The insured pays a certain fixed amount as premium for a fixed term with the assurance from the insurance company that in case of an eventuality during the term of the policy or on successful completion of the policy term whichever is applicable to the policy selected the insurer would pay the due amount either to the policyholder or to the beneficiary whichever is applicable.
There are certain points the insured must verify while making the claims request:
1) The status of the policy whether in force or has expired.
2) Whether all premiums are paid.
3) To check if there are any outstanding loans or any interest related issues.
4) Verify the details if completed or not.
The settlement of claims procedure if followed step wise reduces the chances of being rejected.
1) Claim Intimation:
In order to enable the insurer to process the claims at the earliest the policyholder must submit a written application as soon as the eventuality or the maturity of claim has occurred. The claim form must be duly filled with all the information correctly as per the details required i.e. policy number, name of the insured, cause of death, date of death, name of the nominee/ beneficiary etc.
2) Documents submission:
The claim form must be supported with all necessary documents.
In case of nature death:
a) Death certificate
b) Age proof of the policyholder
c) Policy document
d) Any other document as per the instruction of the insurer.
In case of unnatural or early death
a) Hospital certificate if the policyholder was admitted to the hospital at the time of death.
b) Statement from the attending doctor who attended the policyholder at the time of death.
c) In case of death due to accident copy of the FIR from the police station.
d) Post mortem copy.
3) Settlement of Claim:
As per IRDA rules the insurer is required to settle the claims within 30 days of receiving the claims application after all the documents required have been submitted along with clarifications required if any. A maximum of six months is provided in cases which require further detailed investigation.
After the received investigation is done, the amount payable is calculated based on the policy selected. In case of any loan outstanding on the policy, the amount payable is adjusted with the outstanding loan amount. If there are any bonuses due they are added to the final settlement amount. The claims payments are electronically transferred to the account details mentioned in the policy document.
The amount paid at the maturity of the policy would generally include the sum assured along with any bonuses or incentives applicable. The insured can intimate the insurer in advance about the due maturity date and fill the required claims form. The documents required to be submitted would be:
a) Age proof
b) Original policy document
c) Copy of policyholder's passbook
d) Cancelled cheque
After verification of all the documents, the maturity claims amount is paid to the policyholder holder generally in the form of a cheque.
Different policies provide riders such as accidental death rider, critical illness rider, waiver of premium etc. There could be additional documents required in certain cases if riders like critical illness or waiver of premium riders were selected by the policyholder.
Accidental Death or disability rider: Copy of the FIR, Doctor Certificate explaining the disability, original medical bills.
Critical Illness rider: First investigation report, discharge summary, doctor's certificate etc.
In order to get the claims benefit without much delay, the documents and details required must be provided with utmost care. Also, one must make sure that no fraudulent methods are used to receive the claims benefit.