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.