Claim Investigations
Claim Investigation
Cashless claim Investigation
Cashless claim investigation involves verifying the authenticity and eligibility of a health insurance claim raised directly at the hospital without upfront payment by the insured. It includes checking patient records, treatment details, policy coverage, and potential fraud indicators before claim approval. The investigation ensures that the claim is genuine and complies with insurer guidelines.
Reimbursement claim Investigation
Reimbursement claim investigation is conducted after the insured pays for treatment and submits bills for refund. The process involves verifying medical documents, treatment authenticity, policy coverage, and checking for any discrepancies or fraud. It ensures the claim is legitimate and meets the insurer’s terms before approval and payout.
Death investigation Survey
Death investigation survey involves verifying the cause, circumstances, and authenticity of the insured individual’s death. It includes reviewing medical records, death certificates, witness statements, and sometimes conducting field inquiries. The aim is to rule out foul play, confirm policy conditions, and ensure the claim is genuine before settlement.
Personal accident Survey
Personal accident investigation involves verifying the circumstances, nature, and extent of injuries claimed due to an accident. It includes examining medical reports, accident site details, FIR or police records, and witness accounts. The objective is to confirm the incident’s legitimacy and ensure compliance with policy terms before claim approval.
