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Frequently Asked Questions 

Q. Why do insurers deny claims or reduce the claim amount?

  1. At the time of claim, the information given in the proposal is perceived to be incorrect or inaccurate.

  2. The available information is perceived to be inadequate for assessing the loss.

  3. At the time of claim, the insurers may perceive that the terms and conditions of the policy, issued by them, have not been complied with.

  4. There may be a dispute on the identity of the ultimate claimant.

  5. Sometimes the Loss Assessors have questions on the information given to them at the time of assessment of loss.

  6. There may be some misunderstanding or communication gap between the Insurer and Claimant.

  7. Sometimes the insurers may not be able to appreciate the information and documents submitted by the claimants. In such a situation, a professional help can make difference.

Q. What are the options available to the claimants in this scenario?

Discuss in person with the insurer. In case the issue is still not resolved, take assistance from a professional who knows about the intricacies of the insurance policy terms and conditions and procedures.

Q. What is the aim of Expert Claim Solutions India Private Limited (ECSI)?

  1. To aid clients in correctly reporting any potential claims to insurers and providing appropriate technical/ legal guidance to the clients based on the type of claim for faster claim settlements and ensure that their legal rights are protected.

  2.  To review claims before presenting to insurers, loss assessors or lawyers and interpreting coverage in the best interest of the clients. 

  3.  To assist the clients in preparation of claim documentation 

  4.  To liaise with surveyors and loss assessors, claim investigators, insurance officials on behalf of the clients to ensure smoother claim settlement process 

  5.  To offer assistance to clients in presenting the case before ombudsman 

  6.  To offer guidance and technical advice to clients in arbitration process 

  7.  To organizing education and Page 1 of 10 claims workshops for clients on selective topics

  8.  Assisting stakeholders in settlement of claims

Q. What are the services offered by ECSI?

A. Services for a specific Claim:
 

ECSI offers services to claimants for any specific claim which has been either denied or delayed by the insurer or there is any disagreement on quantum of compensation. 
 

B. Services for a specific event:
On occurrence of any event which leads to loss, ECSI offers handholding services to claimants right from intimation to liaising with service providers and insurers, till processing and settlement of claim is complete.

 

C. Services on retainer basis :

ECSI offers services to clients for handling all or part of their claims. 

Q. Is ECSI a TPA?

No, we are not a TPA. 

Q. Is ECSI an authorized representative of any insurer?

ECSI does not represent any insurer. At ECSI, we offer claim resolution services to all clients who wish to avail such services.  

Q. Does ECSI handle General claims only?

While majority of the clients of ECSI are clients of General Insurers and Stand Alone Health Insurers, we also provide claim resolution services to Life Insurance clients

Q. Is ECSI only for individuals?

No. ECSI provides services to individual clients, service providers and also to corporate

Q. What are the documents required by ECSI to provide advisory services for claims?

A.  In case of a specific claim:

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  1. Details and proof of identity of the claimant.

  2. Insurance Policy Copy with wordings, endorsement copies etc., provided by the insurer.

  3. Copies of claim form and other documents submitted to the insurer.

  4. Copies of correspondence with the insurer/service providers.

  5. Discharge Summary (In case of Health claim).

  6. Rejection/Denial Letter if any.
     

After scrutiny of the above documents, ECSI team will seek further details as required. The requirements will be based on the facts of the case which may differ from claim to claim.

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B. In case of occurrence of any event:-

  1. Details and proof of identity of the claimant.

  2. Insurance Policy Copy with wordings.

  3. Details of the event which might give rise to a claim

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After scrutiny of the above documents, ECSI team will seek further details as required. The requirements will be based on the facts of the case which may differ from claim to claim.

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C.  In case of Retainership basis

The documents will be mutually decided and agreed upon, based on the contractual agreement.

Q. Why is it necessary to provide documents in advance to ECSI?

At ECSI we endeavour to give proper and correct guidance to the claimants and all stakeholders. Hence we go through the documents thoroughly to understand the issue involved and give advices on appropriate course of action to be initiated in respect of the claim

Q. Does ECSI provide Insurance Intermediary services at the time of procurement of insurance?

No. We do not provide Insurance placement services and we do not sell insurance policies 

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