In a frantic pace to expedite action on claims settlement, the Nigerian insurance industry is harmonising the minimum documents required for processing different classes of claims.
Delayed and non-payment of claims by insurance companies in Nigeria will soon disappear into thin air as insurers in the country are perfecting measures to rectify the anomaly. They are presently working to set the minimum documents to be requested for different classes of business for quick claims processing and payment.
In insurance, claims payment is the money the insurance company pays to a policyholder (or a third party) after a claim is approved. When something bad happens that is covered by insurance, like a car accident, hospital cost or home damage, the policyholder files a claim. If the insurer reviews it and agrees that it is valid under your policy, they make a payment to you, the healthcare provider or whomever else needs to be paid to settle that cost.
The typical claims payment process usually works step-by-step. For example, when something happens that is covered by the insurance policy (like an accident, fire, theft, etc.), the policyholder or the provider, like a hospital, submits a claim to the insurance company, showing what happened and how much money is involved. Usually, supporting documents like bills, reports, and photos are needed.
The insurance company would review it; check if the claim matches the terms of your policy. They might ask for more information, do investigations, or even send an adjuster to inspect damage for a car or house claim. If everything checks out, they approve the claim. Sometimes, they approve part of it. If not, they deny it and tell you why. Once approved, the insurance company sends the payment. It might go directly to you for things like personal injury or reimbursement, or to a service provider like a hospital, mechanic, or contractor. In some cases, one may have to pay a deductible – your share of the cost – before you get the insurance pays. Afterward, the claim is officially closed.
For example, during a health insurance claim payment due to a fall that led to a broken arm, where the injured had to go to the doctor for treatment, the hospital will send the treatment bill directly to the health insurer or the company; this is called a cashless claim. If the bill had been paid by the insured, such as doctor’s notes, receipt and prescriptions would be sent for a reimbursement.
The insurance company will check if your policy covers broken bones, hospitalisation, X-rays, etc. If your policy covers the illness and you already paid average treatments, and everything is valid, the insurance company approves the payment.
However, there are delays or rejections in claim payment due to one or more reasons like:
• Wrong details – if the details are incorrect or missing, such as the wrong account number, wrong contact information or wrong hospital bill, the insurer may delay the claim or reject it entirely.
• Incorrect coverage – the claim must be for something your policy covers. If you file a claim for an “excluded” incident (not covered), they can deny it. For instance, if the accident was your fault and your policy doesn’t cover it, the claim might be rejected.
• Missed deadlines – most policies have deadlines for filing claims. This can be within days or weeks of the incident, like filing within 7–14 days. If you miss this, the insurer may not accept the claim.
• Lack of proper documentation – failing to provide documents like photos, receipts, police reports, or the right medical papers can result in rejection or request for more info, thus delaying the claim.
• Fraud or suspicion – if the claim looks suspicious or isn’t proven well, the company might deny it or demand further investigation.
• Deductibles – if your policy has a deductible (the amount you pay before insurance pays), and your claim doesn’t go over this limit, they may not pay anything.
To reduce the chances of delay or rejection, you can:
• Notify the insurance company quickly. To speed up claims payment, the insurance company must be informed about the event as soon as possible. Many insurers have a 24–48 hour rule, especially for emergencies. Completing the paperwork properly by filling out the claim form carefully, double-checking your name, dates, policy number, and all event details before submitting can speed up claims payment.
• Endeavour to send all the required documents. Always attach everything with a soft- or hard-copy like reports, ID photos – in one go to avoid back-and-forth follow-up requests. Stick to the correct process, like using a listed hospital for a cashless claim or getting pre-approval for surgeries when needed. Always keep copies of what you submit. If something gets lost, you can resend quickly without starting from scratch. After submitting, follow up politely if you don’t hear anything within their promised time frame.
• Use online portals. Many insurers have apps or websites where you can track your claim status live. It is faster than waiting for phone or email updates. Be honest and clear: Give true, straightforward information. If the insurer feels something is unclear or suspicious, they will slow everything down.
Interestingly, the Nigerian Insurers Association (NIA) is working assiduously to simplify the whole process of speedy claims payment. The Chairman of NIA, Mr. Kunle Ahmed, at a quarterly media chat, said the technical committee of both the insurance body and the Nigerian Council of Registered Insurance Brokers (NCRIB) is currently in the works to set the minimum documents to be requested for different classes of business for quick claims processing and payment.
Mr. Ahmed, who presented the insurers’ body as a plug-in to ease claims payment, said, “We are trying to harmonise that process as an industry item, the number of documents required.” He explained that the industry has come to the acceptable clarity that it was time to have an industry restriction on the minimum documents required for claims to be paid as an industry standard.
He said this point was reached not because the industry was looking for a vent to push claims settlement to policymakers, but to reach the point where valid claims are logged with ease and paid in the shortest possible time. Noting that the history of claims payment has been registered as an industry obligation, he cited the claims payment record of 2023, when the industry recorded a premium income of N1.1 trillion and paid N536.5 billion as claims, translating to 53 percent of the premium received.
“Despite the quantum of claims paid, we still believe we have not done well especially if you assess the ease of making claims and the timely payment of those claims. The hallmark of any insurance company worth its license is the timely payment of claims. So that is why there is a lot of brainstorming now to ensure policyholders and the general public get provision that meets the insurer must pay the claim when the risk crystallises.
“Also, based on the requirement of the anti-money laundering regime, there are some delays associated with that, and those should no longer be hoarded as burdens arising as companies throw insurance users into that circumstance.
“In bringing to bear a new insurance journey and the speed at which claims are paid, what we are trying to see as a structure of the insurance industry now is to have a set policy where once a claim is triggered, the client, the broker, the insurer, or the bank are all clear on the expectations of what the client must provide. Whether the insurance is for goods in transit, a hospital bill or fire and burglary, we must have clarity,” he said.
As a support to the harmonisation agenda, the NIA has also invested in the industry database – NIID – which allows insurers to access claims history and check duplications or trends. This digital approach not only speeds up claims payment but also helps reduce fraud.
The reforms and efforts by NIA are timely and laudable. The move to harmonise the documents and expectations for claims settlement is a big leap forward. It brings relief to policyholders who have experienced long wait times and frustrations while making claims. It also puts pressure on insurance companies to be more efficient and transparent.
The process of digitalizing the insurance industry and making the process a click-button affair seems to be the focus of the new dispensation at the NIA.
There is a help desk handling claims issues on the association’s website (NIA.COM) and that of the regulator (NAICOM on its website). Ahmed said, he has the comfort to publicly offer the website, telephone lines, email box for complaints. He noted that claims issues have remained a zero tolerance and guiding objective of his administration.
However, he said some complex claims have faced setback, but reviews are still ongoing to examine the reasons and make better provisions. He said this will be central to their renewed partnership with the regulator, NAICOM. In the current era of digital transformation, insurers have no excuse for delays. With a strong unified framework being worked on by the NIA and with NAICOM united on the front, the claims settlement process will reach a top place in the customer value chain and NAICOM will send it updates to the listed their website.
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