Understanding the insurance claims process is essential for every policyholder in Ghana to ensure a smooth and efficient resolution of claims in the event of an insured loss. One major factor that is really damaging the reputation of insurance in Ghana and Priority Insurance Company has solved this has to do with claim settlement. An insurance claim is a formal request to an insurance company for compensation against loss or damage to an insured item or risk. A paid insurance claim serves to indemnify a policyholder against financial loss.

When an incident occurs, the first concern is the health and well-being of the persons involved. If there is injury, the priority is to ensure that the injured person(s) receives proper medical attention. If a vehicle is damaged in an accident, an insurance company recommends reliable workshops to make the necessary repairs. If a home gets damaged, the insurer should tell the policyholder how to contain the damage and recommend professionals to fix it.

Here’s what every policyholder must first know about insurance claim processes in Ghana:

1. Prompt Notification: Policyholders should promptly notify their insurance provider in the event of a covered loss or damage. Timely notification allows the insurance company to initiate the claims process promptly and gather necessary information to assess the claim.
2. Documentation: Policyholders are required to provide documentation to support their insurance claim. This may include:
   • Proof of loss (e.g., police report, incident report).
   • Photos or videos of the damaged property.
   • Estimates for repairs or replacement.
   • Any other relevant documents requested by the insurance company.
3. Claim Form Submission: Policyholders need to complete and submit a claim form provided by the insurance company. The claim form gathers essential information about the incident, the extent of damage or loss, and other relevant details.
4. Assessment and Investigation: The insurance company will assess the claim and may conduct an investigation to verify the circumstances of the loss or damage. This may involve contacting the policyholder, visiting the site of the incident, and reviewing documentation provided.
5. Claim Decision: Based on the assessment and investigation, the insurance company will make a decision on the claim. They may approve the claim and provide compensation according to the terms of the policy, or they may deny the claim if it does not meet the policy conditions or is excluded from coverage.
6. Compensation: If the claim is approved, the insurance company will provide compensation to the policyholder. This may be in the form of repair or replacement of the damaged property, reimbursement for expenses incurred, or a cash settlement, depending on the terms of the policy.
7. Appeals Process: If the policyholder disagrees with the claim decision, they have the right to appeal the decision with the insurance company. The appeals process allows for a review of the claim and any additional information or evidence provided by the policyholder.
8. Claim Settlement: Once the claim is finalized, the insurance company will settle the claim by providing the agreed-upon compensation to the policyholder. This may involve issuing a check or direct deposit payment to cover the insured loss or damage.
9. Policy Renewal: Policyholders should review their insurance policy upon renewal to ensure that their coverage adequately protects against potential risks and losses. Any changes in coverage or premiums should be discussed with the insurance provider.

Claim Period

In Ghana the period limit to make a claim for injury is up to three years from the date of accident. Claim limit for death is also up to three years. For damages, the limit is up to six years from the date of accident.

Do not admit Liability

When an accident occurs, the insured is not supposed to admit liability or make any payment or offer payment without the consent of the insurer. If an incident occurs, it is the responsibility of the police to investigate and then identify the one responsible. Nevertheless, an insurance investigator examines matters pertaining to insurance claims that are suspicious or otherwise in doubt for some reason. Investigators in this field have differing specialties and backgrounds. Some insurance companies have their own in-house investigation teams while other companies’ sub-contract the work to loss adjusters. Although such investigations are usually conducted to combat fraud, very often investigators will be working simply to establish the circumstances of a particular claim.

Final Stage

Insurance companies have certain customized insurance policies that provide extra benefits with surcharge. Examples, there are some executive motors comprehensive insurance product in which the claim is settled the same day in which the claim was made. Some insurance companies provide temporal vehicles or apartments when policyholders of such customised policies suffer loss or damage till the claim is settled. Others provided free towing services for their clients when they purchase those customised policies. All these benefits come with extra premiums and it is restricted to comprehensive motor insurance alone.

After all the needed information and documents are submitted to the insurance provider, the insured or policyholder will need to wait a few days until a decision is made. In the case of motor insurance, if the insured decide to repair the vehicle by himself or herself, it is a very good idea to have an adjuster look at the damage and provide an estimate before the repairs are done. In fact, the insurance provider will likely insist on it. This is important as it provides both the insured and the insurer with a solid idea what a reasonable settlement of the damages will be, thus avoiding any subsequent misunderstanding. Once the claim is settled, any additional or remedial repairs or charge will be paid by the policyholder.

In the area of theft or burglary, an investigation has to be done by the police and the insurance company’s in-house investigation team to establish the authenticity of the claim, and if possible arrest the culprit. For injury claims, doctor’s report would be required before the claim can be settled. If the claim is death and the policy is not Life Insurance policy but non-life insurance, there is no limit for the amount that has to be paid. The insurance company has to negotiate with the next of kins of the decease at a reasonable amount.

Understanding the insurance claim process empowers policyholders to navigate the claims process effectively and advocate for fair and timely resolution of their claims in Ghana. It’s essential for policyholders to familiarize themselves with the terms and conditions of their insurance policies and communicate openly with their insurance providers throughout the claims process.

Frequently Asked Questions (FAQ) on Claims Processes and Settlement in Ghana

How do I file an insurance claim in Ghana?

To file an insurance claim in Ghana, you need to notify your insurance provider promptly about the loss or damage. You will typically need to complete a claim form and provide supporting documentation, such as a police report, photos of the damage, and estimates for repairs or replacement.
What documents do I need to submit when filing an insurance claim?

The documents required may vary depending on the type of insurance claim. Generally, you will need to submit a completed claim form, proof of loss (e.g., police report, incident report), photos or videos of the damage, estimates for repairs or replacement, and any other relevant documentation requested by the insurance company.

How long does it take for an insurance claim to be processed in Ghana?

The time it takes to process an insurance claim in Ghana can vary depending on factors such as the complexity of the claim, the responsiveness of the parties involved, and the availability of required documentation. In general, insurance companies strive to process claims promptly and aim to settle them within a reasonable timeframe.

What is the claims assessment and investigation process?

The claims assessment and investigation process involves the insurance company reviewing the details of the claim, assessing the extent of the loss or damage, and conducting any necessary investigations to verify the circumstances of the claim. This may include contacting the policyholder, visiting the site of the incident, and gathering additional information as needed.

What happens if my insurance claim is denied?

If your insurance claim is denied, the insurance company will provide a reason for the denial. You have the right to appeal the decision and provide any additional information or evidence to support your claim. It’s important to review your policy terms and conditions to understand the basis for the denial and consult with your insurance provider about the appeals process.

How is the settlement amount determined for an insurance claim?

The settlement amount for an insurance claim is determined based on factors such as the terms and conditions of the insurance policy, the extent of the loss or damage, the value of the insured property, and any applicable deductibles or coverage limits. The insurance company will assess the claim and provide compensation according to the terms of the policy.

Can I negotiate the settlement amount for my insurance claim?

Policyholders may have the opportunity to negotiate the settlement amount for their insurance claim, especially if they believe the initial offer does not adequately compensate for the loss or damage. It’s essential to provide documentation and evidence to support your claim and engage in open communication with your insurance provider to reach a fair settlement.

How will I receive the settlement payment for my insurance claim?

Settlement payments for insurance claims in Ghana are typically made via check or direct deposit into the policyholder’s bank account. The insurance company will provide instructions on how to receive the settlement payment once the claim is finalized and approved.

Priority Insurance, we are on your side…