Insurance claim kaise karein? Insurance policy lena to aasaan hai, lekin jab claim karne ka samay aata hai to kai log uljhan mein pad jaate hain. Galat ya adhoori jaankari ki wajah se claim reject bhi ho sakta hai. Is guide mein hum health aur life insurance dono ke claim process, zaroori documents aur IRDAI ke niyamon ki poori jaankari denge.
Insurance Claim Kya Hota Hai?
Jab policyholder ya uske nominee ko policy ke tahat milne wali rashi chahiye hoti hai, to insurance company se ki jaane wali maang ko claim kehte hain. Example ke liye — hospital mein bharti hone par health insurance claim, ya policyholder ki mrityu par life insurance claim.
Insurance claim kaise karein, ye jaanne se pehle ye samajh lein ki claim do tarah ka hota hai: cashless claim (jismein company seedha hospital ko payment karti hai) aur reimbursement claim (jismein aap pehle kharch karte hain, phir company aapko paise wapas karti hai).
Insurance Claim Kaise Karein? Step-by-Step Process
Insurance claim kaise karein, iski poori prakriya neeche step-by-step di gayi hai:
- Policy ki shartein padhein: Claim karne se pehle apni policy document mein coverage, exclusions aur waiting period zaroor dekhein.
- Insurer ko turant inform karein: Hospital mein bharti ya ghatna ke baad jitni jaldi ho sake insurance company ya TPA ko inform karein. Deri se claim mein pareshani ho sakti hai.
- Claim form bharein: Company ki website ya branch se claim form lein aur sahi jaankari ke saath bharein.
- Documents jama karein: Neeche di gayi list ke anusaar saare zaroori documents jama karein. Adhoore documents claim reject ka sabse bada kaaran hain.
- Verification aur settlement: Company documents verify karti hai, zaroorat padne par survey karati hai, aur phir claim approve karke payment karti hai.
Health Insurance Claim Process
Insurance claim kaise karein, health insurance mein iske do tareeke hain. Cashless claim ke liye network hospital mein bharti hote samay TPA desk par apna health card dikhayein — company seedha hospital ko payment karti hai. Reimbursement claim mein aap pehle khud payment karte hain, phir bills aur discharge summary jama karke company se paise wapas maangte hain.
Life Insurance Claim Process (Death Claim)
Life insurance mein insurance claim kaise karein, ye nominee ke liye jaanna sabse zaroori hai. Policyholder ki mrityu ke baad nominee ko company ko inform karke death claim form bharna hota hai, saath mein death certificate, policy document aur pehchaan pramaan jama karne hote hain. Company jaanch ke baad claim amount nominee ke account mein transfer karti hai.
Claim Ke Liye Zaroori Documents
Insurance claim kaise karein, ismein sahi documents sabse bada role nibhate hain. Aam taur par ye documents maange jaate hain:
- Bhara hua claim form
- Policy document ki copy
- Pehchaan pramaan (Aadhaar/PAN)
- Health claim ke liye: hospital ke bills, discharge summary, doctor ke prescriptions, jaanch reports
- Death claim ke liye: death certificate, nominee ka pehchaan aur bank details
Company ke anusaar documents ki list thodi alag ho sakti hai, isliye claim karne se pehle company ki official website ya customer care se confirm zaroor karein.
IRDAI Ke Niyam: Aapke Adhikaar
Insurance claim kaise karein, ye jaanne ke saath apne adhikaaron ko jaanna bhi zaroori hai. IRDAI (Insurance Regulatory and Development Authority of India) ke 2024 ke Master Circular on Protection of Policyholders’ Interests ke anusaar:
- Insurance company ko saare zaroori documents milne ke 30 din ke andar claim par apna faisla lena ya suchit karna hota hai.
- Policy lene ke baad aapko 30 din ka free-look period milta hai — is dauraan policy pasand na aaye to wapas ki ja sakti hai.
- Company ko claim process aur uski sthiti ki jaankari policyholder ko deni hoti hai.
Adhik jaankari ke liye IRDAI ki official website (irdai.gov.in) dekhein.
Claim Reject Hone Ke Aam Kaaran
Insurance claim kaise karein, ye to aapne jaan liya — ab ye jaanna zaroori hai ki claim reject kyun hota hai, taaki aap ye galtiyan na karein:
- Galat ya adhoori jaankari: Policy lete samay bimari ya aadat (jaise smoking) chhupana sabse bada kaaran hai.
- Waiting period: Kai bimaariyon par policy ke pehle 1-2 saal mein claim nahi milta.
- Exclusions: Policy mein pehle se likhi hui cheezein (jaise cosmetic surgery) cover nahi hoti.
- Deri se suchna: Ghatna ke baad company ko inform karne mein zyada deri karna.
- Adhoore documents: Zaroori kagaz jama na karna.
Claim Reject Ho Jaaye To Kya Karein?
Agar aapka claim galat tareeke se reject hua hai to ghabrayein nahi. Pehle company ke grievance redressal cell mein likhit shikayat karein. Wahan se santoshjanak jawab na mile to IRDAI ke Bima Bharosa portal par online shikayat darj kar sakte hain. Uske baad bhi samadhan na ho to Insurance Ombudsman ke paas jaane ka vikalp hota hai.
Aksar Puche Jaane Wale Sawal
Insurance claim kaise karein, is vishay par aksar puche jaane wale kuch sawalon ke jawab:
Claim settlement mein kitna samay lagta hai?
IRDAI ke niyamon ke anusaar company ko saare documents milne ke 30 din ke andar claim par faisla lena hota hai. Cashless health claim mein approval aam taur par kuch ghanton mein mil jaata hai.
Cashless claim ke liye kya karna hota hai?
Network hospital mein bharti hote samay TPA/help desk par apna health insurance card aur ID dikhayein. Hospital company se pre-authorization leta hai, aur approve hone par aapko payment nahi karna padta.
Kya nominee ke bina claim mil sakta hai?
Haan, lekin prakriya thodi lambi ho sakti hai. Isliye policy lete samay nominee ka naam zaroor darj karayein. Term insurance lete samay nominee chunna sabse zaroori kadamon mein se ek hai.
Health insurance policy kaise chunein?
Claim settlement ratio, network hospitals ki sankhya, waiting period aur exclusions dekhkar policy chunein. Vistaar se padhein: Health Insurance Kya Hai? Sahi Policy Kaise Chunein — 2026 Guide.
Umeed hai ki insurance claim kaise karein, is guide se aapko poori aur sahi jaankari mil gayi hogi. Finance se judi aur jaankari ke liye hamara Finance section bhi dekhein.
Yeh sirf jaankari hai, financial advice nahi hai. Claim se judi antim jaankari ke liye apni insurance company ke official niyam zaroor padhein.