Claim Settlement - Life Ins

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Life insurance claim settlement: #illing - documentation
Selection of a proper life insurance policy is a $asic re.uirement of indi/idual

s ris0
management policy. 1t the same time proper claim settlement is also an important part of the ris0
management system.
Selection of a proper life insurance policy is a $asic re.uirement of indi/idual

s ris0
management policy. 1t the same time proper claim settlement is also an important part of the ris0
management system. 1 claim is the payment made $y the insurer to the insured or claimant on the
occurrence of the e/ent specified in the contract& in return for the premiums paid for the insured.
+he easy and timely settlement of a /alid claim is an important function of an insurance company.

In this article we ha/e discussed different types of life insurance claims the settlement process of
that.
1 claim may arise in three $asic conditions:

+he Claimant should loo0 a$out the following points $efore intimate a claim:
2hether the policy is in force3
2hether the policyholder has performed his part3 - +he policy status with regard to payment of
premium& age admission& outstanding loan - interest if any& legal restrictions if any.
2hether insured e/ent has ta0en place3
2hat are the o$ligations assumed under the contract3
Is there any assignment done under the policy3
2hether all the premiums are paid3
Claim Settlement )rocess: 4eath Claim
Step 5ne: Intimation of Claim
+he claimant must su$mit the written intimation as soon as possi$le to ena$le the insurance
company to initiate the claim processing. +he claim intimation should consist of $asic information
such as policy num$er& name of the insured& date of death& cause of death& place of death& name of
the claimant etc .Claim intimation form can $e a/ailed from nearest $ranch of the insurance
company or/and $y downloading it from the company we$site.
Step +wo: 4ocumentation
+he claimant will $e re.uired to pro/ide the following documents along with a claimant6s
statement:
I. Certificate of 4eath
II. )roof of age of the life assured 7if not already gi/en8
III. 4eeds of assignment / reassignments 7if re.uired8
I9. )olicy document
9. 1ny other document as per re.uirement of the insurer
#or early death Claim& 7If the claim has accrued within three years from the $eginning of the
policy8& the following additional re.uirements may $e called for:
I. Statement from the hospital if the deceased had $een admitted to hospital
II. Certificate of medical attendant of the deceased gi/ing details of his/her last illness
III. Certificate of cremation or $urial to $e gi/en $y a person of 0nown character and
responsi$ility present at the cremation or $urial of the $ody of the deceased
I9. Certificate $y employer if the deceased was an employee
In special cases as per following the poof of death will $e different from the standard specification
In case of an air crash the certificate from the airline authorities would $e necessary certifying that
the assured was a passenger on the plane.
In case of ship accident a certified e:tract from the log$oo0 of the ship is re.uired.
In case of death from medical causes& the doctors

certificate and/or treatment records may $e

re.uired.
If the life assured had a death due to accident& murder& suicide or un0nown cause the police
in.uest report& panchanama& post mortem report& etc would $e re.uired.
Step +hree: Su$mission of re.uired 4ocuments for Claim )rocessing
#or faster claim processing& it is essential that the claimant su$mits complete documentation as
early as possi$le.
Step #our: Settlement of Claim
1s per the regulation ; of the I<41 7)olicy holder6s Interest8 <egulations& '(('& the insurer is
re.uired to settle a claim within 3( days of receipt of all documents including clarification sought
$y the insurer. If the claim re.uires further in/estigation& the insurer has to complete its procedures
within si: months from recei/ing the written intimation of claim.
1fter recei/ing the re.uired documents the company calculates the amount paya$le under the
policy. #or this purpose& a form is filled in which the particulars of the policy& $onus& nomination&
assignment etc. should $e entered $y reference to the )olicy Ledger Sheet. If a loan e:ists under
the policy& then the section dealing with loan is contacted to gi/e the details of outstanding loan
and interest amount& which is deducted from the gross policy amount to calculate net paya$le
claim amount. =enerally all claim payments would $e made through the electronic fund transfer.
*aturity - Sur/i/al Claims:
+he payment $y the insurer to the insured on the date of maturity is called maturity payment. +he
amount paya$le at the time of the maturity includes a sum assured and $onus/incenti/es& if any.
+he insurer sends in ad/ance them intimation to the insured with a $lan0 discharge form for filling
/arious details in it. It is to $e returned to the office along with 5riginal )olicy document& I4
proof& 1ge proof if age is not already su$mitted& 1ssignment /reassignment& if any and Copy of
claimant

s >an0 )ass$oo0 - Cancelled Che.ue. Settlement procedure for maturity claim is

simple after receipt of completed and stamped discharge form from the person entitled to the
policy money along with policy documents& claim amount will $e paid $y account payee che.ue.
<egarding maturity claims certain points are to $e remem$ered:
If the life assured is reported to ha/e died after the date of maturity $ut $efore the receipt is
discharged& the claim is to $e treated as the maturity claim and paid to the legal heirs. In this case
death certificate and e/idence of title is re.uired.
2here the assured is 0nown to $e mentally deranged& a certificate from the court of law under the
Indian Lunacy 1ct appointing a person to act as guardian to manage the properties of the lunatic
should $e called.
#or Sur/i/al >enefit claim& )olicy $ond and discharge /oucher is re.uired.
<ider Claims:
+he life insurance policy can $e attached with different riders li0e accidental rider& Critical illness
<ider& ?ospital cash <ider& wai/er of )remium <ider etc. #or different <iders different
proceedings can $e opted for claim settlement. In some cases the claim may proceed as well as
with the death Claim 7Li0e 2ai/er of premium rider& accidental death <ider etc8. >ut in some
other cases different documents can $e re.uired for along with the duly filled Claim form -
)olicy Copy:
#or Critical Illness <ider& necessary medical documents such as first in/estigation report&
4octor

s prescription& 4ischarge Summery etc are re.uired

#or 1ccidental disa$ility rider& 1ttested copy of #I<& 4octor Certificate of disa$ility& )hotograph
of the in@ured with reflecting disa$lement& 5riginal *edical $ills with prescriptions/ treatment
papers etc are re.uired.
#or ?ospital cash rider medical documents are re.uired such as *edical - In/estigation report&
)rescriptions& *edical and In/estigation >ills& 4ischarge Card etc.
Conclusion: Importance of )roper 4ocumentation in Claim )rocessing:
It is noted that in many cases the life insurance claim has $een denied $y the insurer $ecause the
claimant has failed to follow some step or not a$le to su$mit the necessary information to the
company. So it is recommended that when you claim for life insurance& ta0e proper steps and
documentation so that you can collect your $enefit without difficulty or delay.
Claim settlement - Life Insurance
http://www.lifeinscouncil.org/consumers/claims-process
Claims )rocess
#iling a Life Insurance Claim
Claim settlement is one of the most important ser/ices that an insurance company can pro/ide to
its customers. Insurance companies ha/e an o$ligation to settle claims promptly. Aou will need to
fill a claim form and contact the financial ad/isor from whom you $ought your policy. Su$mit all
rele/ant documents such as original death certificate and policy $ond to your insurer to support
your claim. *ost claims are settled $y issuing a che.ue within 7 days from the time they recei/e
the documents. ?owe/er& if your insurer is una$le to deal with all or any part of your claim& you
will $e notified in writing.
+ypes of claims
*aturity Claim - 5n the date of maturity life insured is re.uired to send maturity claim / discharge
form and
original policy $ond well $efore maturity date to ena$le timely settlement. *ost companies
offer/issue post dated che.ues and/ or ma0e payment through BCS credit on the maturity date.
Incase of delay in settlement 0indly refer to grie/ance redressal .
4eath Claim 7including rider claim8 - In case of death claim or rider claim the following procedure
should $e followed.
#ollow these four simple steps to file a claim:
!. Claim intimation/notification
+he claimant must su$mit the written intimation as soon as possi$le to ena$le the insurance
company to initiate the claim processing. +he claim intimation should consist of $asic information
such as policy num$er& name of the insured& date of death& cause of death& place of death& name of
the claimant.
+he claimant can also get a claim intimation/notification form from the nearest local $ranch office
of the insurance company or their insurance ad/isor/agent. 1lternati/ely& some insurance
companies also pro/ide the facility of downloading the form from their we$site.
'. 4ocuments re.uired for claim processing
+he claimant will $e re.uired to pro/ide a claimant6s statement& original policy document& death
certificate& police #I< and post mortem e:am report 7for accidental death8& certificate and records
from the treating doctor/hospital 7for death due to illness8 and ad/ance discharge form for claim
processing. >ased on the sum at ris0& cause of death and policy duration& insurance companies
may also re.uest some additional documents.,
3. Su$mission of re.uired documents for claim processing
#or faster claim processing& it is essential that the claimant su$mits complete documentation as
early as possi$le. 1 life insurer will not $e a$le to ta0e a decision until all the re.uirements are
complete. 5nce all rele/ant documents& records and forms ha/e $een su$mitted& the life insurer
can ta0e a decision a$out the claim.
C. Settlement of claim
1s per the regulation ; of the I<41 7)olicy holder6s Interest8 <egulations& '(('& the insurer is
re.uired to settle a claim within 3( days of receipt of all documents including clarification sought
$y the insurer. ?owe/er& the insurance company can set a practice of settling the claim e/en
earlier. If the claim re.uires further in/estigation& the insurer has to complete its procedures within
si: months from recei/ing the written intimation of claim.
Claim intimation
In case a claim arises you should:
Contact the respecti/e life insurance $ranch office.
Contact your insurance ad/isor
Call the respecti/e Customer ?elpline
Claim re.uirements
#or 4eath Claim:
4eath Certificate
5riginal )olicy >ond
Claim #orms issued $y the insurer along with supporting documents
#or 1ccidental 4isa$ility / Critical Illness Claim:
Copies of *edical <ecords& +est <eports& 4ischarge Summary& 1dmission <ecords of hospitals
and La$oratories.
5riginal )olicy >ond
Claim #orms along with supporting documents
#or *aturity Claims:
5riginal )olicy >ond
*aturity Claim #orm