Filing

CLAIM PROCESS Life

Insurance

Claim

Claim settlement is one of the most important services that an insurance company can provide to its customers. Insurance companies have an obligation to settle claims promptly. You will need to fill a claim form and contact the financial advisor from whom you bought your policy. Submit all relevant documents such as original death certificate and policy bond to your insurer to support your claim. Most claims are settled by issuing a cheque within 7 days from the time they receive the documents. However, if your insurer is unable to deal with all or any part of your claim, you will be notified in writing.

Types of claims
Maturity Claim - On the date of maturity life insured is required to send maturity claim / discharge form and original policy bond well before maturity date to enable timely settlement. Most companies offer/issue post dated cheques and/ or make payment through ECS credit on the maturity date. Incase of delay in settlement kindly refer to grievance redressal. Death Claim (including rider claim) - In case of death claim or rider claim the following procedure should be followed. Follow these four simple steps to file a claim: 1. Claim intimation/notification The claimant must submit the written intimation as soon as possible to enable the insurance company to initiate the claim processing. The claim intimation should consist of basic information such as policy number, name of the insured, date of death, cause of death, place of death, name of the claimant. The claimant can also get a claim intimation/notification form from the nearest local branch office of the insurance company or their insurance advisor/agent. Alternatively, some insurance companies also provide the facility of downloading the form from their website. 2. Documents required for claim processing The claimant will be required to provide a claimant's statement, original policy document, death certificate, police FIR and post mortem exam report (for accidental death), certificate and records from the treating doctor/hospital (for death due to illness) and advance discharge form for claim processing. Based on the sum at risk, cause of death and policy duration, insurance companies may also request some additional documents.| 3. Submission of required documents for claim processing For faster claim processing, it is essential that the claimant submits complete documentation as early as possible. A life insurer will not be able to take a decision until all the requirements are complete. Once all relevant documents, records and forms have been submitted, the life insurer can take a decision about the claim. 4. Settlement of claim As per the regulation 8 of the IRDA (Policy holder's Interest) Regulations, 2002, the insurer is required to settle a claim within 30 days of receipt of all documents including clarification sought by the insurer. However, the insurance company can set a practice of settling the claim even earlier. If the claim requires further investigation, the insurer has to complete its procedures within six months from receiving the written intimation of claim.

Claim intimation
In case a claim arises you should: Contact the respective life insurance branch office. Contact your insurance advisor Call the respective Customer Helpline

Claim requirements
For Death Claim: Death Certificate Original Policy Bond Claim Forms issued by the insurer along with supporting documents For Accidental Disability / Critical Illness Claim: Copies of Medical Records, Test Reports, Discharge Summary, Admission Records of hospitals and Laboratories. Original Policy Bond Claim Forms along with supporting documents For Maturity Claims: Original Policy Bond Maturity Claim Form Incase of delay in settlement kindly refer to grievance redressal

Life Insurance provides the dual benefits of savings and security. The following benefits explain why this investment tool should be an integral part of your financial plans. http://www.lifeinscouncil.org/consumers/advantages-of-insurance Advantages of Life Insurance

Risk Cover - Life today is full of uncertainties; in this scenario Life Insurance ensures that your loved ones continue to enjoy a good quality of life against any unforeseen event. Planning for life stage needs - Life Insurance not only provides for financial support in the event of untimely death but also acts as a long term investment. You can meet your goals, be it your children's education, their marriage, building your dream home or planning a relaxed retired life, according to your life stage and risk appetite. Traditional life insurance policies i.e. traditional endowment plans, offer inbuilt guarantees and defined maturity benefits through variety of product options such as Money Back, Guaranteed Cash Values, Guaranteed Maturity Values. Protection against rising health expenses - Life Insurers through riders or stand alone health insurance plans offer the benefits of protection against critical diseases and hospitalization expenses. This benefit has assumed critical importance given the increasing incidence of lifestyle diseases and escalating medical costs.

Builds the habit of thrift - Life Insurance is a long-term contract where as policyholder, you have to pay a fixed amount at a defined periodicity. This builds the habit of long-term savings. Regular savings over a long period ensures that a decent corpus is built to meet financial needs at various life stages. Safe and profitable long-term investment - Life Insurance is a highly regulated sector. IRDA, the regulatory body, through various rules and regulations ensures that the safety of the policyholder's money is the primary responsibility of all stakeholders. Life Insurance being a long-term savings instrument, also ensures that the life insurers focus on returns over a long-term and do not take risky investment decisions for short term gains. Assured income through annuities - Life Insurance is one of the best instruments for retirement planning. The money saved during the earning life span is utilized to provide a steady source of income during the retired phase of life.

Protection plus savings over a long term - Since traditional policies are viewed both by the distributors as well as the customers as a long term commitment; these policies help the policyholders meet the dual need of protection and long term wealth creation efficiently. Growth through dividends - Traditional policies offer an opportunity to participate in the economic growth without taking the investment risk. The investment income is distributed among the policyholders through annual announcement of dividends/bonus. Facility of loans without affecting the policy benefits - Policyholders have the option of taking loan against the policy. This helps you meet your unplanned life stage needs without adversely affecting the benefits of the policy they have bought. Tax Benefits-Insurance plans provide attractive tax-benefits for both at the time of entry and exit under most of the plans. Mortgage Redemption- Insurance acts as an effective tool to cover mortgages and loans taken by the policyholders so that, in case of any unforeseen event, the burden of repayment does not fall on the bereaved family.

BENEFIT OF ULIP http://www.lifeinscouncil.org/consumers/benefits-of-ulips

Unit Linked Plans offer unique opportunity to combine protection with investments. Some special features of Unit Linked Life Insurance Policies (ULIPs) are:

Provides flexibility in investments ULIPs offer a complete selection of high, medium and low risk investment options under the same policy. You can choose an appropriate policy according to your risk taking appetite, coupled with the opportunity to switch between fund options without any additional expense for specified number of switches. ULIPs provide the flexibility to choose the sum assured and investment ratio in the annual targeted premium. It also offers the flexibility of one time increase in investment portfolio, through top-ups to avail investment opportunity offered by external environment or own income flows.

Transparency The charge structure, value of investment and expected IRR based on 6% and 10% rate of returns, for the complete tenure of the policy are shared with you before you buy a product. Similarly, the annual account statement, quarterly investment portfolio and daily NAV reporting, ensures that you are aware of the status of your investment portfolio at all times. Most companies publish latest NAVs on their respective websites on a daily basis.

Liquidity To cope with unforeseen circumstances, ULIPs offer the benefit of partial withdrawal; wherein after 5 years you can withdraw funds from our Unit Linked account, retaining only the stipulated minimum amount.

Disciplined and regular savings ULIPs help you inculcate a regular saving habit. Also, the average unit costs tend to be lower than one time investment.

Multiple benefits bundled in one product ULIP is an outstanding solution for risk cover, long term investments with the benefit of various investment opportunities, coupled with tax benefits.

Spread of risk ULIPS are ideal for those investors who wish to avail the benefit of market linked growth without actually participating in the stock market, with the added benefit of risk-cover

HOW TO BUY LIFE INSURANCE http://www.lifeinscouncil.org/consumers/how-to-buy There's no thumb rule on buying insurance; it depends completely on every individual's financial goals, income profile and risk appetite. However, here are a few basic rules you should keep in mind before you buy an insurance product.

Buy insurance only from a licensed company Buying life insurance is like buying future financial security for your family. Hence when buying insurance, ensure your policy is provided by a licensed company. The list is available on this website too.

Buy insurance only from a licensed agent/ intermediary Buy insurance only from a licensed agent/ intermediary who is licensed to sell Life Insurance Products. You can ask for the license before you actually buy the policy

Shop around Seek premium quotes and proposals from various insurance companies and do a comparative study. Different policies offer different benefits, so choose one that suits you the most. Cheapest is not necessarily the best.

Understand the scope of cover, terms and conditions of the policy Make sure you have a complete understanding of all necessities such as the terms and conditions as well as exclusions in the policy. If necessary, do not shy away from asking for explanations from the insurance company.

Avoid unwanted additional coverage Do not be pressured into buying 'packaged' products, as they often contain fixed coverage's you don't need. However, you may opt to add additional coverage or riders of your choice at an additional premium which offers value for money. Your financial commitment should be in tune with your financial condition.

Get the right life insurance policy Carefully study your agent's recommendation to make sure the policy is what you are looking for. The benefits should match your needs.

Check the date the insurance becomes effective The date the insurance goes into effect may be different from the date the company issues the policy. Ensure you ask your agent when the insurance becomes effective.

Fill in your application carefully Never sign blank proposals or application forms. Ensure all information filled in your application is complete and correct to avoid delays or even denial of claims at a later stage.

Health related particulars Life Insurance is a contract of utmost good faith where the responsibility of disclosure of material fact vests with the buyer. Please ensure that all questions relating to family history, personal health are answered with utmost care. Any concealment or non disclosure of material facts could jeopardize claim to your nominees.

Age and Address Proof Regulations require proposal forms to be accompanied by authentic age and address proof. Kindly ensure that acceptable proof of age and address are submitted with proposal form.

Ensure premiums are paid to your insurance company Make sure your cheque or money order is made payable to the insurance company and not to your agent and insist for a receipt immediately as proof of payment.

Read your policy when you receive it Life policies have a 'free look' period of 15 days from the date you receive it. Use this opportunity to make sure this is the right policy for you. In case the policy document contains any condition which was not explained to you by the agent or intermediary, you have the right to return it to the insurance company and ask for refund within this period. INFORMATION FOR EXISTING POLICY HOLDERS

http://www.lifeinscouncil.org/consumers/information-for-existing-policy-holders If you are an existing policyholder, here are a few pointers to help you amend your cover or make a claim with ease.

Always remember your premium due dates to avoid a policy lapse. Always insist on a receipt as a proof of payment. Ensure your age is stated correctly in the proposal. The life insurance company will pay an amount equal to the insurance ,the premium would have bought, at the age stated in the document. Review your insurance needs regularly for adequate cover.

Keep your policy in a safe place until the life insurance policy money is received. Keep basic details of your policy such as the type of policy, policy number and names of nominees in a separate Always keep the nomination under your policy alive. It helps during unforeseen difficulties and saves your near and dear ones from avoidable hassles. Always intimate change in address to insurance company immediately If your policy is assigned for a loan, ensure that the reassignment notice is sent to insurance company and is noted by them after the loan is repaid. Also make sure that reassigned policy is received back from the lender. Fresh nomination may also be needed in such a case. Always clarify any doubts you have about your policy with the life insurance company INVESTING IN INSURANCE COMPANIES

http://www.lifeinscouncil.org/consumers/investing-in-insurance-companies

Every life insurer is required to maintain a Required Solvency Margin as per Section 64VA of the Insurance Act 1938. As prescribed by IRDA, Required Solvency Margin is the amount by which an insurance company's capital exceeds its projected liabilities; effectively a meas of its financial he

The IRDA (Assets, Liabilities and Solvency Margin of Insurers) Regulations, 2000 describes in detail the method of computation of Required Solvency Mar In case of Life Insurers, the Required Solvency Margin is the higher of an amount of Rs.50 crore (Rs. 100 crore in case of Re-insurers) sum which is based on a formula given in the Act / Regulation. IRDA has set a working Solvency Margin Ratio (Ratio of Actual Solve Margin to the Required Solvency Margin) of 1.5 for all insurers. During 2007-08, IRDA has introduced the quarterly reporting of Solve Status for all the Insurers. Accordingly, all the insurers are now required to file their Solvency Status as on June 30, September 30, Decem 31 and March

One of the important factors that influence insurance penetration is the capital requirement under solvency margin. The pure term prod provide simple life cover and it is believed that companies could design products, which could reach various segments of the populatio meeting their insurance needs thereby enhancing insurance penetration. In line with this objective, the Authority has decided to allow the insurers to reduce the capital requirement in the case of pure term products without changing the factor loadings in the case of the remai products. It is expected that the lower level of solvency for pure term products would provide significant relief to the life insurers both un individual products and under group products. This will also help the insurers in launching more pure term products for sufficiently lon periods and at affordable ra

As linked products are assuming significant share in the total premium collected by the insurance companies, and as the investors in th products are bearing the investment risk, it is necessary that more information is disseminated to the prospects / policyholder so that he / can take informed decisions. In this regard, the Authority has asked the life insurers to be more transparent in the policy wordings of the U products and mandated the insurers to submit to the Authority details on guaranteed benefits and non-guaranteed benefits for each po year. A format has also been introduced for this purpose and the Authority instructed that when the prospects/policyholder propose to tak ULIP policy he/she should sign on both the formats in the proposal form it

This will benefit the policyholders in knowing about the terms/benefits of the policy and also reduce mis-selling by the agents in quo abnormal investment returns.

GRAVIANCE REDRESSAL PROCESS

http://www.lifeinscouncil.org/consumers/ombudsman/grievance-redressal-process The Insurance Regulatory and Development Authority (IRDA) is responsible for addressing complaints filed by policyholders. Complaints against Life and Non-life insurers are handled separately. This cell plays a facilitative role by taking up complaints with the respective insurers. Policyholders who have complaints against insurers are required to first approach the Grievance/Customer

Complaints Cell of the concerned insurer. If you do not receive a response from insurer(s) within a reasonable period of time or are dissatisfied with the response of the company, you may approach the Grievance Cell of the IRDA. The complaints need to be addressed to the correct Grievance Cell of the IRDA and sent to the addresses given below. Please note that the Grievances Cell(s) responsible for life insurance and non-life insurance are separate. Only cases of delay/non-response regarding matters relating to policies and claims are taken up by the Cell with the insurers for speedy disposal. If the grievance is not redressed, insured are advised to approach the Insurance Ombudsmen. For a list of Insurance Ombudsmen along with their contact details, click here. Only complaints from the policy holders themselves or the claimants shall be entertained. The Cell shall not entertain complaints written on behalf of policyholders by advocates or agents or any third parties. If the communication is done over e-mail, then the plaintiffs are requested to submit complete details of the complaint as required in the registration form. Without this, the Cell will not be in a position to register the grievance. In case the claimant is not satisfied with decision of Ombudsmen, appeal can be filed at the appropriate judicial forum like civil courts.

FOR EXISTING POLICY existing policy holders Information for existing policy holders