Complex Questions? Not understandable? What to do?
We offer guidance to complete the claim form because…
Incomplete or ambiguous claim form will be a deterrent for settlement of claims. Hence we would guide in a professional way in properly completing the claim form along with the necessary enclosures for speedy settlement of claim.
Accounts Department!!! Overload!!! One More Claim!!! Where’s the time?
We assist you in preparation and follow up of the claim
Due to paucity of time or due to incomplete knowledge the claim process may become incomplete. We would assist in complete preparation of claim and would also follow up with the concerned Insurance Company for smooth settlement of claim.
Disputes regarding quantum of claim?
In many cases we may find that disputes arise on account of the quantum of claim. In such circumstances we will provide the necessary expert advice and the assistance required to get the full value of the claim
Yes you need our help...
Non settlement of Claim or Rejection of claim:
We would help you as stated here below
Preparation of a letter to the office of the concerned Insurance Company requesting for reconsideration or settlement as the situation may warrant.
Preparation of letter to the grievance cell of the concerned Insurance Company mentioning the details of the claim and the grievance. This is a must since the Insurance Company must be provided with an opportunity to have a relook.
Need professional Assistance for...
Approaching the Insurance Ombudsman
There may be instances when the Insured / customer is not happy with the settlement or non settlement of claim. In such circumstances the next point of redressal of the grievance is to approach the Insurance Ombudsman. The Insurance Ombudsman caters to complaints upto Rs.20 lakhs.
The factual representation in a properly worded and completeness of the procedure for appeal requires the guidance of an expert. We offer this service and also will assist the insured when the case is taken up for enquiry.
Approaching the Consumer Forums:
The aggrieved persons have the benefit of approaching the Consumer Forums for resolution of disputes. The advantages are that every District has a Consumer Forum and the District forums takes up cases where the claim amount payable is less than 5Lakhs. State Commission deals with claims which are more than 5 Lakhs but less than 20 Lakhs. National Commission deals with claims payable more than 20 Lakhs.
Be it District Forum/State Commission/National Commission requires the services of experts. We offer our services for Filing the case and conducting the case. Also in cases where the customer is interested to file and conduct the case by themselves we will offer our assistance in preparation of the case.
Outsourcing of Claims Department:
Most of the Insurance related work are concentrated with the accounts departments in most of the corporate.
We hereby offer our services for taking over the claim department, which require expert guidance and constant follow up.
We offer our services for training the personnel in Insurance and related areas. In many cases it is found that if the personnel are trained, then in the event of a mishap arising due to an unexpected event will reduce the hardship of the said event.
Also trained personnel will be able to provide the required details in the event of a claim.
Patient Assist Services in Hospitals:
In health Insurance cases during hospitalization an insured person or his family members are required to complete the following formalities: Intimating the claims department of the Hospital on admission/ Insurance Company.
Get the preauthorization request duly completed by the treating doctor and submitting the same to the claim department of the Hospital.
In case queries are raised by the Insurance Company or TPA to follow up on the same and to ensure that the reply to queries have been duly communicated to the Insurance Companies/TPA.
In certain cases it will become essential to contact the Insurance companies or their TPA’s as a follow up to know the status of the claims.
In cases of a claim which is not cashless then at the time of discharge to obtain all the required documents that are to be submitted to the Insurance Company.
There could be more than one issue for which our services may be required. In such cases and in order to help the customer on a regular basis we are providing the membership services. The number of issues a member may raise during the currency of one year is however restricted to 10.
The advantage of this service is that the customer need not pay for each and every issue raised which require the opinion of an expert. Also members will be given priority as to the required assistance.
In case of requirement of any of our services the members will be given discounts according to the nature of the service utilized. The Annual membership fees is rated at Rs.2500/-.