The Claims Process

The General Claims Process

1. Report the incident: notify the insurer within the time limit and through the channel required by the policy (phone, app, or official account), and obtain a claim number.
2. Prepare the documents: ID card, policy, invoices, medical records, diagnostic certificates, itemised bills, accident certificates, and so on.
3. Submit the claim: upload online or submit in person; some policies require an on-site survey (motor and property insurance).
4. Review and close the case: the insurer reviews the claim and asks for supplementary documents if needed; once approved, the payout is made.

Document Examples (depending on the type of insurance)

• Medical insurance: invoices, itemised bills, inpatient or outpatient medical records, diagnostic certificates, discharge summaries, social insurance settlement statements.
• Accident insurance: accident certificates (police, traffic police, or emergency room records), diagnostic certificates, invoices.
• Critical illness insurance: diagnostic certificates meeting the contractual definition of a critical illness, pathology reports, and so on.
• Life insurance: death certificate, household registration cancellation or cremation certificate, proof of relationship, and the beneficiary’s ID.

Common Reasons for Claim Denial

• Failure to disclose a serious pre-existing condition, or insuring while already ill.
• Situations covered by the exclusions: drunk driving, self-harm, unlawful activity, and so on.
• The incident occurs during the waiting period (medical and critical illness insurance).
• Incomplete documents, inconsistent information, or a late report.

Tips

• Report first, then seek treatment or handle the scene, and keep the receipts and imaging records.
• Photograph or scan the important documents and keep them, in case they are lost.
• If you disagree with the claim decision, you can apply for a review or take the matter to the regulator.