How to Claim Critical Illness Insurance for Sudden Illnesses

Posted on: Sep 20, 2024 | 3 mins | Written by: HDFC ERGO Team

How to Claim Critical Illness Insurance for Sudden Illnesses

A critical illness is a life-threatening condition that requires regular and long-term treatment. Hence, the medical bills can mount over time, taking away a significant part of your savings. However, if you are covered under a critical illness insurance policy, the insurer will offer a lump sum amount for your treatment and other expenses. This health insurance policy covers over 15 critical illnesses, including cancer, stroke, diabetes, and kidney disease. If you get diagnosed with a life-threatening disease, the lump sum payout can help you opt for quality treatment.

However, when you buy a critical illness insurance policy, you and your family must understand the steps involved in filing a claim. In case you suffer from a sudden illness like stroke or paralysis, filing a claim on time can ensure a quick claim settlement. Read on to understand the steps for claiming critical illness insurance smoothly.

Steps to file a critical illness claim

The following are the steps to file a critical illness insurance claim —

Step 1: Notify the insurance provider

If you get diagnosed with a critical illness, inform the insurance company as early as possible, preferably within a week of getting your first diagnosis. Remember to check the terms and conditions of your critical illness insurance policy to know the exact timeframe for claim notification.

Step 2: Fill out the claim form

Obtain the claim form from the insurer or download it from the insurer’s website. Fill out the required details correctly, like your personal details, critical health insurance policy number, the critical illness you are suffering from, and your bank account details to receive the lump sum payout, etc.

Step 3: Collect supporting documents

You must submit your medical reports and other documents to support your claim. These include diagnostic test reports, X-rays and scans, doctor’s prescriptions, etc.

Step 4: Submit your claim

Once you have filled out the claim form and have all supporting documents in place, submit your claim form to the insurance company. Remember to keep photocopies of all the submitted documents for your records.

The insurer will review the claim form, bills, medical reports, and other documents. If everything looks fine, they will accept the claim and transfer a lump sum payout to your bank account.

Documents to submit with a critical illness insurance claim

When filing a critical illness insurance claim, you must submit the following documents to the insurance provider:

• Photocopies of a valid photo ID proof of the policyholder

• Critical illness policy document

• A duly filled claim form

• Medical certificate from the treating doctor

• Medical and investigation reports, including blood tests, scans, and X-rays

• Doctor’s consultation bills

• Medicine bills

• Discharge summary (if applicable)

• Bank account details of the policyholder

Points to consider to avoid claim rejection

When you are filing a critical illness insurance claim, keep the following points in mind to avoid claim rejection —

1. Check policy coverage

If you get diagnosed with a critical illness, check if the condition is covered under your critical illness insurance cover. File a claim only if your insurance provider covers the condition.

2. Check the waiting period

A critical illness health insurance policy comes with a waiting period of 90 days or more. Insurance companies entertain claims only after the completion of this waiting period. Hence, check the waiting period of your policy and file a claim accordingly.

3. Fill out the claim form correctly

Make sure you fill out the required details correctly. Do not hide your medical history or pre-existing conditions from the insurer, as these can lead to claim rejection.

4. Submit all supporting documents

Insurance companies need supporting documents to verify a claim before accepting or rejecting it. Hence, submit all bills and receipts to expedite the claim process and avoid rejection.

5. Pay policy premiums on time

This is important to keep your critical illness cover active. If you fail to pay the premium on time, your policy will lapse, and the insurer will reject your claim.

Conclusion

In case of sudden illness, like stroke or paralysis, you or a family member must file a critical illness insurance claim without delay. However, before claiming critical illness, review policy coverage to check eligibility. If the condition is covered under the policy and you are eligible to file a claim, you can go ahead with the claim filing process. In case of a query, you can call the customer service toll-free number of your insurance provider.

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.

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