April 15, 2020

Process – Life Insurance Claims

by inheritance in Uncategorized
Process – Life Insurance Claims

PROCESS – LIFE INSURANCE CLAIMS


How to make a life insurance claim in the event of death?

It is important to know the right approach to make life insurance death claim.

General process of Death claim

Register a Death Claim

On the demise of the policy holder, the Nominee or close to kin, family, dependents, trustees, executors of a WILL, guardians, beneficiaries (in case of WILL) etc. must approach the office (branch) of the Insurance Company (which issued the policy) with an application in writing by the Nominee annexing relevant documents as below:

  • Death Claim Form(available for respective website of the Insurance company or its Branch / office)
  • Original Policy Document
  • Original / Attested copy of Death Certificate issued by Municipal Corporation/ city council etc. or authority as per local laws (if death is not in India)
  • Attested copy of nominee’s photo ID and Residential proof together with other KYC documents
  • Medical records at the time of death and documents related to any past illnesses of the insured person
  • Cancelled cheque of the nominee’s bank account (containing IFSC code, name of the nominee etc.)

Death Claim gets registered through an acknowledgement and reference number,on the date of receipt of the written intimation and the documents at the office.

The process about commencement for Claim starts and adequate and necessary information may be sought from time to time to support the claim as also comply with requirements which may arise during processing

If all submissions are in order and to the satisfaction of the department, the claim is admitted, and steps are initiated to settle the same. A bank transfers the claim proceeds is sent to the designated bank account of the nominee(s) through Electronic Fund Transfer. In some cases, a banker’s cheque is also issued to the nominee’s mailing address

In case of claims submitted by claimants of polices issued by LIC

Step 1: Inform the agent / office by intimating of demise to Insured

Step 2: Prepare the documents – Two cases of claims – Non-Early and Early Death

Documents for Non-Early Death ClaimEarly Death Claim(death within 3 years of policy starting)
Letter of Death IntimationMedical Attendant’s Certificate to be completed by the Medical Attendant of the deceased during his/her last illness
Claimants relationship with the deceasedIf the life assured received treatment in a hospital, then details of treatment
Claimants Statement giving details of deceased and claimantCertificate of Identity and burial or cremation to be completed and signed by a person of known character and responsibility
Discharge form duly executed by NomineeCertificate by Employer if the assured was employed person
NEFT mandate formIf death was due to accident or unnatural cause certified copies of the First Information Report (FIR), the Post-mortem report and Police Investigation Report. For most accidental death claims, insurer will also need any accident, autopsy, or toxicology reports.
Certified Extract from Death Register
Proof of Age
Evidence of title to the deceased’s estate if the policy is not nominated, assigned or issued under M.W.P. Act.
Original Policy Document

(Source: https://www.licindia.in)

1. In the absence of nominations under the policy , (prevalent usually in case of earlier issued polices) an application with Nominees need to be submitted in a Form specified (available on website of LIC- Form No 3806) or from any LIC Branch/ office.

Since past few years, LIC has made it mandatory to include Nominees in all policies (from proposal stage itself).

In case the Nominee was not pre-specified / mentioned in the Policy, then an application should be submitted together with a list of all the successors.

Claims up to Rs. 250,000 can be settled without succession certificate.

2. In case of policyholder’s unnatural death is caused by an accident, suicide etc. the Insurer may require some additional details besides the standard documents depending on the nature of the case.

All submissions to LIC Office/ Branch/ LIC officers etc. should be acknowledged and a photocopy of all submissions must be maintained for future reference.

Special situations – Lost policy document – LIC

While the Claim needs to be accompanied with the Policy document, in case of loss, theft, damage or destruction of the same, an application by the Nominee, close to kin of the insured/ beneficiary/ executor/ trustee/ guardian etc. needs to intimate/ inform the concerned branch or divisional office of Insurer, where the policy is serviced, intimating the non-availability and issuance application for a duplicate.

Post evaluation of the situation and genuiness, a duplicate policy document is issued for which the procedure is as below:

A. Duplicate Policy on demise of policy holder- LIC

For issuance of a duplicate policy kin / heir/ beneficiary / executor of the policy holder will have to submit following documents to the Branch office of the Insurance company:

  • Duly filled in Loss of Policy questionnaire (Form No 311)
  • Indemnity Letter unstamped; if the claim is below Rs. 5,000, then no Surety is required
  • Duly filled in Discharge Form
  • Form of Declaration of ‘No Assignment’
  • A declaration by Surety having sound financial status, in Form No 3807 for claims exceeding Rs. 5,0000
  • Submission of KYC documents of claimants:
    • Valid Photo Identity: Passport, PAN card, Voters ID, driving license, Identity card issued by Government
    • Valid Residential Proof: Telephone bill, Bank statement, Electricity bill, Ration card, Lease along with rent receipt
  • Submission of Proof of Residence of Life Assured

( Please note that the Form needs to be franked with rs. 500 and also post filling up the same needs to be notorised by the claimant)

B. Duplicate Policy in other cases – LIC

For issuance of a duplicate policy, the policyholder will have to submit following documents to the Branch office of the Insurance Company:

  • An Indemnity Bond ( Form No. 3756) duly stamped and executed by the policy holder on a stamp paper of appropriate value as applicable as per local laws
  • A declaration by a Surety having sound financial status acceptable to Insurer if the Policy relates to a sum assured exceeding Rs. 50,000 ( Form No-3807)
  • KYC documents:
    • Valid Photo Identity: Passport, PAN card, Voters ID, driving license, Identity card issued by Government.
    • Valid Residential Proof: Telephone bill, Bank statement, Electricity bill, Ration card, Lease along with rent receipt
  • Pay issuance charges for duplicate policy &
  • Incur Stamp Duty charges at prevailing rates
    In case the policy certificate / cover notes partially destroyed due to natural causes like, fire, flood, etc., the residual portion (mutilated or otherwise) may be returned as evidence of loss of policy to Insurer, while applying for a duplicate policy
    The duplicate policy would continue to hold all characteristics and notings of the previous/ original policy in terms of assignment, mortgage etc. Where the Policy is due for maturity or survival benefit within 3 years and if the sum assured is more than Rs.25,000, an advertisement in a Local Daily newspaper having wide circulation would be mandatorily required

Requirements by Private Life insurance Companies

Documents to be submitted to Private Life Insurance Companies

DocumentsAegon Life Insurance CompanyAviva IndiaBajaj Allianz Life InsuranceBirla Sunlife Insurance Company LtdHDFC Standard Life InsuranceICICI Prudential Life InsuranceIDBI Federal Life Insurance
Death Claim Intimation formYYYYYYY
Original death certificate (self-attested) issued by municipality or equivalent authorityYYYYYYY
Claimant’s photograph, current address proof and photo ID proofYYYYYYY
Supporting documents
Claimant’s copy of bank passbook / statement with bank account details/ Cancelled ChequeYYYYYYY
Medical certificate stating cause of deathYYYYYYY
Medical records (consultation notes, treatment records, admission notes, hospital indoor papers, discharge/ death summary, investigation reports, etc.)YYYYYYY
Medical questionnaireYYYYYYY
Copy of certified first information report/ inquest/ medico legal cause / Panchnama (translation mandatory in the case of vernacular language)(If Death is accidental or suicide)
YYYYYYY
Copy Medical records ( admission notes/Death Summary/ Test summary etc.YYYYYYY
Newspaper cutting / Photographs of the accidentY
#Copy of certified post-mortem report/ chemical analysis report (viscera)(If Death is accidental or suicide)
YYYYYYY
Copy of driving license if the insured was driving the vehicle at the time of accident(If Death is due to road accident)
YYYYYYY
Settlement Option Form as applicable
DocumentsSBI Life Insurance CompanyKotak Life Insurance CompanyPNB Metlife India Insurance CompanyReliance Life InsuranceTATA AIG Insurance
Death Claim Intimation formYYYYY
Original death certificate (self-attested) issued by municipality or equivalent authorityYYYYY
Claimant’s photograph, current address proof and photo ID proofYYYYY
Claimant’s copy of bank passbook / statement with bank account details/ Cancelled ChequeYYYYY
Medical certificate stating cause of deathYYYYY
Medical records (consultation notes, treatment records, admission notes, hospital indoor papers, discharge/ death summary, investigation reports, etc.)YYYYY
Medical questionnaireYYYYY
Copy of certified first information report/ inquest/ medico legal cause / Panchnama (translation mandatory in the case of vernacular language)YYYY
Copy Medical records (admission notes/Death Summary/ Test summary etc.YYYYY
Newspaper cutting / Photographs of the accidentYYYY
#Copy of certified post-mortem report/ chemical analysis report (viscera)YYYY
Copy of driving license if the insured was driving the vehicle at the time of accidentYYYY
Settlement Option Form as applicable

Death Claims: – FAQs in unique cases

  • Whom des the Insurance Company settle the claim in case of the nominee being erstwhile wife of the Policyholder, while and on date of death of the Policy holder they were already divorced?
    In such as case the terms of divorce settlement would prevail whereby if there is no mention of the Life Insurance Policy as part of the asset of the policyholder, then the Insurance Company would settle the claim with legal heirs/ successors of the policy holder except erstwhile wife.
  • What happens if the nominee dies prior to the Policy holder or along with the Policy holder?
    If the Nominee dies before the policy holder, the policy holder should inform the Insurance Company and make an application in required formats to change the Nominee or replace the Nominee. However, if the Nominee died simultaneously with the Policy holder, then the Insurance Company will settle the claim to the next legal heir/ successor. For this the claimant would have to provide all necessary documents to the satisfaction of the Insurance company.
  • When can a Life Insurance Company deny a claim?
    If the claim is genuine and is supported with all the valid and required documents, Insurance Company cannot reject the claim. However, if the life insurance company arrives at a decision that the claim is not genuine and is fraudulent, claim may get rejected.
  • If an insurance Policy has named two nominees with distinct distributable ratios, if during claim process any one of the nominees refuses to sign the Claim Form how does the insurance Company settle the claim?
    The Life Insurance Company will require signatures and consent of all the living nominees for disbursing the claim amount. No part settlement of Claim is possible.
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