Accident
3. Fire
4. Agriculture
5. Property Damage
These five types of insurance are financial products that are the primary offerings of several leading companies.
The Main Purpose of Insurance Claims
The primary purpose of insurance is to provide financial protection. When an unexpected event occurs and our financial situation is in disarray, an insurance claim is the ultimate savior.
Furthermore, this is also a parameter for proving the company's responsibility to its policyholders. Don't just offer sweet talk when offering insurance services, but be aware of the complexities involved in filing a claim.
Policyholder Preparation
Before filing a claim, it's important for customers to pay attention to the following important points:
1. Understanding the Policy Contents
Customers must understand the exact declarations contained in a policy, including the losses the company can cover, the claims process, and the claim deadlines. This knowledge must be ingrained in the customer's mind to prevent their claim from being rejected.
2. Completeness of Supporting Documents
The success or failure of a customer's claim depends heavily on the completeness of the attached supporting documents. For example, in the case of a car accident, the supporting documents include:
a. Police report
b. Photographic evidence of vehicle damage
c. Receipts for repair costs
d. Medical diagnosis results.
3. Insurance Claim Submission Deadline
This third point is crucial for customers to highlight. Even if the documents are complete and submitted after the company's deadline, the claim will be rejected.
So, when an unexpected event occurs, report it immediately to the company along with the supporting documents. The reporting period is usually between 7 and 30 days from the date of the claim.
4. Field Verification and Validation
Customers need to be aware that their submitted claim will enter the field validation testing phase. The company will immediately conduct a field survey to verify the claim.
Therefore, provide accurate and complete information to ensure the smooth verification process. Avoid lying about important facts, as this could result in the claim being denied.
5. Archive documents
Customers should neatly archive all documents, from the claim submission to the field inspection stage. This will be extremely helpful in the event of a dispute or claim issue.
If the claims process has been followed and the results are not optimal, customers can file a complaint with the Financial Services Authority (OJK) by calling 157 or WhatsApp at 081157157157.
Conclusion
An insurance claim by a policyholder is a key tool that provides financial protection. When unexpected circumstances arise, a claim is the quickest solution to remedy the situation.
Therefore, a policyholder must have basic knowledge regarding the insurance claim they are currently pursuing. This will be extremely helpful when filing a claim.
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