The simple and
timely settlement of a valid claim is an important function of an insurance
company. The parameters to judge an
insurance company’s efficiency is to check the past history of settlements of
valid claims. The timely settlement of
claims with kindness and fairness shows the maturity of the company and may
lead to great satisfaction of the client.
The main job of the company is not only to insure but more than that it
is the immense responsibility of the company to honour valid and legal claims, also
to identify the fraudulent and invalid claims.
The situation to
file a claim may arise in the following conditions:
a) On death of
Policyholder before the maturity date.
b) On maturity,
i.e. after expiry of the endowment period specified in the policy contract when
the policy money becomes payable.
A few points are
common to claim all life insurance policies are:
1. Policy must be
in force at the time of claims.
2. Insured must be
covered by the policy.
3. Nothing was
outstanding to the insurer at the time of claim.
4. Claim is covered
by the policy.
DEATH CLAIMS
On the event of
mishappening, the death of the life assured has to be intimated in writing to
the insurer. This can be done by the
nominee or from any person or by agent or development officer.
Sometimes, the office need not wait till the
intimation of claim is received. The concerned agent, newspaper reports in case
of accidents or air crashes, obituary columns may give information and claim
action can be started. However, the identity of the deceased should be
established carefully.
The intimation of
the death of the life assured by the claimant should contain the following
particulars: (i) his or her relationship with the deceased, (ii) the name of
the policyholder, (iii) the number/s of the policy/policies, (iv) the date of
death (v) the cause of death and (vi) sum assured etc.
The following
documents are required:
(i) Certificate of
death. (ii) Proof of age of the life assured (if not already given). (iii)
Deeds of assignment / reassignments.
(iv) Policy document. (v) Form of discharge.
If the claim has
accrued within three years from the beginning of the policy, the following
additional requirements may be called for:
(i) Statement from
the hospital if the deceased had been admitted to hospital.
(ii) Certificate of
medical attendant of the deceased giving details of his/her last illness.
(iii) Certificate
of cremation or burial to be given by a person of known character and
responsibility present at the cremation or burial of the body of the deceased.
(iv) Certificate by
employer if the deceased was an employee.
Proof of death and
other documents to be submitted will depend upon the cause of death and
circumstances of each case.
If by any chance
policy contract is lost, advertisement of the lost of policy is to be given.
Payment can be made on the basis of an indemnity given by the policyholder. If
the deceased has taken out policies with more than one branch and the claimant
has produced proof of death to any one of them and desires that the other
branch or branches, may act on the same proof, his request should be complied
with. The Branch requiring proof of death should directly call for the
certified copies from the branch concerned.
In the case of ‘in
force’ policy unpaid premiums if any due before the Assured’s death with late
fee where necessary and the premium falling due in the policy year current at
the time of death should be deducted from the claim amount.
MATURITY CLAIMS
If the life insured survives to the full term, amount payable at
the time of the maturity includes a sum assured and bonus/incentives.
The insurer sends in advance the intimation to the insured with
a blank discharge form for filling various details in it. It is to be returned
to the office along with (i) Original Policy document (ii) Age proof if age is
not already submitted (iii) Assignment /reassignment, if any.
Legally no claim is
acceptable in respect for a lapsed policy or death of the Life assured
happening within 3 years from the date of beginning of the policy. However,
some concessions are given and payment of claims is made:
(i) If the Life
assured had paid at least 3 years' premiums and thereafter if premiums have not
been paid, the nominees/life assured get proportionate paid up value.
(ii) In the event
of the death of' the Life assured within 3 years and the policy is under the
lapsed position, nothing is payable.
Presently, all over
the country there are 12 centers where the Insurance Ombudsman has been
appointed. They are part of grievance redressal machinery. They consider the
complaints regarding disputes related to premiums, claims etc.
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