Ada became a widow after her husband passed away suddenly due to a car accident. She and her husband had two children, and it became her sole responsibility to raise them. Thankfully, Ada’s husband had a life insurance policy, and she is the beneficiary.
A month after her husband’s funeral, Ada filed a claim with the insurer, attaching the documents she believed were required: a copy of the death certificate, her identity card, and a thoroughly filled-out claims form.
After two weeks and a few follow-up calls, Ada received an email stating her claim had been declined due to missing documentation, specifically a medical report and proof of recent premium payments.
Ada was devastated. Her husband had taken out the policy as a financial safety net and had assured her that it would ease the burden on their little family if anything ever happened.
Many people have had experiences similar to Ada’s, straining their trust in insurance providers. The common sentiment is that the insurer wants to frustrate policyholders or their beneficiaries. In this article, we correct that narrative by detailing how claims work, why claims are sometimes declined, and how to get them approved faster.
Insurance Claims: A Policyholder’s Greatest Ask
A premium validates the contract between a policyholder and an insurance provider. The contract, a policy document, binds an insurer to financially compensate the affected policyholder or their beneficiary.
For the compensation to be activated, a claim must be filed.
An insurance claim is the formal request a policyholder or a beneficiary makes to their insurer for compensation according to their policy coverage.
Claims are typically filed after an unfortunate incident, such as a car accident, fire outbreak, or theft, occurs and results in permanent disability or death of the policyholder.
Also, claims are important because the policyholder or beneficiary filing can immensely influence how lucid or difficult the process is.
Why Do Claims Get Rejected?
Claims are delayed or rejected by insurance providers for an array of reasons. However, the three recurring ones are:
- Insufficient Documentation
When a person files a claim request without the necessary documentation, such as valid identification, proof of relationship, e.g, a marriage certificate, medical report, or a death certificate, their chances of getting a successful payout are drastically reduced.
Insurers request these documents to validate the claim. Without sufficient and accurate documentation, insurers cannot perform their due diligence and, as a result, cannot approve a claim.
- Withholding or Exaggerating Information
Anyone filing a claim has to provide accurate information to their insurer throughout the process. Insurers reserve the right to decline a claim when they investigate and discover new information that was withheld or exaggerated in a claim request.
For example, if a policyholder had a terminal health condition but failed to disclose it to their insurer prior, their insurer could reject their beneficiary’s claim if it is uncovered during their investigation.
- Policy Exemptions
Life insurance policies have exemptions. Some occurrences are not covered under a policy, while some are covered after the policyholder has fulfilled a mandatory requirement.
For instance, a beneficiary’s claim could be rejected because the policyholder is required to pay their premium for up to eight months to be eligible for a payout, and they have not done so.
Insurers also decline valid claims from beneficiaries whose policyholders neglected to pay their premiums, exempting them from any benefits under the policy.
How to Get Your Claims Paid Faster
The success or failure of a claim request often begins with the policyholder and beneficiary’s actions prior to filing the claim. Anyone filing a claim must understand that they can influence the swiftness and success of a claim payout by doing the following:
- Understand Your Policy
The appropriate time to learn everything about a life policy is before subscription, not after an unforeseen event, and a claim payout is needed to scale through.
Policyholders must take time to understand their policy, the limits of its coverage, exemptions or conditions, and if there are any timelines for filing a claim. This applies to beneficiaries also.
This provides clarity and enables management of expectations. An in-depth understanding of a policy also makes it easier to make alternative preparations and decisions in unforeseen circumstances.
- Stellar Documentation
Documentation is a major factor that distinguishes successful claims from unsuccessful ones.
Impeccable evidence is needed to file a claim, and this can be achieved by obtaining documents such as medical reports, a death certificate, valid identity card, and other documents that the insurer may require from the beneficiary.
Providing detailed, accurate, and organized documentation helps the insurer assess a claim request faster, leading to a quick and easy payout.
- Swift and Sincere Communication
Insurers sometimes need additional information to reach a conclusion concerning a claim. As a result, they might contact the beneficiary for support. Beneficiaries have a responsibility to revert to insurers quickly to provide the information they need.
Longer wait times usually result in longer claims processing times.
Also, avoid garnishing or omitting any information that your insurer requests. Strive to provide accurate information at all times.
Take Control of Your Insurance Claims Experience with Coronation Life Assurance
At Coronation Life Assurance, we understand that making a life insurance claim often comes at a difficult and emotional time. It is during these critical moments that the true value of insurance is revealed; not just in the payout, but in the ease, empathy, and support you receive throughout the process.
Unfortunately, many people approach the claims process with anxiety and skepticism, often assuming that their claim will be rejected. This could not be further from the truth. Life insurance is designed to provide a financial safety net when unforeseen events occur, ensuring that life’s unexpected turns do not disrupt your stability or that of your loved ones.
As your insurer, we are legally and contractually obligated to honour claims as long as the policy conditions are met. Our role is not to create barriers, but to stand beside you, ensuring you receive the benefits due to you with minimal stress and maximum efficiency.
That is why at Coronation Life Assurance, we have put in place a dedicated claims team professional, empathetic, and highly responsive to walk with you every step of the way. From guiding you through the required documentation to ensuring that valid claims are processed promptly. our goal is simple: to make your experience clear, fair, and stress-free.
To make the most of your policy benefits, we also encourage policyholders to stay informed, honest, and proactive. Understanding your policy, keeping your documentation updated, and reaching out early can go a long way in ensuring a smooth claims process.
To read more articles from Coronation Life Assurance LTD, please visit https://coronation.ng/insights/
For assistance concerning claims, please contact us via email at contactcentre@coronationinsurance.com.ng or call 020-1-2774500, 020-1-2774566, 020-1-2774577.
