1. A policy claim proposal form is submitted to an insurance company to initiate a claim under an insurance policy. It provides contact and policy details, as well as information about the incident or loss being claimed. 2. Insurance companies evaluate financial and medical information to assess risk when underwriting policies. For claims, policyholders must disclose all material information truthfully, and both parties are expected to act in good faith. 3. To settle a claim, the policyholder notifies their insurer, provides documentation of the loss, and the insurer investigates. If approved, the insurer makes a settlement offer which can be accepted or rejected by the policyholder.

1. POLICY CLAIMS
Presented By Litty Sylus

2. Proposal Form
A policy claim proposal form is a document that an individual or
entity submits to an insurance company to initiate the process of
making a claim under an insurance policy. This form serves as an
official request for coverage and compensation for a covered loss
or event as outlined in the insurance policy.

3. Information In Policy Claim Proposal Form
1.Personal/Policyholder Information:
1. Name of the policyholder
2. Contact details (address, phone number, email)
2.Policy Details:
1. Policy number
2. Type of insurance (e.g., auto, home, health, life)
3. Coverage start and end dates
4. Name of the insured person (if different from the policyholder)
3.Claim Details:
1. Date and time of the incident or loss
2. Location of the incident or loss
3. Description of the incident or loss
4. Brief explanation of what happened and the circumstances leading to the claim

4. 4. Witness and Third-Party Information:
1. Names and contact information of any witnesses present during the
incident
2. Names and contact information of any third parties involved (if applicable)
5. Police or Incident Report:
1. If applicable, a copy of the police report or any other official documentation
related to the incident
6. Documentation of Loss:
1. Photographs or videos of the damaged property or items
2. Estimates, invoices, or bills for repairs or replacements
7. Injury Details (if applicable):
1. Description of injuries sustained (if a personal injury claim)
2. Medical treatment received and medical records

5. 8. Liability Information (if applicable):
1. Description of any liability issues or responsible parties (for liability claims)
9. Declaration and Signature:
1. The claimant's declaration that the information provided is accurate and
complete to the best of their knowledge
2. Signature and date
10. Authorization to Process the Claim:
1. A statement authorizing the insurance company to access necessary
information to process the claim
11. Additional Information:
1. Any other relevant information or documents that might support the claim

6. Forms To Grant Policy Claim
• Claim Form: Most insurance companies require you to fill out a claim form.
This form collects essential details about the incident that led to the claim.
You'll need to provide information such as your policy number, date and
details of the incident, and a description of the damages or losses.
• Proof of Loss: This is a detailed document describing the extent of the
damage or loss. Depending on the nature of the claim (e.g., property
damage, medical expenses), you may need to provide photographs,
estimates for repair, medical reports, and any other relevant
documentation to support your claim.
• Police Report or Incident Report: If the claim involves theft, vandalism,
accidents, or any other incident that involves law enforcement, a police
report or incident report may be required.

7. • Medical Records: For health or medical insurance claims,
you may need to provide medical records, bills, and receipts
for treatments, prescriptions, and related expenses.
• Estimates and Invoices: For property damage claims, you'll
likely need to provide repair estimates or invoices from
contractors to demonstrate the cost of repairs or
replacements.
• Receipts and Proof of Ownership: If the claim involves
personal property, providing receipts, photographs, or other
evidence of ownership can be crucial in substantiating your
claim.

8. • Witness Statements: If there were witnesses to the incident,
their statements might help support your claim. These
statements should be collected as soon as possible after the
incident to ensure accuracy.
• Insurance Policy Copy: A copy of your insurance policy to
verify your coverage and terms.
• Proof of Payment: If you've already paid for any expenses
related to the claim, such as medical bills or temporary
repairs, providing proof of payment is important.
• Other Relevant Documents: Depending on the nature of the
claim and the insurance policy, additional documents might
be needed. These could include vehicle registration for auto
claims, repair history for equipment claims, and more.

9. Financial Underwriting In Policy Claim
1.Income and Employment: Insurance companies want to ensure that the
applicant has a stable source of income to cover their premium payments. This
includes evaluating the applicant's job history, salary, and employment stability.
2.Credit History: The applicant's credit score and credit history provide insights into
their financial responsibility and payment habits. A good credit history suggests
that the applicant is likely to make timely premium payments.
3.Debt Levels: Existing debts, such as mortgages, car loans, and credit card
balances, are considered. High levels of debt might indicate financial strain and
affect the applicant's ability to afford insurance premiums.
4.Financial Stability: Overall financial stability is assessed by looking at factors like
savings, investments, and other financial assets. A stable financial foundation
indicates that the applicant can sustain premium payments.
5.Risk Assessment: Based on the above factors, the insurer assigns a risk profile to
the applicant. This profile helps determine the premium amount and any
conditions related to premium payment, such as frequency and payment
methods.

10. Medical Underwriting In Policy Claim
1.Medical History: Applicants are typically required to provide
detailed information about their medical history, including past
illnesses, surgeries, treatments, and medications. This
information helps insurers understand the applicant's overall
health.
2.Pre-existing Conditions: Insurers focus on pre-existing
medical conditions that the applicant already has before
obtaining the insurance policy. These conditions might impact
the likelihood of future claims related to those conditions.
3.Family Medical History: Genetic predispositions and family
history of certain medical conditions can influence an
applicant's risk profile. Certain hereditary conditions might
increase the risk of future claims.

11. 4. Lifestyle Factors: Lifestyle choices like smoking, excessive
alcohol consumption, and engagement in high-risk activities
(e.g., extreme sports) are considered. These factors can
contribute to potential health issues and claims.
5. Medical Examinations: Depending on the insurance type
and applicant's age, insurers might require a medical
examination to assess the applicant's current health status.
This can involve medical tests, screenings, and assessments
by healthcare professionals.
6. Risk Classification: Based on the medical information
provided, insurers categorize applicants into different risk
classes. These classes determine the premium amount and
may also lead to exclusions or limitations on coverage for
specific conditions.

12. Material Information in Policy Claim
1.Disclosure Obligation: When submitting a policy claim, it's typically
the obligation of the policyholder to provide all material information
related to the claim. This information could include details about the
incident, the extent of damage or loss, and any relevant
circumstances surrounding the claim.
2.Impact on Claim Processing: Failure to disclose material
information can lead to complications during the claim process. If the
insurer finds out that relevant information was withheld or
misrepresented, it might result in a delayed or denied claim, as it can
be seen as a breach of the duty of good faith.
3.Application to Policy Underwriting: Material information also
plays a critical role during the underwriting process when the policy
is initially issued. Policyholders are expected to provide accurate and
complete information about themselves, their property, or their
situation to help the insurer assess the risk and determine the
appropriate premium.

13. 4. Consequences of Non-Disclosure: In some cases, if
material information was intentionally withheld or
misrepresented, the insurer might void the policy from its
inception, essentially treating it as if it never existed. This
means that any claims, even legitimate ones, could be
denied, and premiums paid might not be refunded.
5. Professional Assistance: Policyholders are often
encouraged to seek professional advice, such as legal or
insurance counsel, when navigating claims, especially if
there's uncertainty about what constitutes material
information. Professionals can help ensure that all relevant
details are accurately communicated to the insurer.
6. Good Faith and Fair Dealing: Both the policyholder and the
insurer are expected to act in good faith and with fair dealing.
This means that the policyholder should provide information
truthfully, and the insurer should fairly assess and process
claims based on the information provided.

14. Nomination
Nomination, in the context of policy claims, usually refers to the
process of designating or specifying a person or entity who will
receive the benefits or proceeds of a policy in the event of the
policyholder's death or another specified event. This is commonly
seen in life insurance policies. The policyholder can nominate a
beneficiary (or multiple beneficiaries) who will receive the payout
when the insured event occurs. The nomination can be revocable
or irrevocable, depending on whether the policyholder can
change the beneficiary designation later.

15. Assignment
• Assignment, on the other hand, refers to the transfer of the
rights or benefits of an insurance policy from one party (the
assignor) to another party (the assignee). The assignor might
do this for various reasons, such as selling the policy for cash or
transferring it to a third party. Once assigned, the assignee
becomes the new beneficiary of the policy and is entitled to
receive the benefits in the event of the specified insured event.

16. Procedure Regarding Settlement Of
Policy Claims
1.Notify the Insurance Company: As soon as an incident occurs that
may lead to a claim, it's important to notify your insurance company
promptly. This notification could be through phone, email, or an
online portal, depending on the company's preferences.
2.Claim Documentation: The insurance company will ask you to
provide relevant documentation to support your claim. This might
include:
1. A completed claim form.
2. Details of the incident, including date, time, location, and description of what
happened.
3. Police reports or incident reports, if applicable.
4. Photos or videos of the damages or losses.
5. Medical records and bills, if the claim involves injuries.
6. Any other relevant evidence or documentation.
3.Investigation: The insurance company will conduct an investigation
to assess the validity of the claim. This might involve contacting
witnesses, reviewing documents, and assessing the extent of the
damages or losses.

17. 4. Approval and Offer: If the claim is approved, the insurance
company will make an offer for the settlement amount. This
offer is typically communicated to you in writing and will
outline the details of the settlement, including the amount and
any conditions.
5. Acceptance or Rejection: Once an agreement is reached,
you can either accept the settlement offer or reject it. If you
accept, you'll typically need to sign a release form, which
means you won't be able to pursue further claims related to
the incident.
6. Payment: Upon accepting the settlement, the insurance
company will initiate the payment process. The payment could
be made via check, direct deposit, or other agreed-upon
methods.
7. Closure: After the settlement payment is made and any
necessary paperwork is completed, the claim will be