Life Insurance
Claims
Essential Elements of Insurance Concept of Claim Beneficiaries under Life Insurance claims Claims Payment on Maturity Claims payment on Death Disputes in Life Insurance Claims Settlements of Claims Limitation of claims
Concept of Insurable Interest
Doctrine of Good Faith
Proximate Cause
Claim is a right of insured to receive the amount secured under the policy of insurance contract promised by Insurer.
Beneficiary depends on the followingconditions:-
Nomination Transfer Assignment
The amount insured or face value of policy
Bonus if declared by company
Share of profit in case of participation policy
Surrender value if policy lapsed
Procedure of Claim Settlement Letter of intimation of Death
including
1. Proof of Age
2. Death certificate
3. Policy number and name
4. Name & address of claimant
Internal enquiry when notice received
1. Any dues pending2. Policy status lapsed or running3. Exclusions & inclusions of that policy4. Nomination, assignment or transfer5. Cause of death6. Place of death7. Hospitalization details (if any)8. Statement of Doctor & hospital 9. Statement from organization where the person is working
For unnatural death accidents or suicide etc
1. FIR 2. post mortem3. chemical analysis report
If original death certificate not available, then alternative proofs considered such as-
1. Death in air crash
2. Disappearance on board a ship
3. Presumption of Death if not seen for seven years
Procedure for Claim settlement
1.Policy document submission2.Age Proof3. Internal enquiry4.Original Deed of assignment (if any)5.Other documents (Receipt of Payment
etc)
Identify the person to whom the payment is to be made
Whether the payment is within the terms of policy
Whether the amount claimed is reasonable
Proof of Death
Identification of assignee, nominee or the legal heir to whom the payment is to be made
Settlement within sixty days if no Dispute
In case of dispute, company can apply to court within ninety days on following circumstances:
When there is conflicting claimants When there is insufficiency of proof When there is any other adequate reason
Limitation of claim
Claim concessions
Administrative concessions
Ex-Gratia
Case study Kantiben took life insurance policy on 2-3-
97 for two lakh & paid premium regularly In 1999 she was diagnosed as suffering
from cancer Continued to pay premium without any
notice to LIC & She expired in 2 feb 2000 Nominee approached to LIC for claim LIC refused to pay on the basis of
fraudulent to not report her health status when she was required to do so.
Nominee approached to State commission for justice
Case study Dharam took policy on 3-7-96 with FIL
for 5 lakh & submitted his medical report
After two year he diagnosed Rheumatic Heart disease & died on 11-9-99
His wife claimed for payment FIL repudiated the claim on context of
hiding information about disease His wife then approached to state
commission for justice
What do you think should she get sum assured or surrender value or nothing.