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Claim Procedures

Claim Procedures Under Life Insurance
Under Life Insurance Companies, claims can arise on maturity of policy or death of the policyholder.
The Life Insurance Companies sends intimation at least 2 months before the maturity date. If the notice of maturity is not received and the date of maturity is known to the policyholder, then the policyholder can take the necessary steps to get the due Maturity amount

 

Claims Procedure on Death (accidental or natural)
Intimation about death of policyholder should be given to Life Insurance Companies by any relative/ nominee/ assignee of the deceased policyholder which should contain the information
·Death certificate
·Date, reason & place of death
·Policy Number/s
Claims Procedure on Maturity
On maturity of policy, the policyholder has to submit certain requirements on maturity of the policy
·Submit the policy document (if not in the custody of Life Insurance Companies as security for loan) to the concerned branch office as mentioned on the policy
·Collect discharge form no. 3825, put a revenue stamp & sign it, also get your signature attested by a witness and submit it to Life Insurance Company
·Submit a proof of age document (if age has not been admitted earlier)
·Submit Assignment/ Re-assignment Deed if any
·Existence certificates in case of Children's Deferred Assurance and Pure Endowment policies

 

On Death (accidental or natural)
If the policyholder or Life Assured dies during the term of the policy, a death claim arises. Death claims are of two types

 

Early Death Claim - Claims arising within 2 years after date of risk/ revival/ reinstatement are termed as Early Claims or "Premature Claims".

 

They can be classified into two groups
1.     Those having arisen within 2 years from the date of acceptance or risk or revival
2.     Those having arisen after 2 years but within 3 years of acceptance of risk or revival
 

Non Early Claim - Claims arising more than 2 years after the date of risk/ revival are called as Non-Early Claims. However, the policy should be in force for at least 3 years at the time of death of Life Assured.
For claiming the benefit, the nominee or any person related may apply to Insurance Company and the following requirements are required further for settlement of claim:
·Policy Document
·If death has occured due to an accident, then Police Panchnama & Senior Divisional Manger's verdict are required
·Medical attendants' report (In proforma given by the insurance company)
·Claimants' statement (in proforma given by the insurance company)
·Death certificate
·If the Life assured has been working before his or her death then the employer's certificate for last 5 years relating to leave record along with details of medical leave taken and reasons supported with photocopies of certificates issued by medical practitioner.
The following documents should be submitted if death occurs after 3 years from the date of risk covered
·Policy Document
·Death Certificate
·Documentary evidence of age if the age was not admitted at the time of issuing the policy
·Claimant's statement (Claim Form 'A')
·Evidence of Title to the deceased estate if policy is not nominated, assigned or issued under MWP Act.
·If death is due to an accident the Police Panchnama, Senior Divisional Manager's verdict for claiming Double Accident Benefit
 

Ex-gratia Settlement of Death Claims
Ex-gratia Settlement of Death Claims are not a right claim but on grounds of humanity presently Life Insurance Companies are giving such claim amount for the policies which are not in force but
·If Death occurred after the expiry of grace period of premium due date then Full Sum Assured along with the bonus will be payable as Ex-gratia settlement
·If Death occurred after three months but less than six months after the expiry of first unpaid premium date half of the Sum Assured without bonus will be paid as Ex-gratia
·If the death occurred between six months and one year from the due date of the first unpaid premium date, claim may be considered to the extent of the proportionate notional paid-up value on the basis of actual premium paid.
 

Double Accident Benefit
The Insurance Company is not liable for any loss or damage after the expiry of 12 months from the date of loss unless the claim itself is the subject of pending action or arbitration.
If the insurance company disclaims liability then such claims have to be made the subject matter of a suit in a court of law within 12 calendar months from the date of the disclaimer. In case the dispute refers only to the amount of payment claimed then the matter has to be compulsorily referred to arbitration as per the provisions of the Indian Arbitration Act.