Claims settlement procedure:
The settlement of claims is a very important aspect of service to the policyholders. Hence, the Corporation has laid great emphasis on expeditious settlement of Maturity as well as Death Claims.
The procedure for settlement of maturity and death claims is detailed below :
1) In case of Endowment type of Policies, amount is payable at the end of the policy period. The Branch Office which services the policy sends out a letter informing the date on which the policy monies are payable to the policyholder at least two months before the due date of payment. The policyholder is requested to return the Discharge Form duly completed along with the Policy Document, NEFT Mandate Form (Bank A/c Particulars with supporting proof), KYC requirements etc. . On receipt of these documents payment is processed in advance so that maturity amount gets credited to the policyholder’s bank A/C on the due date.
2) Some Plans like Money Back Policies provide for periodical payments to the policyholders provided premium due under the policies are paid up to the anniversary due for Survival Benefit. In these cases where amount payable is up to Rs.500,000/-,payments are released without calling for the Discharge Receipt or Policy Document. Survival Benefit under Jeevan Anand policies up to Sum assured Rs. 200000/- is also released without calling for policy bond or discharge form. However, in case of higher amounts these two requirements are insisted upon.
The death claim amount is payable in case of policies where premiums are paid up-to-date or where the death occurs within the days of grace. On receipt of intimation of death of the Life Assured the Branch Office calls for the following requirements:
a) Claim form A – Claimant’s Statement giving details of the deceased and the claimant.
b) Certified extract from Death Register
c) Documentary proof of age, if age is not admitted
d) Evidence of title to the deceased’s estate if the policy is not nominated, assigned or
issued under M.W.P. Act.
e) Original Policy Document
The following additional forms are called for if death occurs within three years from the date of risk or from date of revival/reinstatement.
a) Claim Form B – Medical Attendant’s Certificate to be completed by the Medical Attendant of the deceased during his/her last illness
b) Claim Form B1 – if the life assured received treatment in a hospital
c) Claim form B2 – to be completed by the Medical Attendant who treated the deceased life assured prior to his last illness.
d) Claim Form C – Certificate of Identity and burial or cremation to be completed and signed by a person of known character and responsibility
e) Claim form E – Certificate by Employer if the assured was employed person.
f) Certified copies of the First Information Report, the Post-mortem report and Police Investigation Report if death was due to accident or unnatural cause.
These additional forms are required to satisfy ourselves on the genuineness of the claim, i.e., no material information that would have affected our acceptance of proposal has been withheld by the deceased at the time of proposal. Further, these forms also help us at the time of investigation by the officials of the Corporation.
Double Accident Benefit Claims:
Double Accident Benefit is provided as an additional benefit to the life insurance cover. For this purpose an extra premium of Rs.1/- per Rs.1000/- S.A is charged. For claiming the benefits under the Accident Benefit the claimant has to produce the proof to the satisfaction of the Corporation that the accident is defined as per the policy conditions. Normally for claiming this benefit documents like FIR, Post-mortem Report are insisted upon.
Disability Benefit Claims:
Disability benefit claims consist of waiver of future premiums under the policy and extended disability benefit consisting in addition of a monthly benefit payment as per policy conditions. The essential condition for claiming this benefit is that the disability is total and permanent so as to preclude him from earning any wage/compensation or profit as a result of the accident
Claims Review Committees:
The Corporation settles a large number of Death Claims every year. Only in case of fraudulent suppression of material information is the liability repudiated. This is to ensure that claims are not paid to fraudulent persons at the cost of honest policyholders. The number of Death Claims repudiated is, however, very small. Even in these cases, an opportunity is given to the claimant to make a representation for consideration by the Review Committees of the Zonal office and the Central Office. As a result of such review, depending on the merits of each case, appropriate decisions are taken. The Claims Review Committees of the Central and Zonal Offices have among their Members, a retired High Court/District Court Judge. This has helped providing transparency and confidence in our operations and has resulted in greater satisfaction among claimants, policyholders and public.
- »The Grievance Redressal Machinery has been further expanded with the appointment of Insurance Ombudsman at different centers by the Government of India. At present there are 12 centres operating all over the country.
- »Following type of complaints fall within the purview of the Ombdusman
a) any partial or total repudiation of claims by an insurer;
b) any dispute in regard to premiums paid if payable in terms of the policy;
c) any dispute on the legal construction of the policies in so far as such disputes relate to claims;
d) delay in settlement of claims;
e)non-issue of any insurance document to customers after receipt of premium.
- »Policyholder can approach the Insurance Ombudsman for the redressal of their complaints free of cost.