What Is an Insurance Claims Adjuster?

Insurance claim refers to the insurance company to perform compensation or The act of paying liability is a work that directly reflects the insurance function and fulfills the insurance liability.

Insurance claim

Articles 22 and 23 of the Insurance Law provide that after an insured accident occurs,

1. File investigation

Claims are fulfilled by the insurance company

Keep the contract and keep promises. The rights and obligations under the insurance contract are protected by law. Therefore, the insurance company must respect the contract, keep its promises, and properly safeguard the rights and interests of the insured.

Insist on seeking truth from facts. In the process of handling claims, we must deal with them realistically, and correctly determine the insurance liabilities, payment standards, and payment amounts according to the specific circumstances.

Proactive, fast, accurate and reasonable. The policyholders should be assured that they can be assured and convinced.

The documents to be provided in the claim mainly include: an insurance policy or

Supervising and inspecting the compensation situation after the insurance company undertook the insurance subject loss in the event of an insured accident. The main contents of the audit: Check whether the claims file is complete. Whether there is a notice of danger, the insured's accident report loss list, survey report, verification certificate, on-site photos, insurance policy copy, compensation calculation book, etc. Check whether the estimated damages are accurate and the responsibility is determined to comply with the provisions. Whether the calculation of compensation is correct. Whether the approval procedures are complete. Check whether the reasons for refusal of compensation are sufficient, and whether there is no compensation or not. Check whether there is any personal gain.

1. According to different types of insurance, the way to report the case is different.

All applications for inpatient medical insurance benefits must be passed to the company's claims department through the marketing department.

Application for insurance other than the hospital medical insurance can be reported through the office or directly to the claims department.

2. According to the type of insurance premium, the information to be provided in the claim is different (generally required to provide the original of the relevant certificate).

The death benefit application generally requires the application for payment, the identity card of the insured, beneficiary of death and applicant, the account book of the insured, death certificate, forensic appraisal or traffic accident liability certificate, insurance policy and final A receipt.

The application for disability payment generally requires the application for payment, the ID card of the insured person, the beneficiary of the disability pension and the applicant, the forensic medical certificate, the inpatient outpatient medical record or the traffic accident responsibility certificate, the insurance policy and the last receipt.

Medical payment applications generally require payment application forms, identification of the insured, medical beneficiaries and applicants, hospital outpatient medical records and medical expenses receipts, insurance policies and last receipts.

Third, the health medical insurance claim process

1. Procedures required by the insured for claims due to illness:

(1) Medical diagnosis certificate or discharge summary;

(2) Original receipt of medical expenses;

(3) Expense list and settlement details;

(4) A copy of my ID card or household registration certificate.

Fourth, accident injury insurance claims process

1. After an accidental injury or hospitalization, you should call the insurance company's customer service phone in time to understand the documents that need to be prepared so that the insurance company can quickly settle the claim. You must report to the insurance company within 3 days.

2. Procedures required for the insured to handle claims due to accidental injury (inpatient medical insurance needs to be hospitalized in a second-level (including second-level) hospital recognized by the insurance company):

(1) Medical diagnosis certificate;

(2) Accident injury certificate issued by relevant departments;

(3) Original receipts and prescriptions for medical expenses;

(4) A copy of my ID card or household registration certificate. ^[2]

3. The insurance company will make a notice of closing the case within 7 days if all the documents are complete. After receiving the notice, the insured or beneficiary can claim the compensation from the insurance company with his ID card and household registration certificate. ^[1-2]