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Steps that will ensure smooth settlement of life insurance claims

The most common reason for insurance claim being denied is incomplete disclosure about the insured person.

September 25, 2018 / 10:45 AM IST

The purpose of buying a life insurance policy is to provide protection to one's family. “The prime purpose of life insurance is to ensure your family’s standard of living that would be compromised by your untimely death,” said Anshuman Verma, Chief Marketing & Digital Officer, DHFL Pramerica Life Insurance.

It is more important to understand that if the policyholder is the bread earner of the family, then his or her death can also give rise to legal and financial issues which can be quite a challenge to resolve at times at the time of claims settlement.  Thus, if one not have to worry about the same then they should always buy a life insurance policy with companies which have high claim settlement ratio or the company should hold a good reputation in the market.

Every insurer has their own claimant statement form and documentation. However, the process of filing a death claim is more or less the same for all insurance company.

Here are five important steps which you need to follow for a life insurance death claim are as follows:

Inform the company

Any such incident if occurs, the nominee must inform the insurer about the scenario and death of the policyholder. This is the first step towards the claim settlement process. You need to register for claim either by calling the insurer, e-mailing them or directly reaching out to the nearest insurance provider of the same company.

Process initiation

Once you have informed the insurer, they will ask you for certain documents. In such a scenario, the claimant or the nominee has to provide with the supportive documents to claim insurance amount. The nominee has to prove that the death occurred due to natural or accidental reasons. The insurer will verify the nominee's declaration and if required, the insurer may ask for some other additional documents too.

Get ready with the mandatory documents required:

-- Original policy documents
-- Original / Attested copy of Death Certificate Issued by local municipal authority.
-- Death Claim Application Form (Insurance Company specific)
-- NEFT Mandate form attested by bank authorities along with canceled cheque or bank account passbook.
-- Nominee's photo identity proof like the PAN Card, copy of passport, Aadhaar Card, Voter identity card, etc.

Additional documents (as per the cause of death)

Medical / Natural death:

-- Attending Physician's Statement
-- Medical records (Admission notes, Discharge/Death Summary, Test reports etc.)

Accidental/ Unnatural Death:

-- Copy of the First Information Report (FIR) or Panchanama/Police Complaint.
-- Copy of Post Mortem Report (PMR)/Autopsy and Viscera report.
-- Copy of the Final Police Investigation Report (FPIR)/Charge sheet

Know the terms

Santosh Agarwal- Associate Director and Cluster Head- Life Insurance, said that one should also know the following clauses before making claims:

-- Most common reason for insurance claim being denied is incomplete disclosure about the insured person. Hence one should give complete & correct disclosure while taking the policy.

-- In case policy has lapsed the claim will not be paid. Hence premium due should be paid on time or within the grace period. If premium remains unpaid after grace period the policy shall lapse & any claim arising will not be honoured. (Grace Period is the additional time given by insurance company to pay the premium due)

-- Every policy has a free-look period of 15-30 days (depending on the policy), where if the insured is not satisfied with the policy terms then he/she has a right to cancel the policy within the free-look period by paying very nominal or no charges at all.

-- If death has happened in the first 12 months of buying the policy due to the suicide committed by the insured, the insurance company pays back the premium amount. If the suicide is committed after 1 year, then the insurance company pays the claim amount to the beneficiary.

Claim processing payouts

Once you (nominee) are done with the above mentioned points your claim process of payouts start. After the claims assistance reviews the documents, the insurance company proceeds with the claim settlement. The claims are paid to the nominee through ECS mode. In such case, the nominee has to provide his/her bank details along with cancelled cheque and other documents to the insurance company so as to get the payouts in his/her bank account.

Navneet Dubey
first published: Sep 25, 2018 10:45 am