Our team of experts will assist you in the declaration and follow-up of your claim
After an incident, it is time to take steps to obtain compensation. There are many formalities to be completed, from recording the damage to reporting it to the insurer, including who to notify and the deadlines. It’s best to know them to avoid unpleasant surprises.
What is a claim
A claim is an event (fire, death, etc.) that brings the contract’s guarantees into play: compensation, capital or annuity. In the context of civil liability insurance, a claim only occurs if the victim claims compensation from the insured party (cf. Article 51 of the CIMA Code).
The claim is therefore the implementation of the guarantee covered by the insurance contract.
What to do in the event of a claim?
A police or bailiff's report is recommended.
To prove the existence and value of the damaged goods, you must gather all the documents in your possession: invoices, warranty cards, etc.
Personal insurance requires documents provided by the medical profession attesting to the illness, disability or death of the insured.
In the event of theft, the insured must file a complaint with the police station or the gendarmerie before making a declaration to the insurance.
The deadlines for reporting to your broker/insurer depend on the nature of the claim. As a general rule, the declaration of the loss must take place at least within five working days following the occurrence of the loss.
However, this period is reduced to two working days in the event of theft.
It is important to read the General Conditions of the Contract and respect the prescribed reporting deadlines under penalty of being deprived of the guarantees provided for in the contract.
Warning! You must first check with your broker/insurer that you are authorized to carry out the repairs yourself. In the event of significant material damage, the insurer may require the establishment of an expert report by an authorized professional, before any repairs.
Based on the evidence gathered, you can estimate the amount of damage and compare it with the expert's assessment. In case of disagreement, you must inform your broker/insurer.
How to report a claim?
The form of claims reporting is not legally specified.
However, claim forms are available from your broker/insurer and can be completed with the help of an advisor.
The declaration must contain :
- contact details of the insured ;
- the number of the insurance contract ;
- the date of occurrence of the loss;
- a description of the incident;
- a description of the damage ;
- any damage caused to third parties.
In the event of theft, the insured must attach the receipt of the complaint and a copy of the theft report to the claim form.
The sickness claim forms give details of, among other things, the nature of the illnesses and the treatments have undergone.
Please refer to your policy for details on how to report claims.
Case studies :
- Claim form to be completed
- Joint report for accidents meeting the criteria required for the application of the IDA Convention (Direct Compensation of the Insured): No bodily injury / Material damage less than 500 000 FCFA / Accident involving two insured vehicles.
- Additional documentation: Repair quotation / Photos / Complaint in case of theft / etc…
For a sickness claim
- Sickness declaration form duly completed by the attending physician
- Medical prescription
- Proof of the costs of care incurred.
Third-party payment is a mechanism whereby the insured person is exempted from advancing health costs that are partially or fully covered by his or her health insurer or mutual health insurance company.
The insured person pays the hospital, pharmacist or practitioner the co-payment. He then signs a subrogated invoice for the part of the cost that he has not paid. This bill will be paid by his insurer.
The total third-party payment system allows the insured person not to advance any costs (100% insurance cover).
The insured person is often issued with an insurance card which may or may not be biometric and which can only be used in a health care network.
What is a co-payment?
The co-payment is the part of the costs remaining to be paid by the insured person after they have been covered by the insurer. It corresponds to the difference between the cost of the service and the guaranteed cost. its amount may vary according to several criteria:
- depending on the procedure or treatment,
- depending on the type of medicine,
- depending on the nature of the risk,
- depending on the duration of the condition
What is the Health Insurance Card?
The health insurance card allows you to benefit from the services covered by the health insurance. Only one card is issued per person and is valid for the duration of the contract. Among other things, it makes it possible to identify the policyholder and, when it is biometric, to obtain information on the cover provided by the policy.
What is the care network
Health care networks puts policyholders in touch with health care professionals approved by insurers and play an important role in the quality/price ratio of services.
Three key points determine how well a claim is handled:
- The timeframe for care and assistance
- the compensation period
- the quality of the exchanges and clarity of the information given throughout the process.