Guide to Life Insurance Claim Process: Tips & Steps

Welcome to our comprehensive Guide to Life Insurance Claim Process, where we offer valuable insights, tips, and step-by-step instructions to help you navigate the often-complex world of life insurance claims. Losing a loved one is difficult, and dealing with the claim process can add to the emotional burden. However, understanding the procedures and requirements can make the process smoother and ensure your beneficiaries receive the benefits they deserve. In this guide, we will walk you through the essential steps, answer common questions, and give you professional advice so you may make wise decisions at this crucial time. Let's begin to ensure the financial future of your loved one.

What Does a Life Insurance Claim Entail? 

A life insurance claim is a significant procedure that occurs after the insured individual's death. The beneficiary or their representative initiates this formal process by officially requesting the insurance company to fulfil the benefits outlined in the policy. It serves as a vital legal procedure to ensure the payment of the financial benefits specified in the life insurance policy. The claim settlement process involves thorough verification by the company, supervised by their underwriters and legal advisors. Once the claim is approved, the designated amount is transferred to the nominee's registered account as per the supporting documents provided. Flexibility now exists for digitally or physically submitting these documents, making the process more accessible and efficient.

Types of Life Insurance Claims

 Having a clear understanding of the different types of life insurance claims can be beneficial for policyholders when navigating the complexities of compensation and ensuring they receive their rightful benefits. Let's delve into some of the most common insurance claims, shedding light on their distinctive features and considerations.

Maturity Claim: A life insurance policyholder submits the maturity claim when their policy reaches its maturity period. The discharge form should be sent along with the original policy before the maturity date to facilitate prompt payment. Most insurance companies issue post-dated checks on the specified maturity date or make payments through ECS credits.

The Rider Claim: Additional protection can be added to the primary life insurance policy through various riders. Examples include premium waiver riders, accidental riders, and critical illness riders. Each rider requires its own specific claim settlement process. For instance, the accidental death rider might be applicable alongside a death claim, while the waiver of premium rider in the event of incapacity must be processed separately.

The Process of Claiming Term Insurance

The term insurance claim process consists of three steps as outlined below:

Step 1: Notification to the insurance company: To begin the claim settlement process, the beneficiary or nominee must inform the insurance company about the claim. It is done by submitting a claim settlement form and necessary documents, such as a death certificate. It is essential to notify the insurer within 90 days or three months from the date of the policyholder's death. The claim form can be submitted physically at the branch or filled out online, providing details like the policyholder's name, policy number, date of birth, date and cause of death, and the place of death.

Step 2: Assessment by the insurance company: Upon receiving the claim settlement form, the insurer will assess the claim. They will carefully review the submitted documents and may request additional information if required. In case of any doubts or suspicions, the insurance company may conduct a thorough investigation.

Step 3: Claim settlement: Based on the assessment, the insurance company will approve or reject the term insurance claim. If approved, the sum assured will be transferred to the nominee's bank account. A letter explaining the reasons for refusal will be provided in case of rejection. The IRDAI mandates that insurance companies complete the claim settlement within 30 days. However, if further investigation is needed, the claim must be settled within six months, per IRDAI rules.

Insurance companies may conduct further investigation, especially for claims made within three years of availing of the term insurance policy. It may involve verification with relevant authorities, such as doctors and accident investigation personnel, to ensure the accuracy and validity of the claim.

Required Documents for Claim Settlement

Once the claim registration process is completed, the insurer will provide a claims pack to the nominee or beneficiary. This pack includes essential forms that must be submitted to initiate the claim settlement process. The nominee can obtain these forms from the insurer's office or the nearest branch. Alternatively, they can access and download the forms from the insurer's website, which can be more convenient, especially in current pandemic conditions.

The key documents needed for claim settlement are as follows:

1. Death Claim Form: This is the primary document that the nominee must fill out, providing details about the policy and the circumstances surrounding the insured person's death.
2. Physician's Statement: Medical practitioners, such as the attending doctor or the deceased's family doctor, need to fill out this form, providing clinical observations about the circumstances leading to the death.
3. Treating Hospital Certificate: Authorities from all hospitals where the deceased received treatment for the illness that caused their death should fill out this form.
4. Employer Certificate/School/College Certificate: If the deceased was employed, the employer needs to complete this form. In the case of a minor, the authorities of the deceased's school or college should fill it out.
5. KYC Documents: To process the claim, the beneficiary's KYC documents, such as photo ID and address proof, must be submitted. These documents should be certified by authorized personnel, such as an agent of the company, a bank manager, or a government official.

• Copy of Cancelled Cheque and Bank Statement

1. Legal Representative Documents: If a legal representative is handling the claim on behalf of the nominee, they need to provide documents proving their identity and authority.

In the case of unnatural deaths, additional documents are required:

1. FIR Copy (First Information Report)
2. Post-Mortem Reports
3. Death Certificate Issued by the Local Authority

Gathering these necessary documents is crucial to ensuring a smooth and timely claim settlement.

Various Approaches to Settling Insurance Claims

Nominees must provide the documents above to expedite the settlement and streamline the claim settlement process. Nowadays, insurance companies offer more flexibility by allowing claimants to submit these documents digitally or in physical form. 

Nominees or beneficiaries can directly reach out to the nodal officers designated by the insurance companies to facilitate the process. Lists of these officers are often available on the respective company's website. Alternatively, claimants can seek instant assistance by contacting customer care executives. 

Once the claim is submitted, the insurance company conducts a thorough verification process supervised by their underwriters and legal advisors. Once the claim successfully passes this stage, the approved claim amount is transferred to the nominee's registered account, as indicated in the supporting documents.

Conclusion

Now that you're well-versed with the entire claim process ensure that you or your nominee diligently follow each step to ensure a smooth and hassle-free claim experience. If you have any questions about your claim, don't hesitate to contact your insurer for clarification. Additionally, store all relevant documents securely in your DigiLocker app or e-insurance account and inform your family about the details to be well-prepared for any eventuality.

FAQs

• How long does it take to process a life insurance claim? 

The complexity of the case and the amount of paperwork needed can affect how long it takes to process a life insurance claim. The dispute may generally be resolved within a few weeks to a few months.

• What documents are needed to file a life insurance claim? 

Typically, you will need to provide the original policy documents, a death certificate, proof of identity, and any other relevant medical or legal documents related to the insured's passing.

• Can the claim be denied? 

Yes, a life insurance claim can be denied if the policyholder's death falls under specific exclusions stated in the policy, such as suicide within the policy's initial period or misrepresentation of information during the application process.

• Can multiple beneficiaries claim the death benefit? 

If the policy has multiple beneficiaries named, they can collectively or individually claim the death benefit. The insurance company will distribute the proceeds according to the policy's instructions.

• Is it advisable to seek professional assistance for the claim process?

While filing a life insurance claim can be straightforward in some cases, seeking professional assistance from a lawyer or financial advisor may be helpful, especially if you encounter any complexities or challenges.