What is the trauma insurance claims process?

The trauma insurance claims process involves several steps to ensure your condition meets the policy definition. First, you or your representative must notify your insurer as soon as possible after diagnosis, typically by phone or through your financial adviser. The insurer will provide a claims form which must be completed with details of your condition, diagnosis date, and treating doctors. You'll need to authorize your doctors to release medical information to the insurer and gather comprehensive medical evidence including diagnostic reports, clinical notes, pathology results, radiological scans (X-rays, MRIs, CT scans), specialist reports, and any other documentation proving your condition meets the policy definition. This medical evidence must come from qualified medical practitioners and specialists. Once submitted, the insurer reviews your claim, which may take several weeks depending on complexity. They may request additional medical information or arrange for an independent medical examination. If your condition meets the policy definition and you've survived the required survival period (typically 14 days), the insurer approves your claim and pays the lump sum benefit directly to you or your nominated bank account. According to industry statistics, approximately 86% of trauma insurance claims are paid. Claims may be declined if the condition doesn't meet severity definitions, pre-existing conditions weren't disclosed, or exclusions apply.