10 Tips to Speed Up Your Insurance Claim Process
Jakarta, CNBC Indonesia – The viral case of a critical illness insurance claim that was delayed for six months and only processed after going viral serves as a reminder that understanding insurance claim procedures is important so that claims can be paid out promptly.
In that case, the policyholder’s family said the claim process was delayed several times because the insurer kept requesting additional medical documents, including histopathology (anatomical pathology) evidence.
On the other hand, the insurer explained that the process was part of verification in accordance with the policy terms before the claim was finally approved and payment processed.
Such differences in perception are actually quite common in the insurance industry. Some policyholders believe all documents are complete, while the insurer still requires additional information so that the benefits paid genuinely match the policy contents.
Before this case erupted, the national insurance industry was also being sued by a policyholder. The lawsuit, registered at the Constitutional Court (MK) in Case Number 25/PUU-XXIV/2026 filed by Ng Kim Tjoa, seeks to have Article 304 of the Commercial Code (KUHD) declared conditionally unconstitutional insofar as policy clauses are not interpreted more strictly, including setting out claim requirements in a final and rigid manner.
The applicant requests that Article 304 of the Commercial Code be interpreted as requiring claim conditions to be set out in a final and rigid manner from the start. This is intended to ensure the insured knows what documents are needed from the beginning and to prevent insurers from unilaterally adding requirements, as the applicant felt disadvantaged by the insurer’s continued requests for additional documents not stated in the policy.
So how can the insurance claim process run more quickly? Here are 10 tips to get your claim processed quickly by the insurer:
- Understand the Policy Contents from the Start
Many claim disputes are not caused by the company refusing to pay, but because the benefits claimed do not match the policy terms.
Therefore, pay particular attention to the following five things: the definition of critical illness, the waiting period, the contestable period, policy exclusions, and the documents required for filing a claim.
The better you understand your policy, the smaller the chance of your claim being delayed, let alone rejected. Also make sure your policy is active and there are no outstanding premium payments.
- Do Not Delay Filing a Claim
Report a claim as soon as the risk occurs. Some policies have reporting deadlines; if you are late, the company may request additional clarification, making the process longer.
- Ensure the Diagnosis Is Complete
For critical illness, insurers usually require a diagnosis that meets the medical definition in the policy. Documents typically required include: a medical summary, laboratory results, CT scan or MRI, anatomical pathology results (if required), and a letter from a specialist doctor.
The more complete the documents from the start, the fewer additional document requests. When seeking treatment, you can also inform the doctor and hospital that you will be filing a reimbursement claim with the insurer so they can prepare the documents from the outset.
- Ask the Doctor to Write a Detailed Medical Summary
Many claims are delayed not because of the illness itself, but because the medical summary is too brief. Ask the doctor to explain, among other things: the main diagnosis, the stage of the illness, examination results, treatment given, and the basis for the diagnosis. Clear medical documents help the claims team assess faster and more accurately.
- Fill in the Claim Form Honestly
Small mistakes on the form can trigger additional investigation. Make sure dates are accurate, your medical history is written in full, and nothing is concealed. The principle of utmost good faith applies to both the insurer and the policyholder. If you are later proven dishonest, the insurer may take legal action against you.
- Keep All Medical Documents
Do not rely solely on the hospital. Keep the following documents yourself: receipts, laboratory results, radiology CDs, prescriptions, biopsy results, hospitalisation letters, and medical summaries. If they are requested again, you will not need to reapply to the hospital, which usually takes a long time.
- Use the Help of an Insurance Agent
An insurance agent’s job is not only to sell policies. A good agent will help policyholders with the claims process. An agent can help by checking document completeness, ensuring forms are correct, communicating with the claims team, and monitoring the progress of the submission.
Agent assistance does not guarantee your claim will be approved, but it can at least speed up the administrative process, as agents are the party most familiar with claim procedures.
- Respond Quickly to Requests for Additional Documents
When the insurer requests additional documents, complete them immediately. The longer documents take to send, the longer the evaluation takes. In practice, most delays actually occur while waiting for completeness from the policyholder or hospital. Always monitor your claim communication channels, whether email, SMS, or WhatsApp chat.
- Keep All Evidence of Communication
Document the entire process, including emails, ticket numbers, letters, proof of document submission, and conversation notes. If problems arise, this evidence will make it easier to trace the status of your claim.
- Do Not Hesitate to Ask for an Explanation
If the process feels too long, ask for a written explanation, or through your agent, about why the claim is still under review, what documents are still missing, the estimated completion time, and the policy provisions being applied. Open communication reduces misunderstandings between policyholders and insurers.
Learning from the Viral Claim Case
The case that went viral in recent days shows that the claims process can be complex, particularly for critical illness benefits requiring in-depth medical verification. On one hand, insurers are obliged to ensure payments are made according to policy terms. On the other hand, policyholders need certainty that protection benefits will be received on time.
Therefore, the key to quick claim payouts lies not only in the speed of the company’s processing, but also in document readiness, understanding of the policy, good communication, and transparency from the start.
Ultimately, insurance works on the principle of mutual trust and utmost good faith. The more complete the data provided and the clearer the basis of the benefits claimed, the greater the chance the claim can be resolved quickly, accurately, and in accordance with the policy terms.
It should also be noted that not all insurance claims, particularly health insurance, are complicated. There are health insurance products, especially employee benefits, where claims are processed by system, making the process faster.