What is a claim form? When is it needed? How long will it take?

Traditionally, for your medical insurance claim to be assessed by your insurer, it was always necessary to complete a claim form. Thankfully today more claims than ever can be assessed in full while you’re on the phone, giving you the benefit of a speedy decision that will set your mind at ease. However, there are still some circumstances when a claim form need to be sent out in order to assess the eligibility of your claim.

First of all its important to stress that requesting you fill out a claim form is no indication that your insurer is doubting your claim is genuine. With certain types of underwriting such as moratorium and fully medically underwritten policies, it’s often a necessary requirement to check the history of your condition with your GP.

So what is a claim form?

  • Claim forms are a claims assessment tool that are sent out to you to complete by yourself and your GP.

  • Your GP will need to provide information surrounding your medical history for the condition you are claiming for.

  • In order to assess the claim your GP will need to provide the date which you first started suffering from symptoms, along with the details of any subsequent trips to your doctor.

  • The claim form will also ask for consent to obtain a medical report if your insurer deems this necessary. A medical report will provide answers from your GP to specific questions they have regarding your medical history. You have the option to see this report first before it’s sent on to your insurer.

  • Your insurer may request a copy of the specialist referral letter alongside the claim form. This is the initial letter that is sent by your GP to the hospital consultant.

When is a claim form needed?

  • Moratorium underwriting – With this type of underwriting whether you’re covered or not will depend on your medical history, so it’s often necessary to complete a claim form. This is particularly true if you’ve taken a new policy out in the last few months, as many people fail to understand what their underwriting actually means, and try and claim for conditions that are outside the scope of their cover.

  • Fully medically underwritten policies – Your claims assessor will often need to see a claim form to check when you initially showed symptoms of the problem. This will be able to highlight whether you declared the relevant information on your application form. Your assessor won’t always ask you to complete a claim form, usually just if the start of the illness is close to the inception date of your policy.

  • Claim forms can be used to help establish whether a condition is regarded as acute or chronic by your insurer. They will be able to provide information as to when you first started with the condition, but also what kind of advice and treatment you’ve had. If there’s a pattern of routine monitoring and checks in your medical record, it’s more likely your insurer will class the condition as chronic and deny cover.

  • Complex and unusual cases – Some cases can be particularly complex, especially if they involve a variety of symptoms which may be related to a previous or excluded condition. In these circumstances its essential for a claims assessor to see the big picture, in order to make an accurate and well informed assessment concerning your cover.

Is there a charge?

It depends – some GPs choose to charge you for filling out a claim form while others still do this for free. If you’re charged for the completion of the form, it shouldn’t be any more than £25. Unfortunately you’ll be unable to claim this expense back from your insurer.

How long will it take to process?

From receipt of your claim form most insurers will complete an assessment in 5 working days. You can speed the process up by opting to receive the form by email or fax, and using the same method to return the copy. Many insurers have the claim form uploaded onto their website, so you can access it quickly when you need it.

Can you proceed with treatment if your insurer requests a claim form?

You can proceed with your treatment if you wish, but until the claim is assessed this will be at your own financial risk. Provided the claim is eligible you will be covered retrospectively for any treatment that you’ve had. However, as private medical costs can be prohibitively expensive with charges up to £300 for a consultation alone, its often wise to wait until your insurer has made their decision.

If your insurer asks you to complete a claim form, don’t be alarmed. It’s a standard procedure used by all major insurance companies and it could help your claim be approved. Assessors aren’t looking for a way to deny your claim, they just need to know all the facts so they can make an accurate decision.

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