Your Rights As A Policyholder: What You Should Expect During The Claims Process

SOURCE : NEW18 NEWS

Last Updated:April 26, 2025, 12:57 IST

Expert stresses knowing your rights in the claims process: clear communication, timely responses, fair assessments, respectful treatment, dispute options, and data protection.

When you purchase an insurance policy, you’re not just buying financial protection—you’re entering into a relationship based on trust. As a policyholder, you have rights that are essential to ensuring this relationship remains fair, transparent, and supportive, especially during the most critical moment in your insurance journey: the claims process.

When someone buys an insurance policy, it’s understandable that filing a claim can often feel overwhelming, particularly if it follows a stressful event like an accident, theft, or natural disaster. However, understanding your rights can help you approach the process with confidence and clarity.

Here’s what you should expect—and are entitled to—during the claims process.

1. The Right to Clear and Honest Communication

At the core of any fair claims process is transparency. From the moment you report a claim, you have the right to receive clear and complete information. This includes details on the documents required, steps involved, timelines, and the contact information for assistance.

Insurance providers are obligated to explain the terms of your policy and how they apply to your particular claim. You should never feel left in the dark or forced to interpret complex jargon on your own. If anything seems unclear, you have every right to ask questions—and to receive the right answers.

2. The Right to a Timely Response

Time is critical, especially when you’re dealing with the aftermath of a loss. Whether it’s damage to your vehicle or property or a medical emergency, you need prompt support.

As a policyholder, you are entitled to timely updates on the status of your claim. There are industry standards that insurers are expected to meet when it comes to acknowledging, processing, and settling claims. While minor delays can occasionally occur due to external factors, excessive lag without explanation is not acceptable and can be questioned.

3. The Right to Fair Assessment and Settlement

A key aspect of insurance is the principle of indemnity: to put you back in the position you were in before the loss occurred. This requires a fair and unbiased assessment of the claim.

Once all necessary documentation is submitted, the insurer must investigate and evaluate the claim based on the terms of the policy. If an inspection or surveyor visit is required, it should be scheduled promptly and conducted professionally.

Importantly, you have the right to understand how the claim amount was calculated. If any deductions are made or if a partial settlement is proposed, it should be justified with clear reasoning. You can, and should, request this in writing if not provided upfront.

4. The Right to Be Treated with Dignity and Respect

It might sound basic, but it’s worth emphasizing you deserve the right to be treated with empathy and respect throughout the claims process. Whether you’re interacting with a claims adjuster, a surveyor, or a call center representative of your insurance company, courteous service is your right—not a favour.

Insurance exists to support people during difficult times. A well-trained, professional team will recognize the emotional and financial strain you’re undergoing and respond accordingly. If your experience falls short of this standard, you have the right to escalate your concerns within the organization.

5. The Right to Dispute and Appeal

No system is perfect, and sometimes disagreements do arise—be it over claim amounts, rejections, or delays. As a policyholder, you are fully entitled to challenge a claim decision you believe is unfair.

Insurance companies must offer a grievance redressal mechanism. Start by escalating the issue internally ( your insurance provider). If you still don’t receive a satisfactory resolution, you can approach the insurance ombudsman or the regulatory authority for further redressal. These bodies are in place to ensure that your interests as a consumer are protected.

Make sure to document all communications, retain copies of submitted documents, and keep a detailed timeline of the claim process. This not only strengthens your case but also helps you stay organized during any further review.

6. The Right to Privacy and Data Protection

In today’s digital age, your personal and financial information is shared more than ever before. You have the right to expect that your data is handled with the highest level of confidentiality. Insurance companies are obligated to protect your information from unauthorized access or misuse.

If you ever feel your data has been compromised, or you’re being contacted by third parties without your consent, it’s important to raise the issue immediately.

Signing for an Insurance is more than just a contract or buying a product —it’s a promise. And during the claims process, this promise is put to the test. Knowing your rights ensures that you’re not just a passive recipient but an informed participant in the process and your insurance provider is there by your side  throughout your policy journey .

A well-informed policyholder opts for a healthier insurance ecosystem. Companies are striving to make claims handling faster, more transparent, and more customer-centric to offer the best customer experience. But your awareness, your voice, and your engagement are what truly drive change.

So, the next time you find yourself navigating a claim, remember—you’re not asking for a favour. You’re exercising your right.

It is authored by Shashi Kant Dahuja, ED and Chief Underwriting Officer, Shriram General Insurance

The views expressed in this article are those of the author and do not represent the stand of this publication.