Marklet

Claims Performance Review

Group Insurance Claims Management & Performance Review

Executive Overview

Broker: India Insure Risk Management & Insurance Broking Services Pvt. Ltd. | Client: EMRI Green Health Services | Coverage Period: Active Policies (2023–2027)

Group Personal Accident (GPA) - United India Insurance Co. Ltd.

Total Claims Reported

₹2,47,50,000 Total Claim Amount

50

Claims Settled

₹1,92,50,000 Settled (77.78%)

39 (78.00%)

Claims Pending

₹55,00,000 Pending (22.22%)

11 (22.00%)

Claims Rejected

₹0 Rejected

0 (0.00%)

Group Term Life Insurance (GTLI) - Aviva Life Insurance Co. India Ltd.

Total Claims Reported

₹18,54,99,419.18 Total Claim Amount

373

Claims Settled

₹14,49,99,419.18 Settled (78.17%)

310 (83.11%)

Claims Pending

₹2,90,00,000.00 Pending (15.63%)

60 (16.09%)

Claims Rejected / Repudiated

₹15,00,000.00 Rejected (0.81%)

3 (0.80%)

SOP – Claim Intimation to Settlement Process Flow

  1. 1Stage 1: Incident / IntimationHR / Family intimates India Insure within 30 days (GPA) or ASAP (GTLI).
  2. 2Stage 2: Verification & GuidanceIndia Insure validates policy eligibility and issues customized document checklist.
  3. 3Stage 3: Document AggregationHR collects primary/secondary documents from nominee; sends to India Insure desk.
  4. 4Stage 4: TPA / Insurer SubmissionIndia Insure audits dossier and files claim with United India / Aviva within 90 days.
  5. 5Stage 5: Deficiency ManagementInquiries/Deficiencies resolved by India Insure within 5–7 business days.
  6. 6Stage 6: Approval & DisbursementInsurer approves and remits payment directly to Nominee Bank Account via NEFT/UTR.

Process Responsibilities at Each Stage

HR Team (EMRI Green Health Services): Capture immediate oral/email intimation upon event occurrence; coordinate with field units/family to assemble legal and medical documents; ensure correct Nominee KYC and bank account details (canceled cheque) are collected. Insurance Broker (India Insure): Pre-audit claim file prior to insurer submission to avoid queries; register intimation in insurer systems within 24–48 hours; follow up weekly on pending requirements and drive escalation matrix. Insurance Companies (United India / Aviva): Issue claim registration number / acknowledgment; process claim upon document receipt and issue payment approval/UTR.

Required Documentation Checklist: Group Personal Accident (GPA - United India Insurance)

  1. 1Mandatory Standard DocumentsDuly completed and signed GPA Claim Form; First Information Report (FIR) / Panchnama copy; Post Mortem Report (PMR) & Forensic/Toxicology Report (if preserved); Death Certificate issued by local Municipal Authority; Detailed Cause of Death Certificate / Hospital Discharge Summary; Attested Nominee ID proof (Aadhaar/PAN) & canceled cheque with printed name; Employer Certificate confirming active employment on date of accident.
  2. 2Policy-Specific RequirementsClaim Intimation within 30 days; full document submission within 90 days. Additional allowances: Ambulance benefit up to ₹2,000; Children Education Benefit up to ₹20,000 (max 2 children); Carriage of mortal remains up to 2% of CSI or ₹2,500.