Process and Requirements | Life Insurance Claims | MetLife (2024)

FAQs

How do you answer insurance claim questions? ›

Think deeply about the exact question the agent asked, and only provide that specific information. Never admit to fault. Never admit to even being partially at fault. Never admit that you are uninjured.

The insurance claim life cycle has four phases: adjudication, submission, payment, and processing. It can be difficult to remember what needs to happen at each phase of the insurance claims process. This blog post will break down the insurance claims life cycle for you so that you know where your claim stands!

Insurance is a contract, represented by a policy, in which a policyholder receives financial protection or reimbursem*nt against losses from an insurance company.

Filing a claim is more straightforward than it may sound at first. Once you know the policy details and insurer, you'll need to fill out a claims form and submit it along with a certified copy of the policyholder's death certificate.

Life insurance claims may be denied for policy delinquency, material misrepresentation, contestable circ*mstances or documentation failure. Misrepresentations may include lying about medical history, occupation and hobbies.

Some of the top reasons for a claim to be denied include fraud, high-risk activities, suicide clauses, policy expiration and the possibility of beneficiaries' involvement in the insured's death.

Patient Registration. It all begins with the initial patient check-in and collection of personal and insurance details. Accurate and complete information is a claims processing best practice. Registration information includes demographics, name, policy type, policy number, and group number.

When you file a claim, you'll be asked to provide some basic details, such as where and when the accident or incident took place, contact information for everyone involved and a description of what happened. You might also be asked to give an estimated cost of the damage from the accident—if you have that available.

What is the first thing an insurer must investigate before taking on a claim? ›

Investigate all grounds for coverage

The insurance company must investigate all possible grounds for coverage. In order to perform a reasonable and proper investigation, insurance companies must also investigate all bases for the insured's claim.

The claimant must submit the written intimation as soon as possible to enable the insurance company to initiate the claim processing. The claim intimation should consist of basic information such as policy number, name of the insured, date of death, cause of death, place of death, name of the claimant.

The lifecycle of a claim is typically 30 to 90 days. The ideal processing timeframe is within a 45 to 60-day window.

The Insurance Regulatory and Development Authority of India (IRDAI) mandates insurance companies to settle death claims within 30 days. The guideline applies to all cases where no investigation into the death is required. If there is an investigation, the timeline extends to a maximum of 120 days.

An insurance claim is a formal request from the policyholder to their insurance company asking for payment after a covered incident, such as a hospital stay, a natural disaster, theft, and more.

When it comes to the value of specific items, condition is more important than age. An older item that's in excellent condition should be depreciated less than a newer item that's frequently used or one that's regularly exposed to water, sun, wind, etc.