Life Insurance Claim Process

The main purpose of taking an insurance policy is that it should come in use in the times of crises. In this article, we will look at the different types of life insurance claims and how the settlement process works.

Selection of the right policy from a good life insurance company with a healthy claim settlement ratio is the main requirement for buying a life insurance. The main function of an insurance company is to ensure easy and timely settlement of a valid claim in return for the premium paid by the insurer/ policy holder.

Before intimating the insurance company, the nominee/claimant should check some basic facts:

If the insurance policy is active and all the premiums have been paid?
Does the particular situation for which the claim is being made is covered in the policy?
Exclusions of the policy

Death claim settlement process

Step One: Intimation to the insurance company about the Claim

The nominee should inform the insurance company as soon as possible to enable the insurance company to start with the claim process. The details required for intimation are policy number, name of the insured, date of death, cause of death, place of death, name of the nominee etc. The claim intimation form can be obtained from the nearest insurance company branch or even by downloading it from the insurance company website. Alternatively, many insurance companies also have online forms these days on their website for claim intimation.

Step Two: Documents required

The nominee will be asked to furnish the following documents:

Death certificate
Age of the life insured (if not already given)
Original Policy document
Any other document as per requirement of the particular insurer or case related

For early death claims i.e the claim that has arisen within three years of the policy being in force the company will do extra investigation to ensure it is a genuine claim. They might do the following:

Check with the hospital if the deceased was admitted to hospital.
In case of an air crash confirmation from the airline authorities check if the policy holder was a passenger on the plane.
In case of death from medical causes, the insurance company will ask the hospital to provide doctor’s certificate, treatment records etc If the policy holder dies due to murder, suicide, accident then police FIR report, panchanama, post mortem report etc shall be required.

Step Three: Submission of required Documents for Claim Processing

For quicker claim processing, it is essential that the nominee submits complete documentation as early as possible and any other documents that the company needs to pass the claim.

Step Four: Settlement of Claim

As per the regulation 8 of the IRDAI (Policy holder's Interest) Regulations, 2002, the insurer is obligated to settle a claim within 30 days of receipt of all necessary documents including extra documents sought by the insurer. If the claim requires further investigation, the insurer needs to complete its procedures within 6 months from receiving the written intimation of claim.

Maturity & Survival Claims

The payment made by the insurance company on completion of term of policy or maturity date is called maturity payment. The amount payable consists of sum assured plus any bonus/incentives.

The insurance company informs the policy holder in advance by sending bank discharge form for filling details in it. The form needs to be returned back to the insurance company with original policy document, ID proof, Cancelled Cheque and copy of pass book.

Rider Claims:

Different riders can be attached to the base life insurance policy for enhanced protection. The riders can be accidental rider, critical illness rider, waiver of premium rider etc. For different riders, different claim proceedings are required. Some riders may be valid with the death claim like accidental death rider or some riders need to processed standalone like waiver of premium rider in case of disability.

For Critical Illness Rider- necessary medical documents such as first diagnosis report, Doctor’s report, etc are required. For Accidental disability rider - copy of FIR, Certificate of disability by the treating doctor, doctor’s report etc are required.

Conclusion:

In many cases, life insurance claims have been delayed or denied due to lack of proper documentation or simply because the proper claim process was not followed. Hence, it is recommended that the claimant should be aware of the claim process in order to have a hassle-free claim settlement process during the emotionally draining time especially while filing a death claim. Coverfox has taken a great initiative in NASPRO which is specially aimed at assisting nominees to have a smooth claim settlement experience.

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