What Happens During an Insurance Claim, Step by Step

After an insured event, you (or your nominee, for a life claim) notify the insurer, submit the required documents, the insurer's team reviews and verifies the claim against your policy's terms, and then either approves and pays it, requests more information, or — subject to your policy's specific conditions — declines it with a stated reason.

1. Notify promptly

Most policies expect notification within a specific window after the event — delaying can complicate or jeopardize a claim, so contacting your insurer or advisor as soon as possible after the event matters more than people often expect.

2. Gather the required documents

Exactly what's needed depends on the claim type — for a health claim, typically hospital bills, discharge summary, and diagnostic reports; for a motor claim, an FIR (where relevant), repair estimates, and photos; for a life claim, the death certificate and policy documents. An advisor can tell you the exact list for your specific policy and claim type before you start.

3. The insurer reviews and decides

The insurer verifies the claim against your policy's terms and conditions — checking, for example, that the event falls within the coverage, isn't an excluded cause, and doesn't fall within a waiting period. Timelines vary by claim type and insurer; straightforward cashless health claims can resolve in days, while more complex claims can take longer.

4. Where an advisor helps

We help clients understand exactly what documents are needed and coordinate communication with the insurer — but the insurer makes the final claim decision, subject to your policy's terms and conditions; an advisor doesn't have authority to approve or override that decision.