How to make an insurance claim in Nepal

Notify the insurer immediately, and do it in writing even if you also telephone. Late notification is one of the leading reasons Nepali claims are refused, and it is entirely avoidable. A message or email on the day of the event, saying what happened and when, protects the claim even if you have none of the other details yet.

Get a claim reference number and write it down. Everything that follows attaches to it, and a claimant who can quote a reference gets a materially different quality of response from one describing an incident from memory.

Report to the police where the event requires it. Theft, burglary, road accidents, fire and any event involving injury or a third party generally need a police report, and insurers will ask for it. Making the report immediately is easier than explaining a delay, and a report filed days later invites questions about why.

Photograph everything before anything is moved, repaired or cleaned up. Damage, the scene, the surrounding context, vehicle positions, and the date if your device records it. This is free, takes two minutes, and is the evidence most often missing when a claim is disputed. A cleaned-up scene is an uncontestable loss of evidence.

Do not repair, replace or dispose of anything before the insurer has assessed it. This instinct is strong — a damaged shop wants to trade, a damaged vehicle wants to be driveable, a family wants the mess gone — and acting on it before assessment can compromise or destroy the claim. If emergency repairs are unavoidable for safety, photograph first and tell the insurer what you did and why.

Take reasonable steps to prevent further loss, because policies generally require it. Securing a damaged property, turning off a water supply or moving undamaged stock away from water is expected of you, and doing nothing on the basis that the insurer will pay for it all is a misunderstanding of how cover works.

Find the policy document and read it before you speak to anyone at length. What is covered, what is excluded, the sum insured, any excess, and the notification and documentation requirements. Claimants who have read their own policy have far better conversations than those who have not.

For most non-life claims of any size, the insurer appoints a surveyor to assess the loss. Surveyors in Nepal are licensed and regulated by the Nepal Insurance Authority, which maintains licensing and renewal arrangements for them — this is a regulated function, not an informal inspection by someone the insurer knows.

Understand what the surveyor is and is not. They are assessing what happened, whether it falls within the policy, and what the loss is worth. They are not deciding your claim as an adjudicator and they are not your representative. Being cooperative and organised with a surveyor is straightforwardly in your interest; treating them as an opponent is not.

Be present for the survey if you possibly can, and bring your documents. A survey conducted with the policyholder present, able to explain what was where, what it cost and when it was bought, produces a more accurate assessment than one conducted in their absence from whatever remains visible.

Provide evidence of value, not just of loss. Purchase invoices, bank or card records, warranty documents, photographs of items in use before the event, and stock or inventory records for a business. A claim for something whose existence and value cannot be evidenced is a claim that will be assessed conservatively, and conservatively means low.

Ask for a copy of the survey report. Whether you are given it depends on the insurer and the type of claim, but asking is legitimate and the report is the basis of the settlement offer. Being told what the report concluded rather than seeing it puts you at a considerable disadvantage in any subsequent discussion.

Understand depreciation, excess and the sum insured, because these three between them explain most of the gap between what claimants expect and what they are offered. Settlements on damaged property frequently reflect depreciated value rather than replacement cost; an excess is deducted; and a sum insured that was set low, or never updated as values rose, caps what can be paid however large the loss.

Do not inflate. Adding items that were not lost, or values that were never paid, converts a legitimate claim into a fraudulent one, gives the insurer a reason to repudiate the whole thing rather than negotiate part of it, and in serious cases has consequences beyond the policy. The temptation is highest where the claimant feels the deductions are unfair — which is exactly when it does the most damage.

Non-disclosure at proposal stage is the most damaging, because it can void a policy years after it was written. Insurance is priced on the information given, and a material fact that was not disclosed — a health condition on a life or health proposal, a prior loss, the actual use of a vehicle, the real nature of a business — allows an insurer to challenge the contract itself rather than merely the claim.

Lapsed premium is the most avoidable. A policy on which the premium was not paid within the permitted period may not be in force at the moment of loss, and families discover this at the claim. Set a reminder independent of the insurer's, and confirm renewal rather than assuming an unpaid reminder means nothing happened.

Exclusions are the most predictable. Every policy excludes categories of loss and every policyholder is entitled to read them before buying. Common ones people are surprised by include wear and tear, pre-existing conditions, certain natural events unless specifically added, business use of a private vehicle, riding without a valid licence, and cover that stops at a geographic boundary.

Late notification and missing documents are the most fixable, and they are the reasons within your control on the day. Everything in the first section of this guide is about these two.

Under-insurance is the quietest. Where a property or stock is insured for less than its value, a settlement may be reduced proportionately even for a partial loss — so a shop insured for half its value can find a partial claim halved. This affects households who insured a building years ago and never revised the sum insured.

Cause-of-loss disputes are the hardest. Whether damp damage was a sudden escape of water or long-term deterioration, or whether an illness began before the policy started, are genuinely contestable questions, and this is where contemporaneous evidence — dated photographs, maintenance records, medical records — decides the outcome.

The pattern across all of these is that most claim outcomes in Nepal are determined at purchase and in the first hours after a loss, not during the negotiation everyone remembers. That is unwelcome, because the negotiation is the part that feels consequential, and it is the part where least can still be changed.

Life insurance claims are documentation-heavy and are made by people who are grieving, which is a bad combination. The documents come from other institutions — the hospital, the ward office for death registration, the district office for identity documents, and the police where the death was unnatural — and none of them move quickly. The single most useful thing a policyholder can do is tell the family the policy exists and where the document is; policies that nobody knows about are simply never claimed.

Where a death occurs abroad, the document chain lengthens considerably and involves the Nepali diplomatic mission and attestation. Start it early and expect it to take much longer than a domestic claim.

Health insurance claims turn on whether treatment was inside or outside the insurer's network and whether it was pre-authorised. Establish before treatment, not after, whether the hospital bills the insurer directly or whether you pay and reclaim, because those are different cash-flow situations for a household. Emergency admissions have their own notification requirements and these are frequently tighter than people expect.

Pre-existing conditions are the central battleground in health claims everywhere, and Nepal is no exception. The defence against a dispute is disclosure at proposal stage and a medical record that establishes when a condition actually began. This is another instance of a claim being decided years before it is made.

Travel and trekking cover carries specific traps in Nepal, particularly around altitude limits, adventure activity exclusions and helicopter evacuation. Evacuation cover in particular is frequently subject to conditions about who authorises the evacuation and whether it was medically necessary, and there is a well-documented history of unnecessary evacuations in Nepal that has made insurers considerably more rigorous about verification.

Motor claims are the most common and the most procedural. A police report, the driver's valid licence, the vehicle documents and prompt notification are the basics, and driving without a valid licence or under the influence will generally take a claim outside cover entirely regardless of who caused the accident.

For any claim involving a third party — someone else injured or their property damaged — do not admit liability or agree a private settlement before speaking to the insurer. Doing so can prejudice the cover you have paid for, and the instinct to settle quickly at the roadside is strong.

Get the refusal or the offer in writing, with reasons. A verbal 'this is not covered' is not something you can escalate. A written decision identifying the policy clause relied on is, and insurers are far more careful about what they write than about what they say.

Read the reason against your own policy document. A surprising number of disputes resolve at this point, either because the clause does not say what the insurer says it says, or because it does and the claimant now understands why. Both outcomes are better than an unresolved grievance.

Use the insurer's own complaint route first and in writing, addressed above the person handling the claim. Keep the claim reference on everything and keep the thread. Most insurers resolve a proportion of disputed claims internally once a complaint is formally on the record.

Escalate to the Nepal Insurance Authority if the insurer does not resolve it. The Authority is the regulator of insurers, intermediaries and surveyors under the Insurance Act, 2079, publishes the directives and circulars insurers must follow, and publishes enforcement action it has taken. Its province offices mean the escalation is not exclusively a Kathmandu matter.

Frame the escalation around conduct and the policy terms, not around hardship. Regulators act on whether a regulated entity followed the rules and the contract. The hardship is real and it is not the lever; the clause, the directive and the timeline are.

Assemble a clean file before escalating: the policy document, the proposal form, premium receipts, the notification you sent and when, the claim reference, the survey report if you have it, the correspondence, and the written refusal. A complaint that arrives complete is acted on faster than one that generates three requests for documents.

Consider legal routes for significant sums, and get advice on whether the amount justifies it. Nepal has free legal aid arrangements for those who qualify, and mediation is a realistic option for disputes where litigation would cost more than the claim is worth.

Complete the proposal form yourself, and read every answer before signing. Agents in Nepal routinely fill these in for the client as a convenience, and an inaccurate answer written by someone else is still your answer at claim time. This is the single most common origin of a voided policy.

Get the policy document, not just a receipt, and read the exclusions section specifically. If you read nothing else in the document, read what is not covered. Twenty minutes here prevents most of the disappointment described in this guide.

Check the sum insured against current value, and revisit it. A building insured for what it cost to build a decade ago, or stock insured at last year's level, produces under-insurance that reduces even partial claims. This is a five-minute annual check that nobody performs.

Verify the agent and the insurer are licensed. The Nepal Insurance Authority publishes information on insurers and on intermediaries, and premiums paid to someone who is not a licensed intermediary may not reach the insurer at all. Ask for a receipt issued by the insurer rather than by the individual.

Keep the documents where the family can find them, and tell them the policy exists. This applies to life insurance most acutely, but it applies generally: policies are claimed by families who know about them and are quietly abandoned by families who do not.

Set your own renewal reminder rather than relying on the insurer's. Lapsed cover is the avoidable failure that hurts most, because the policyholder believed they were insured throughout.

Finally, be honest about what insurance is for. It transfers a loss you could not absorb, and it is not a savings scheme or a way to come out ahead. Buying cover for small, affordable losses while leaving the catastrophic risk uninsured is the most common structural error Nepali households make with insurance, and it is a decision taken at purchase rather than at claim.