Why claiming insurance at work feels like a battle?

Nearly 25% of employees never claim their group mediclaim insurance policy for employees, even after a valid health or workplace incident. That’s a huge gap. Insurance is meant to protect employees, but when the claim process feels like a maze, it only adds more stress.

Let’s unpack why this happens and how HR leaders and SMEs can make it easier.

Common challenges:

• Too much paperwork (bills, discharge summaries, reports, prescriptions).
• No updates on the claim status.
• Multiple follow-ups with insurers or TPAs.
• Confusing claim forms with unclear instructions.

Why this matters:

When claims feel like a hassle, employees lose trust in the company’s group mediclaim policy. It affects satisfaction, loyalty, and even retention.

What HR can do:

• Share a simple claim guide or checklist during onboarding.
• Use a digital claim tracking tool like the Pazcare dashboard for real-time status updates.
• Run internal surveys to check how aware employees actually are about their benefits.
• Conduct short awareness sessions—especially before policy renewals—to explain coverage, process, and how to use cashless facilities.

Work accident claims that never get filed

In industries like logistics, sales, or field operations, employees often face small injuries or accidents on the job. While these are covered under group insurance, many employees skip the claim process altogether.

Why employees skip these claims:

• They don’t know if it qualifies under the group mediclaim insurance policy for employees.
  
• Fear of paperwork or blame.
  
• No clear post-incident reporting process.
  

What HR can do:

• Encourage prompt reporting without judgment.
  
• Ensure claim forms and help guides are easily accessible.
  
• Train managers to handle post-incident steps smoothly.
  
• Test employee awareness and ask if they know how to raise a claim and whether their preferred hospitals are in-network.
  

The step-by-step claim journey

Understanding the process helps reduce confusion and frustration. Here’s a simple breakdown of how a typical claim works:

Step 1: Hospitalization or treatment

The employee should inform HR or the insurer within 24 hours (for cashless) or after treatment (for reimbursement).

Step 2: Choose claim type

• Cashless Claim: Available at network hospitals; insurer pays directly.
• Reimbursement Claim: Employee pays first and gets reimbursed later.

Step 3: Collect required documents

These may include:

• Final hospital bill
• Discharge summary
• Diagnostic reports
• Prescription copies
• Health card or ID proof
• Completed claim form with Part A and Part B

Step 4: Submit the claim

Upload all documents via the insurer’s mobile app, email, or Pazcare App.

Step 5: Track claim status

Use the tracking tool or contact support to stay updated.

Step 6: Receive Settlement or Follow-Up

If approved, the amount is transferred to the employee’s account. If any query raised by the insurer, they can resubmit with additional documents , if the claim is rejected ask for reasoning, reach out to your insurance broker to reopen your claim

How HR & SMEs can make claiming easier

Here’s how HR teams can transform the employee claim experience:

• Break down the process: Share infographics, videos, and FAQs internally.
• Go digital: Use platforms that support easy, mobile-first document uploads.
• Communicate regularly: Answer doubts in open forums, especially during policy renewals.
• Assign a benefits champion: Someone employees can approach when stuck.
• Collect feedback: Run short surveys to find out what’s working and what’s not.

How Pazcare makes insurance claims simple?

At Pazcare, we understand how confusing insurance claims can feel. That’s why our platform focuses on making the entire experience human-first and tech-driven.

Here’s how we help:

• 24/7 support: Employees can get help via call, chat, or WhatsApp.
• Mobile-first tools: Claim submissions happen in just a few clicks.
• Dedicated assistance: Our team supports employees from filing to payout.
• Smart HR dashboard: Real-time view of claims, approvals, and usage.

When employees understand and trust the claims process, they’re more likely to use their benefits, and that builds a happier, more loyal workforce.

Conclusion 

Insurance is supposed to be a safety net, but when the claim process is too complex, it ends up causing more anxiety than support.

When employees don’t feel confident about claiming insurance, your investment in group health insurance loses its impact. That’s why Pazcare deals with claims with empathy.

But with the right communication, tools, and partners like Pazcare, your company can ensure that every employee knows how to file a claim and feels supported throughout.

Here’s what to do next:

• Share this article with your HR and leadership team.
• Review your current claims process and identify gaps.
• Book a demo with Pazcare and experience how claims should really work.