It started with a simple cold...
Sneha, a graphic designer at a growing tech startup, took a few sick days after a severe flu. When she submitted her hospital bills for reimbursement under her group health insurance, she expected a smooth process.
Instead, she found herself caught in a maze of paperwork, email loops, and follow-ups that lasted weeks. By the end of it, Sneha was more stressed about her claim than her actual illness.
Unfortunately, Sneha’s story is not unique. For many employees across SMEs, claiming insurance feels more like a frustrating battle than a benefit they’ve earned.
In this blog, we break down why the insurance claim process feels broken, and how HR leaders and business owners can fix it.
1. Health Claims: The Endless Waiting Game
What’s happening:
When employees fall sick or get hospitalized, they rely on their group health insurance for quick financial relief. However, the claim process is often filled with long wait times, multiple documentation rounds, and confusing back-and-forths.
Pain Points:
- Complex documentation (hospital bills, doctor reports, claim forms).
- Delays in verification and approvals.
- Lack of real-time updates on claim status.
- Repeated queries from TPAs or insurers.
Why it matters:
A poor claims experience reduces employee trust in their health benefits. Over time, this leads to:
- Lower satisfaction scores.
- Negative employer branding.
- Higher attrition rates.
What HR can do:
- Partner with insurers offering app-based claims tracking.
- Provide employees with pre-filled forms and claim checklists.
- Organize awareness sessions during onboarding and renewals.
2. Work Accidents: Claims That Never Get Filed
What’s happening:
In industries like manufacturing, logistics, or field services, employees often encounter minor injuries or workplace incidents. While insurance exists to protect them, many don’t even attempt to file claims.
Why claims go unfiled:
- Employees don’t know what’s covered.
- They fear the paperwork or retaliation.
- HR teams may not proactively guide them after incidents.
Key Stat: Up to 25% of eligible workplace accident claims go unreported due to process intimidation or lack of awareness.
Why it matters:
When employees don’t claim, they absorb the cost personally, hurting morale and creating compliance risks for the company.
What HR can do:
- Build an incident reporting culture.
- Keep claim forms accessible and easy to understand.
- Ensure managers know how to support employees post-incident.
3. Legal Insurance: A Hidden Safety Net
What’s happening:
Some advanced group insurance plans offer legal coverage, protecting employees in case of harassment complaints, wrongful termination, or contractual disputes.
Why it gets missed:
Employees and even HR often don’t realize that legal insurance is part of their policy. Those who do may feel nervous using it, fearing HR or company backlash.
Opportunity for SMEs:
Use legal insurance as an employee empowerment tool. Transparency here builds a culture of fairness and trust.
What HR can do:
- Share easy guides on what legal insurance covers.
- Partner with insurers who offer anonymous access to legal consultation.
- Assure employees that using this benefit won’t affect internal performance records.
4. Why Does Claiming Insurance Feel So Hard?
Root Causes:
- Complexity: Insurance jargon and long forms make it overwhelming.
- Lack of clarity: Employees don’t know what’s required or what’s missing.
- Fear of rejection: Many assume they’ll be denied reimbursement.
- Insufficient HR bandwidth: In SMEs, lean HR teams may not handhold employees through claims.
Result:
Employees either give up halfway or never start the process at all. That’s a loss for the employee and for the employer’s investment in insurance.
5. How HR & SMEs Can Simplify the Claims Experience
Simplify the flow
- Create and circulate step-by-step infographics for claim filing.
- Highlight do’s and don’ts on internal HR portals or Slack.
Digitize the journey
- Work with insurers that offer mobile-friendly claim submission.
- Use employee benefits platforms that offer one-click document uploads.
Communicate regularly
- Host Q&A sessions after policy renewals.
- Celebrate successful claims stories in newsletters.
Assign HR touchpoints
- Nominate an HR benefits champion for queries.
- Maintain a response time promise for claim escalations.
Review and refine
- Send out pulse surveys on claim experiences.
- Use insights to improve provider partnerships or switch TPAs.
How Pazcare Is Making Insurance Claims Easier
Pazcare is transforming the way SMEs and startups approach employee insurance. With a tech-first platform and human-led support, it ensures that employees not only understand their benefits, but actually use them.
How Pazcare helps:
- Claim support on chat, call, or WhatsApp.
- Mobile-first claim submissions with real-time status tracking.
- Dedicated claim assistance from onboarding to settlement.
- Custom HR dashboards for tracking usage, claims, and approvals.
CTA: Want to simplify insurance claims for your team? Book a demo with Pazcare and discover how easy claiming insurance can actually be.
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