LIFE

• Claim Settlements
• Hints on Proposal Forms
  
• Nomination
  
• Revival of Policies
  
• Loan on Policies
  
• Lost Policies
  
• Tax Benefits
  
• Surrender Value
  
• Assignment
  
• Delayed Payment of Premiums
  
  
  NON-LIFE
  
• Claim Settlements
  
• Hints on Proposal Forms
  
• Legal Aspects
  
• Guide
  

Claim Settlements

The settlement of a claim arises due to Death of the Policyholder or due to Maturity of the Policy.

Death Claim

• In respect of a death claim an intimation regarding death of a policyholder from a relative / nominee / or assignee is to be received.

• The facts required to be submitted are:

  1. Date of death,

  2. Reason and Place of Death,

  3. Full details of policies held by the Life assured should also be submitted.

Death claims are categorized as Non-Early Death claims and Early Claims. The procedure for processing these claims is different.

Non-early Death Claim:

Non-early Death Claims refer to death of the Life assured occurring after 3 years from the date of commencement of policy or Date of last revival / reinstatement

If the policy is in force till death by regular payment of premiums, full sum assured is payable along with bonus (if it is a with profit policy).

The following are the requirements for the settlement of the death claim:

• Policy Document

• Death Certificate from the appropriate authority

• Legal evidence of Title, if the claimant is not an assignee / nominee

• Abridged claim Form (3783/A)

• Discharge Form in 3801, duly signed

• Assignment / Reassignment deed, if any

• Age proof, if age is not already admitted

Once these documents are received and if they are found in order, claim is settled and payment is made to the person entitled to.

Early Claims:

Early Claims refer to the death of Life assured occurring within 3 years from commencement of policy.

The following forms are to be submitted duly completed:

• Claim Form B: Statement from the medical attendants who last treated the deceased Life assured.

• Claim form B1: certificate of treatment issued by the hospital authorities where the deceased was treated last.

• Claim form E - certificate by the employer if the deceased was an employee.

• Claim form C - certificate of burial/cremation signed by a person who attended the funeral of the deceased.

• Where death takes place due to accident, the death has to be reported to the police and a FIR (First Information Report), police inquest report, and postmortem report (if conducted only) are to be submitted.

• Wherever death takes place within 2 years from Date of commencement an enquiry is conducted to determine the genuineness of claim.

On the basis of these, the decisions to settle accidental benefits are taken.

Maturity:

If the life insured survives to the full term, then basic sum assured is payable. This payment by the insurer to the insured on the date of maturity is called maturity payment.

In majority of the plans, full sum assured becomes payable along with Bonus as a maturity payment, unless survivals benefits are paid earlier as in a money back policy.

At least 2 months before maturity date, information is sent to the life assured with a blank discharge form for signature & completion by him. It is to be returned to the office along with:

• Original Policy document

• Age proof if age not already submitted

• Assignment /reassignment, if any.

Postdated cheques are submitted to the Life Insured on receipt of the above mentioned requirements.

Certain Relaxations in Settlements of the claims:

Legally no claim is acceptable in respect of a lapsed policy or death of the Life assured occurring within 3 years from the date of commencement of the policy. However, some concessions are available and payment of claims are made -

• If the Life assured had paid at least 3 years' premiums and thereafter if premiums have not been paid, the nominees get proportionate paid up value.

• In the event of the death of the Life assured within 3 years and the policy is under the lapsed position, nothing is payable.

Other concessions are:

If minimum 2 years premiums are paid and if death of Life assured occurs :

1. Within 3 months from the Date of first unpaid premium

   Full sum assured along with bonus is payable subject to recovery of the premium already fallen due and the premium that falls during the policy anniversary.

2. Between 3 to 6 months from fully unpaid premium

   Only 50% of basic sum assured is payable. No bonus is paid and no arrears of premium are received.

3. 6 months to 1 year from fully unpaid premium

   Only notional paid up value is given.