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Making a claim

Making a claim

An insurance policy is meant to compensate you in case of a loss of income due to health reasons, or your financial dependents in the event of your death.

An insurance policy is meant to compensate you in case of a loss of income due to health reasons, or your financial dependents in the event of your death. However, most people believe that making a claim is complex. That’s not true; if you know the policy clauses, and if your paperwork is in order.

THE PROCESS

Intimation

  • Inform the company, in writing, that you intend to file a claim
  • Use the claim intimation form available on the insurer’s website or at its branch offices or ask your serving agent for the form
  • To ensure quick processing, make sure to mention the policy number, name of the insured, date and cause of claim, and name and address of the claimant in the intimation

Procedure

  • Submit all the required papers (see Paperwork) to the nearest branch or the corporate claims cell of the insurance company
  • The insurer should inform you of the status within 15 days; you will also be informed if supplementary documentation is needed

Settlement

  • If the documents and forms are in order and the claim is approved, the insurer will send the payment within two weeks (at the most)
  • If the claim is rejected, the insurer sends the claimant the reasons for rejection in a detailed letter

THE PAPERWORK

  • Original policy document
  • Copy of death certificate issued by local authority (only for death claims)
  • Claimant’s statement
  • Treating doctor’s certificate
  • Family doctor’s certificate
  • Employer’s certificate (for salaried group policy)
  • Medical records such as admission notes, discharge/death summary

MATURITY CLAIMS

When the policy matures, you need to file a claim to get the money due.

  • Completed claim form
  • Policy document of life assurance (original)
  • Proof of age, if not submitted earlier
  • Other documents that may be required (bank account details, PAN card, proof of survival)

LOSS/DAMAGE/LAPSE

  • Insurance certificate (bond) is your proof of having the policy. Making a claim will be very difficult in case you lose, misplace or damage the certificate
  • However, in case the document gets lost or damaged, you can apply for a duplicate policy
  • If the bond is only partially destroyed submit the remaining portion to the insurance company as evidence
  • Again, you can apply for a duplicate if the bond is untraceable due to unknown causes

Applying for a duplicate policy

  • There is no fixed format to avail yourself of a duplicate policy; however, some insurers ask for a newspaper advertisement at your cost in one English daily with wide circulation in the state where the loss occurred declaring the loss of policy.
  • A copy of the newspaper should be sent to the servicing office one month after the advertisement appeared
  • If no objection has been lodged with the insurer regarding the policy, a duplicate will be issued after some formalities (indemnity bond, payment for preparing duplicate policy, stamp fees, etc)

GRIEVANCE

If your insurer’s grievance/customer complaint cell does not address a complaint, you can take up the matter with the Insurance Regulatory and Development Authority (Irda):

Sudipta Bhattacharya, Senior Assistant Director, Insurance Regulatory and Development Authority, Parishrama Bhawanam, 5-9-58/B, Basheerbagh, Hyderabad – 500004, (040) 66820964/66789768 Extension–251, e-mail id: lifecomplaints@irda.gov.in

Irda’s Grievance Redressal Cell looks into complaints from policyholders, by taking up these complaints with the insurers concerned. Life insurance complaints are dealt with separately.

Complainants can also approach the insurance ombudsmen who are located in 12 locations in the country and have a wide area of jurisdiction to address grievances of policyholders. The location for each ombudsman can be got from www.irdaindia.org.