Article

Procedure: How to Make an Insurance Claim
January 30 , 2013
  1. In life insurance policies, claim is the payment made by the insurance company to the policy holder or claimant in case of death or occurrence of the event (for eg being diagnosed with a critical illness) specified in the insurance contract.
  2. Typically all insurers would endeavor to settle claim within 7-8 days of receiving necessary documents, duly filled forms and records. In case further verification is required, they would intimate the claimant about the same. IRDA guidelines direct insurers to settle claims within a month unless further verification is required. In case of further verification requirements, the claim must be settled within 6 months of submitting the intimation form. Interest must be paid by the insurer on the claim amount if not settled within 6 months, provided all requirements had been submitted.
  3. Claims can be death claim, rider claim or maturity claim depending on the type of policy held and the nature of event occurred. Death claim is payable on death of the person insured. Rider claim is payable when the event stipulated in the rider contract happens. It could be diagnosis of a disease, accident, disability, etc. Maturity claim is payable on policies that have maturity benefits, when the policy has completed its term.
  1. Claim should be lodged with the insurer as early as possible after the event occurs. Death claim becomes valid from the following day of signing the contract. Claim under mediclaim becomes valid after 30 days and under critical illness cover after 90 days of signing.
  2. Claim should be made by the nominee- one who is designated by the policy holder to make claim at the occurrence of the event. The nominee and insured can be the same person, as is possible in case of mediclaim or different persons like in life insurance.
1. List of standard documents any insurer would seek in case of death by natural reasons:
  • Filled claim intimation form
  • Original policy document
  • Original death certificate
  • Original certificate by physician who last attended
  • Past & present medical/hospitalization documents
  • Cremation/burial certificate

2. In case death is by an unnatural cause, say by accident, additional documents must be produced::

  • Police report
  • Police panchnama/FIR
  • Post mortem report
  • Chemical analysis report, if any

Some might ask to produce newspaper cutting with photograph of the accident, if available. All these must be duly certified by respective  authorities. In case of maturity claim, duly filled maturity claim form must be submitted.

If there has been delay in intimating them be prepared with a reason (reasonable one!) for the delay. Don't leave any stone unturned while making the claim, to avoid unnecessary hassles adding to your woes, keep every relevant document ready even if they might not require it.

  1. Fill and submit claim intimation form along with supporting records and documents as mentioned. It will be in your best interest to co-operate with the insurer in processing and/or investigating the claim. Documents are to be submitted at the nearest branch office of the insurer or from the branch that issued the contract, as directed by them.
  2. Claim amount will be paid to the nominee where policy holder is different from the insured. In case the nominee is a minor it will be paid to the appointee.
  3. You can check the status of your claim by calling the customer care helplines.

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