Claim Settlement Process in Life Insurance

By purchasing life insurance policies, you are augmenting the financial security of your family. Moreover, life insurance policies are quintessential in clearing off your debts/liabilities in your absence, without stretching your family’s financial status. Thus, you should opt for a life insurance policy with a high claim settlement ratio because a higher claim settlement ratio will not only ensure your family’s financial security but also makes the claim process hassle-free. But very often, people have the fallacy that settling down claims is the only responsibility of the insurer. But you should remember that policyholders also contribute a pivotal role in simplifying the process.

It would be prudent to choose an insurer with a healthy claim settlement ratio while purchasing life insurance plans. This is because the prime function of an Indian insurance company is to ensure easy and timely settlement of a valid claim against the premiums paid by policyholders.

Before informing the insurance company, the nominee/beneficiary should check some imperative facts

  • Whether the insurance policy is active and all the premiums have been cleared?
  • Does the situation for which the claim is filed be covered under the policy?
  • All the exclusions of the policy

 

Let’s take a look at some simple steps that will guide you regarding the death claim settlement process.

Intimate the insurer about the claim on time

The beneficiary should inform the insurance company as early as possible to initiate the claim process. The beneficiary needs to submit the details including, policy number, name of the insured policyholder, date of death, the exact cause of death, place of death, name of the nominee, etc. The nominee can get the claim intimation form by visiting the nearest branch of the insurance company or downloading it from the insurer’s official website. In this digital-driven era, many insurance companies are offering online claim forms on their websites so that nominees can fill and submit them as soon as possible.

Keep all documents organized

After informing the insurance company, you need to arrange and submit certain documents. Keep all imperative documents properly because if anything goes missing while making a claim, it may take longer to settle the claim.

Documents required

The beneficiary/claimant needs to submit the following documents:

  • Death certificate of the insured policyholder
  • Age of the life insured (if not already given)
  • Original documents of the policy
  • Any other document as per the requirement of the insurer

 

For early death claims (the claim that has been initiated within three years of the insurance policy being in force), the insurer will do some add-on investigations to ensure whether it is a genuine claim or not. For example, the insurance company might do the below-mentioned things.

  • They might visit or check with the hospital to confirm whether the deceased was admitted to the hospital or not.
  • In case of an air crash, they might check with the airline to confirm whether the policyholder was traveling on the plane or not.
  • If the insured policyholder dies due to medical issues, the insurer will ask the hospital to submit the doctor’s certificate, treatment records, etc. If the policyholder expires due to murder, suicide, or an accident, the company will ask for the police FIR report, panchnama, post mortem report, etc.

 

Submit all the documents

The beneficiary should submit all imperative documents as early as possible to make the claim hassle-free and faster.

The final claim settlement by the insurer

According to regulation 8 of the IRDAI (Policy holder’s Interest) Regulations, 2002, the insurance company is mandated to settle a claim within 30 days on receipt of all necessary documents by the beneficiary. If the insurer needs further investigation, it must complete the entire procedure within 6 months after receiving the claim intimation.

Important things to remember before requesting for the claim process

  • Read your policy carefully: Read your life insurance policy plan carefully to understand its inclusions and exclusions. You should have an adequate idea about the do’s and don’ts while making a claim.
  • Understand the claim settlement process: As an esteemed policyholder, it’s your responsibility to understand the claim settlement process to arrange all the required things associated with it.
  • Update your policy timely: Always update your insurance policy to portray all the latest information. If you need to change the nominee’s name or address, inform your insurer about the same.
  • Educate the nominee about your plan: You must inform and educate your beneficiary about the policy terms and conditions. He/she should have a sufficient idea about the premium amount, policy period, the sum assured, and inclusions and exclusions of the policy.

 

Maturity and survival claims

Maturity payment is the payment made by the insurance company after the completion of the policy term. The insurer offers the sum assured along with bonuses/incentives. The policyholder needs to submit the bank discharge form (properly filled up) along with the original policy document, ID proof, canceled cheque, and copy of the passbook.

Rider Claims

You can incorporate various riders into your base insurance policy to improve your protection and coverage. Some common riders are the accidental rider, critical illness rider, waiver of premium rider, etc. Different riders have different claim settlement processes. For example, some riders, like accidental death riders, may be valid with the death claim, while other riders (the waiver of the premium rider) can be processed separately.

For critical illness riders, the policyholder needs to submit necessary medical documents like the first diagnosis report, doctor’s report, etc. For an accidental disability rider, a copy of FIR, disability certificate by the treating doctor, doctor’s report, etc., are mandatory.

Sometimes, insurance companies often deny or delay the claim settlement processes because of improper or lack of documentation. Some insurers have a poor claim settlement ratio, and thus, they don’t follow the proper claim settlement process. So, it is recommended that the policyholders have adequate knowledge about the claim settlement process and go with an insurer with a wholesome claim settlement ratio.

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