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Life Insurance

Claims
 EssentialElements of Insurance
 Concept of Claim
 Beneficiaries under Life Insurance claims
 Claims Payment on Maturity
 Claims payment on Death
 Disputes in Life Insurance Claims
 Settlements of Claims
 Limitation of claims
 Concept of Insurable Interest

 Doctrine of Good Faith

 Proximate Cause
Claim is a right of insured to
receive the amount secured under
the policy of insurance contract
promised by Insurer.
Beneficiary depends on the following
conditions:-

 Nomination
 Transfer
 Assignment
 The amount insured or face value of policy

 Bonus if declared by company

 Share of profit in case of participation policy

 Surrender value if policy lapsed


Procedure of Claim Settlement
 Letter of intimation of Death including

4. Proof of Age

6. Death certificate

8. Policy number and name

10. Name & address of claimant


 Internal enquiry when notice received

3. Any dues pending


4. Policy status lapsed or running
5. Exclusions & inclusions of that policy
6. Nomination, assignment or transfer
7. Cause of death
8. Place of death
9. Hospitalization details (if any)
10. Statement of Doctor & hospital
11. Statement from organization where
the person is working
 For unnatural death accidents or suicide etc
2. FIR
3. post mortem
4. chemical analysis report

 If original death certificate not available, then


alternative proofs considered such as-

8. Death in air crash

10. Disappearance on board a ship

12. Presumption of Death if not seen for seven years


Procedure for Claim settlement

3. Policy document submission


4. Age Proof
5. Internal enquiry
6. Original Deed of assignment (if any)
7. Other documents (Receipt of Payment etc)
 Identify the person to whom the payment is to be
made

 Whether the payment is within the terms of policy

 Whether the amount claimed is reasonable

 Proof of Death

 Identification
of assignee, nominee or the legal heir to
whom the payment is to be made
 Settlement within sixty days if no Dispute

 In case of dispute, company can apply to court


within ninety days on following
circumstances:

 When there is conflicting claimants


 When there is insufficiency of proof
 When there is any other adequate reason
Limitation of claim
Claim concessions

Administrative concessions

Ex-Gratia
Case study
 Kantiben took life insurance policy on 2-3-97
for two lakh & paid premium regularly
 In 1999 she was diagnosed as suffering from
cancer
 Continued to pay premium without any notice
to LIC & She expired in 2 feb 2000
 Nominee approached to LIC for claim
 LIC refused to pay on the basis of fraudulent
to not report her health status when she was
required to do so.
 Nominee approached to State commission for
justice
Case study
 Dharam took policy on 3-7-96 with FIL for 5
lakh & submitted his medical report
 After two year he diagnosed Rheumatic Heart
disease & died on 11-9-99
 His wife claimed for payment
 FIL repudiated the claim on context of hiding
information about disease
 His wife then approached to state commission
for justice

What do you think should she get sum assured


or surrender value or nothing.