Dedicated Policyholder Support
Claims Assistance & Documentation Guidance
Understand the insurance claim process, required documents and available grievance mechanisms across Health, Life, Motor, and Commercial insurance.
Policyholder Claims Guidance Desk
Claims Guidance Framework Supervised by Pushkal
RakshaPoint Insurance Marketing LLP | Last Reviewed: 19 August 2026
Statutory Advisory: Claim underwriting decisions, admissibility of claims, and settlement payments are made solely by the concerned insurer as per applicable policy terms. RakshaPoint assists policyholders in understanding claim procedures, documentation, and available grievance escalation mechanisms.
Health Insurance Claim Workflow
Option A: Cashless Hospitalization (Network Hospital)
- Show your Health E-Card & Government Photo ID at the network hospital Insurance / TPA desk.
- Hospital sends Pre-Authorization request form to the insurer/TPA (48 hrs prior for planned, within 24 hrs for emergency).
- Insurer issues initial cashless approval within 1 to 2 hours.
- At discharge, hospital submits itemized bill to TPA for final cashless authorization (mandated within 3 hours by IRDAI).
Option B: Reimbursement Claim (Non-Network Hospital)
- Intimate claim to insurer/RakshaPoint IMF within 24 hours of emergency admission.
- Pay hospital bills upfront and collect all original bills, payment receipts, discharge summary, diagnostic reports, and doctor prescriptions.
- Submit signed claim form with original documents to the insurer/TPA within 15-30 days of discharge.
Life Insurance Death Claim Workflow
- Intimate the claim to the insurer/RakshaPoint IMF specialist immediately with policy number.
- Submit official municipal Death Certificate, original policy document, claimant bank account details (cancelled cheque), and nominee KYC (Aadhaar & PAN).
- In case of accidental or unnatural death, provide FIR copy, Post-Mortem report, and Police Investigation / Panchnama report (where applicable).
- Life insurers process and settle claims in accordance with timelines prescribed under applicable IRDAI regulations upon receipt of complete documentation.
Motor Accident & Cashless Garage Claim Workflow
- Do Not Move Vehicle without taking clear photos or videos of the accident spot and vehicle damage.
- Intimate claim to insurer immediately to generate a Claim Registration Number.
- Tow vehicle to a recognized cashless network garage.
- Insurer appoints a surveyor who inspects damage within 24-48 hours and approves repair estimate.
- Garage completes repairs; insurer settles bill directly with workshop minus compulsory deductible.
Frequently Asked Questions on Claims
Cashless pre-authorization allows network hospitals to coordinate directly with the insurer or Third Party Administrator (TPA). Upon receiving the pre-authorization request, initial approval, or final bill documents from the hospital billing desk, the insurer evaluates policy coverage terms, room rent limits, and active benefits to issue approval directly to the hospital.
Standard document requirements generally include: 1. Official Municipal Death Certificate, 2. Original Policy Bond, 3. Nominee Photo ID & Address Proof (Aadhaar/PAN), 4. Cancelled cheque or bank passbook copy of nominee for direct NEFT payout, 5. Medical records/death summary (for illness deaths), or FIR, Post-Mortem, and Police Investigation/Panchnama reports (for accidental or unnatural deaths, where applicable).
If a policyholder or nominee has questions or concerns regarding a claim decision, they may contact the insurer's Grievance Redressal Officer (GRO) for clarification. Policyholders also have access to statutory consumer options, such as IRDAI's Bima Bharosa portal or the Insurance Ombudsman, to seek independent guidance or redressal if they choose.
In cashless treatment, covered medical expenses are settled directly between the insurer/TPA and network hospitals. In reimbursement claims, the policyholder pays medical bills upfront at any licensed hospital and submits original bills, payment receipts, discharge summaries, and prescriptions to the insurer for evaluation and direct bank account reimbursement.
Insurance policies operate under the principle of utmost good faith (Uberrimae Fidei). Full disclosure of pre-existing health conditions, past surgeries, and lifestyle habits during proposal submission ensures smooth claim evaluation and protects policyholders from claim rejection or policy cancellation during claim processing.
Request Claim Assistance
Stuck with a claim or need guidance on document filing? Our team is here to assist.
Grievance Escalation
If your claim was unjustly rejected by an insurer, you can escalate through official statutory channels:
Grievance Redressal & Ombudsman