Real claims scenarios

Health

Scenario 1: Pre-Authorization of a Medical Procedure - Direct Payment to Medical Facility

April 12

Client Contacted Guardian Insurance MX

Client contacted Guardian Claims Department to inform us of a necessary surgery and requested pre-authorization and for the insurance provider to pay the expenses directly to the facility.
Guardian Claims Department contacted the insurance company to inform them of this and to ask what documents we needed to provide.
The insurance company replied to Guardian Claims Department with the list of the necessary info to proceed with the pre-authorization of the procedure. This info included medical notes on the condition, the medical order from the doctor, the date and place of the procedure, and a medical fees breakdown (surgeon fees, anesthesiologist fees, assistant surgeon fees).

April 27

Client sent documents

The client sent all documents that were requested to our Guardian Claims Department, but the expense breakdown was missing. We requested that from the client again.

May 3

Client sent us the expense breakdown

Client sent us the expense breakdown.
The insurance company requested further information (MRI and a medical report including info of the beginning of the medical issue, including date of first diagnosis, etc.).

May 5

Client submitted MRI

Client submitted MRI and medical report, but it was missing a doctor’s signature and some other information, so we requested that from the client

May 11

Client sent medical report

Client sent the complete medical report with the doctor’s signature and missing info

May 13

All information submitted

With all information submitted, the insurance company sent the Guarantee of Payment Letter.

May 13

Client had successful surgery

The client had successful surgery, which was paid directly to the facility by the insurance company.

Total amount paid directly to hospital: $35,935.82 USD

Total claim processing time: 33 days

Scenario 2: Reimbursement after meeting deductible

June 11

Guardian Claims Department received the medical report, doctor’s prescription, and payment receipt from the client.

June 14

Guardian Claims Department sent the documents to the insurance company.

June 21

The insurance company replied confirming receipt of the documents.

July 14

The insurance company reimbursed the prescription medication expenses in full to the client.

Total Amount Reimbursed to Client: $7,628 MXN ($382 USD)

Total claim processing time: 33 days

Scenario 3: Applying Expenses Toward the Annual Deductible

August 17

Client suffered a minor accident and sent Guardian Claims Department the necessary documents, including payment receipts, itemized bills and medical records.
Guardian Claims Department sent that documentation to the insurance company.

August 26

The insurance company confirmed receipt of the documents.

September 2

The insurance company notified Guardian Claims Department that they are missing the hospital intake form. Guardian Claims Department contacted the client regarding this.

September 8

Client sent Guardian Claims Department the intake form, which was then forwarded to the insurance company.

September 10

The insurance company confirmed receipt of the intake form.

September 13

Claim is processed and applied towards the client deductible.

Total Amount Applied Towards Annual Deductible: $2,867 USD

Total claim processing time: 26 days

Tourist and Resident Auto

Scenario 1: Collision insured at fault.

January 26th

at 2:52 pm

The insured contacted Guardian Claims Department. Informed of having an accident with a bus.
Guardian Claims department called the insured and requested a description of the event, his location, and other required information to proceed with making the report to the insurance company

January 26th

at 2:55 pm

Guardian Claims department calls the insurance to inform them of the insured’s accident. The insurance company takes the information and creates the report number.

January 26th

at 3:08 pm

The insurance company sends an adjuster to the insured location.

January 26th

at 3:43 pm

Adjuster arrived at the insured location.

January 27th

Guardian claims department contacts the insured to ask about the resolution to his accident. Since the insured was at fault the adjuster gave a pass to the third party for his repairs and well to our insured.

February 7th

Insured visits Guardian insurance office and confirms having his car repaired without issues.

Total time for an adjuster to arrive since the report was made: 35 min

Scenario 2: Collision Insured affected.

January 26th

1:59 pm

Insured contacts the Guardian Claims department through WhatsApp mentioning he was just in an accident.

January 26th

at 3:08 pm

The insurance company sends an adjuster to the insured location.

January 26th

at 3:43 pm

Adjuster arrived at the insured location.

January 26th

2:59 pm

Adjuster arrives at the insured location.

January 26th

3:19 pm

Adjuster makes an agreement with the third party which had to pay the costs of damages. The Insured receives an admission note for his vehicle to be paid without a deductible.

February 9th

Insured confirmed his vehicle had been repaired without issues.

Total time for an adjuster to arrive since the report was made: 35 min

Property

Scenario 1: Theft

February 16th

Insured contacts Guardian Claims department to inform he suffered a robbery the night before. The Guardian Claims department takes the necessary information and files a report with the insurance company.

The Insurance company assigns an adjuster and makes an appointment with the insured to visit his home for an inspection.

February 18th

Adjuster does inspection at insureds property. After the inspection, he sends an email to the insured copying Guardian claims department with the next instructions and documents needed to proceed with the claim.

March 5th

Insured finishes recollecting the full documentation to proceed with the claim and sends to Guardian Claims department that reviews confirming everything is in order and forwards it to the insurance company

March 6th

The insurance company confirms receiving the documents and begins reviewing them.

March 13th

The Insurance company sends an agreement for the insured to review with costs approved and what would be paid. The insured reviews the information and signs the agreement. March 22nd- The insurance company makes payment to the insured.

March 22nd

The insurance company makes payment to the insured

Total claim processing time: 34 days