Types of Claims

Claims

Death Maturity
Claim Claim
 Death Claim
• If the insured dies before the expiry of the
term of the policy
• Death has to be intimated in writing to the
insurer
• The intimation must satisfy 2 conditions:

a. It must be from a concerned person

b. It must establish beyond doubt, the identity of the
deceased person as the life assured under the policy
The facts to be submitted by the
claimant are:

Full details of
Reason and Place
Date of death policies held by
of Death
the life assured.
 Categories of Death Claims
• When death of life assured occurs after 3
years from the date of commencement of
Non – Early Policy or Date of last revival/reinstatement
Death Claims

• When death of life assured occurs within 3

years from the date of commencement of
Early Claims Policy.
 Non-Death Claim Requirements
• Policy Document
• Death Certificate from the appropriate authority.
• Legal Evidence of Title, if the Claimant is not an
assignee/nominee
• Abridged Claim Form
• Discharge Form Duly Signed
• Assignment/Reassignment deed, if any
• Age Proof
 Early Claim Requirements
• Statement from the medical attendants who last
treated the deceased Life assured
• Certificate of treatment issued by the hospital
authorities where the deceased was treated last
• Certificate of the employer if the deceased was
an employee
• Certificate of burial/cremation signed by a person
who attended the funeral of the deceased.
 Maturity Claims
• Payable as per terms of the policy
• Amount payable on maturity = sum assured +
bonuses/incentives
• The insurer has to satisfy:
– Identity of the Life assured
– Age of the policy holder
– All premiums are paid
– Original policy is handed in together with a completed
discharge voucher before making payment.
 Documents Required
• Policy Document
• Age proof
• Deed of assignment, if any
• Discharge form issued by the office
 Settlement
• After receipt of the completed and stamped
discharge voucher from the person entitled to
the policy money, along with the policy
documents, claim amount will be paid by
account payee or crossed and order cheque.
 Additional Benefits
• Accidental Benefit and Disability Benefit
• Major Surgical Assistance Benefit
• Waiver of Premium Rider
 Claim Procedure
• A life insurance policy shall state the primary
documents required to be submitted
• Upon receiving a claim, it should be processed without
delay
• Claim shall be paid or be disputed giving all relevant
reasons, within 30 days from the date of receipt of all
relevant papers and clarifications required.
• Where there is a delay on the part of the insurer in
processing a claim, the life insurance company shall
pay interest at a rate 2% above bank rate (prevalent at
the beginning of the financial year)
 Policy or Claim Amount
• The amount of claim are the following
– Sum Assured
– Surrender Value
– Paid-up Value
 Surrender Value
• Calculate the duration elapsed under the policy
Paid-Up Duration = Date of First Unpaid Premium(FUP) – Date of
Commencement of Policy (DOC)

• Calculate Paid up Value, inclusive of vested bonus

under with profit plans
• Ascertain the surrender value factor per Rs. 100/-
paid up value, corresponding to plan, duration
elapsed and original term
• Surrender Value = Paid Up x Surrender Value
Factor/100
 Paid – Up Value
• If the policy holder discontinues the payment
of premium after at least two years premiums
have been paid and subsequent premium is
not paid, the policy does not become void, but
continuous as a paid-up policy.
 Example
• Sum Assured = Rs. 1,00,000
• Term of the policy = 20 years
• DOC = 01.01.85
• Due date of last premium paid = 01.01.97
• Date of Calculation of Surrender Value = 01.03.97
• Paid – Up Duration = 01.01.97 - 01.01.85 = 12years
• Paid – Up Value = 12/20 x 1,00,000 = Rs. 60,000 (A)
• Vested Bonus = Rs. 77,000 (B)
• Paid – up value including Vested Bonus = A+B = Rs.
1,37,000