Claim Form

A claim form is the standard document an insurer requires the policyholder (or the nominee, in a death claim) to fill out and submit, alongside supporting evidence, to formally request payment under a policy. Different lines of insurance use different forms, and most insurers publish them on their website and at the hospital insurance desk. For Indian health insurance, IRDAI mandates a standardised claim form structure with two parts.

Part A is filled by the insured or their representative and captures policy details, claim reference, hospital details, dates of admission and discharge, the reason for admission, and a declaration that the information is accurate. Part B is filled by the treating doctor or hospital and captures the diagnosis, line of treatment, procedures performed, ICD codes, and the doctor's medical certification. For motor claims, the form captures vehicle details, accident date and location, brief description, FIR reference (for third-party or theft claims), driver details, and a damage diagram.

For life claims, the form captures the deceased's details, cause and date of death, and the nominee's bank-account details for payout. Worked example: Priya's mother is hospitalised for five days for cardiac investigation; the family pays the bill at discharge as the hospital is non-network and files a reimbursement claim. The claim packet contains the completed Part A signed by Priya, Part B signed and stamped by the cardiologist with the diagnosis and procedure codes, the discharge summary, the itemised final bill, all payment receipts, every diagnostic report and prescription, a copy of the policy, KYC of the policyholder, and a cancelled cheque.

The packet is submitted on the insurer's portal on day 4 after discharge, and the insurer's response — settlement of the admissible amount — typically arrives within four to six weeks. A common misconception is that 'the doctor's certificate on the discharge summary is enough; the claim form is just paperwork'. It is not — the claim form is the legal request to the insurer and triggers the 30-day statutory settlement clock.

Without the claim form, the insurer's claims team cannot open a file, and the claim languishes. Another common misconception is that 'one claim form covers multiple admissions in the same year'. Each hospitalisation event needs its own claim form and supporting documents.

The administrative effort is repeated, but the documentation discipline is what protects the policyholder if any claim is later contested. Keep photocopies of every submitted form and an acknowledgement from the insurer's portal or registered post. Related: claim-intimation, reimbursement-claim, cashless-claim.