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Presented to: Presented by:

Mr. Abhishek Parikh Ushas Gopinathan (53)
Priyanka Patel (75)
Sweety Paul (87)
Divya Vyas (97)
 Vntroduction

! Settlement of claims is the culmination of a

contract of life insurance.

! Claim settlement occupies an important place in the

total operations of an insurance company.

! V DA has issued instructions to all insurance

companies to settle claims within a period of 30
days.
 ÷ypes of claims

1. Maturity claims

2. Death claims

3. Accident and disability claims

! Settlement of claims under insurance policy depend

upon the nature of the claim, eligibilities to policy
money, proof of the happening of the event insured
against, proof of title etc.
 Maturity claims

! ÷he payment to the life assured/assignee at the end

of the stipulated term of the policy is called maturity
claim.

! Payment of maturity claims is the easiest to

manage:

1. ÷here is no need on the part of the policyholder to

prove the happening of the event.
 Contd«
Contd«

2. ÷he policy holder is alive so proof of title does not

pose any problem.

3. ÷he insurance company need not wait any claim

from the policyholder and take initiative to settle
the claims expeditiously.
 Contd«
Contd«
! Procedures/practices to make pmt. of maturity claim
(LVC):
1. Branch offices ± servicing and accounting centers.
2. A list of policies is generated.
3. ÷hese lists are of two types ± one in respect of
maturities and the other in respect of survival
benefits under money back type of policies.
4. Action is initiated about three months in advance
of their due dates.
 Contd«
Contd«

! easons to initiate action in advance:

1. ÷o build up the image.

2. Policy holders ± happy and satisfied.

3. A great boost to the field force.

4. From accounting point of view, it is a good and

prudent practice.
 Contd«
Contd«

! Vn view of these reasons, all branch offices try

excellent performance in respect of two µkey result
areas¶ viz.

1. µzero¶ ratio of outstanding maturity claims.

2. A very high µspeed ratio¶.

 Contd«
Contd«
! ÷o claim a maturity benefit the requirements are
following:
1. A discharge voucher to be sent in advance
2. Policy document
3. Any deed of assignment, if the same was executed
on a separate stamp paper.
4. Age proof (if not submitted)
5. Vdentity proof
 Contd«
Contd«

! Vn case of misplacement of documents the

corporation settles maturity claims on the basis of
an indemnity bond to be executed on a non-judicial
stamp paper of the value of s. 100 by the policy
holder along with a surety of sound financial
standing.
 Death Claims
! Great importance in the total operations of any life
insurance company.

! Unlike in maturity claims, the policy holder is not

alive.

! Problems in settlement of death claims:-

1. Obtaining satisfactory proof of death

2. Obtaining satisfactory proof of title

 Contd«
Contd«
! Letter of intimation should contain the following
particulars:-
1. Policy number and the name of the policy assured.
÷hese two should match otherwise the policy no.
must be wrong.
2. Date of death, on which depends the status of the
policy and the amount payable.
3. Name and address of the claimant as requirements
are to be called from them.
 Contd«
Contd«
! Vn considering a death claim, it becomes necessary
to verify the duration of the policy.
! Vn some cases alternative proofs are also
considered:-
1. Death in air crash ± records of passengers
2. Disappearance on board a ship ± logbook
3. Presumption of death ± date of death as declared
by court
 Contd«
Contd«
! ÷o claim a death benefit the requirements are as
follows:-

1. Policy document

2. Assignment deed

3. Age proof (if not submitted)

4. Certificate of death

5. Legal evidence of title

6. Discharge voucher
 Accident and disability benefit

! Settlement of accident benefit:-

1. Death should be due to accident

2. Death should take place within a specified period

of time after the accident.

3. Proof satisfactory to the insurance company

should be submitted.
 Contd«
Contd«
4. ÷he policy must be in full force at the time of death.
5. ÷here are also exclusions in considering granting
accident benefit.
- Liquor
- Drug
- Breach of law
- War like operations
- Police or police like operations
- Suicide
- Hazardous sports
 Contd«
Contd«

! Settlement of disability benefit:-

i ÷ypes of disability benefits

1. Waiver of premium

2. Payment of the income to the life assured

! equirements for the disability benefit:-

1. First information report of the police
 Contd«
Contd«
2. ecords of the hospital where the treatment was
given.

3. Statement of the extent of disability

V
 
!