Types of Claims in Insurance (Life
and Non-Life) in Relation to Ghana
Insurance claims represent the mechanism
through which policyholders seek compensation or benefits as specified in their
insurance contracts. In Ghana, insurance plays a vital role in mitigating risks
and protecting individuals and businesses from unforeseen financial losses. The
claims process differs between life insurance and non-life
insurance, and understanding the types of claims available in each
category is essential.
I. Types
of Life Insurance Claims
Life insurance provides financial
security to policyholders or their beneficiaries in events such as death,
disability, or maturity of the policy. The following are the common types of
claims in life insurance in Ghana:
Death Claims
A death claim arises when the life insured under the
policy passes away.
Beneficiaries or next of kin must present the death
certificate and other required documentation to claim the sum assured
(the policy benefit).
In Ghana, insurers like Enterprise Life and SIC Life
provide a straightforward claims process to ensure timely disbursement.
Maturity Claims
These are claims payable when the policy reaches its
maturity period.
The insured receives the sum assured, along with any
accrued bonuses, provided the premiums were fully paid during the policy
term.
For example, endowment policies in Ghana typically
include a maturity benefit.
Critical Illness Claims
Some life insurance policies cover critical illnesses
like cancer, stroke, or heart disease.
The insured can file a claim upon diagnosis to
receive financial support for treatment.
This type of coverage is particularly relevant as the
cost of healthcare continues to rise in Ghana.
Disability Claims
These arise when the insured suffers a disability
that prevents them from earning a livelihood.
Disability benefits help cover medical expenses and
living costs.
Rider or Add-on Claims
Riders such as accident or funeral benefits are
additional features that policyholders may include in their life
insurance policies.
Claims under these riders are paid when the specific
event occurs, such as accidental death or funeral expenses.
II. Types
of Non-Life Insurance Claims
Non-life insurance, also known as
general insurance, covers tangible assets and liabilities. The types of claims
in this category vary significantly due to the broad range of risks covered. In
Ghana, non-life insurance claims include:
Motor Insurance Claims
Comprehensive Claims: Cover
damages to the insured vehicle and third-party liability due to
accidents, theft, or fire.
Third-Party Claims: Address
damages caused to third parties, including injuries, property damage, or
death.
Motor insurance is mandatory in Ghana, and insurers
such as Vanguard Assurance offer robust support for claim processing.
Fire Insurance Claims
Fire insurance compensates policyholders for losses
caused by fire, explosion, or related perils.
Claims require proof of loss, including a report from
the Ghana National Fire Service.
Marine Insurance Claims
Covers loss or damage to goods during transit by sea,
air, or land.
Claims are typically filed for stolen, damaged, or
delayed shipments.
Property Insurance Claims
Compensates for damages to property caused by risks
like natural disasters, theft, or vandalism.
This is particularly significant for businesses and
homeowners in Ghana, where risks such as flooding are common.
Health Insurance Claims
Health insurance covers medical expenses incurred by
the insured.
In Ghana, claims are filed with private insurers or
under the National Health Insurance Scheme (NHIS) for reimbursement or
direct settlement of bills.
Travel Insurance Claims
Cover expenses related to trip cancellations, delays,
or medical emergencies while traveling.
Ghanaians traveling abroad often purchase travel
insurance to safeguard their journeys.
Liability Insurance Claims
Liability policies protect businesses or individuals
from legal liabilities resulting from injuries or damages caused to third
parties.
Examples include product liability and professional
indemnity claims.
Burglary/Theft Insurance Claims
These claims compensate businesses and individuals
for losses caused by theft or burglary.
III. The
Claims Process in Ghana
The claims process generally follows
these steps:
Notification of the Insurer
The policyholder or beneficiary must notify the
insurer immediately after the event occurs.
For example, in motor insurance claims, notification
must occur within a stipulated time frame, often 24 hours.
Submission of Required Documents
Claimants must submit supporting documents such as a
police report, medical records, or a fire report.
Non-life claims often require photographic evidence
or inventory of damaged items.
Assessment of the Claim
The insurer assesses the claim's validity and
investigates the cause of the loss or event.
Settlement
Upon approval, the insurer pays the claim according
to the policy terms and conditions.
In cases of disputes, the claimant can escalate the
issue to the National Insurance Commission (NIC).
Challenges
in Claims Processing in Ghana
Fraudulent Claims
Fraud remains a significant issue in the industry,
leading insurers to implement strict verification measures.
Delays in Documentation
Many claimants face delays due to incomplete or
missing documents.
Low Awareness
Many Ghanaians lack understanding of their policy
terms, leading to disputes during claims.
Conclusion
Insurance claims in Ghana play a crucial
role in providing financial relief to individuals and businesses during
unforeseen events. Understanding the types of claims and the processes involved
is essential for maximizing benefits. While insurers continue to improve their
services, policyholders must also play their part by adhering to policy
requirements and promptly submitting accurate claims.
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