Chapter 16

Payments Under A Life Insurance policy

Claim Its a demand that insurer should make good the promise
specified in the contract .
Types of Claim Survival Benefit Periodic payments are made during
the term of the policy , by the insurer
( eg money back plan ) . policy bond
is returned to policyholder bearing the
endorsement on each survival benefit
paid
Surrender Premature closure or voluntary
termination of the contract by the
policyholder during the Term .
Rider Benefits On occurrence of specified event , as
mentioned in the policy document .
Eg critical illness rider , hospital care
rider
Maturity Benefit Insurer pays the benefit at the end of
the term to the life assured on
surviving the entire term
Under maturity claim Participating Plan SA + accumulated
Bonuses(if any ) less
any outstanding
premium / policy
loan & interest theron
Return of Certain term plans
premium Plan allows the life
(ROP) assured to get back
all the premium paid
during the term after
maturity
ULIP Fund value is paid
Money Back Maturity claim
 minus the survival
benefits already paid

Death Claim Paid to the nominee/ legal hier or assignee as may be the case
on event of death of the Policyholder .
Claim may be early death ( less than 3 years from policy
inception ) or Non early ( after 3 years period of policy
inception )
Documentation #Claim form by nominee
in death claim #certificate of burial or cremation
# Treating physician report
# hospital certificate
# employers certificate
# death certification issued by municipality office
# FIR / Post mortem report / Inquest report
Repudiation of In case of wrong information or fraudulent intention found ,
death claim claim will be repudiated .

Sec 45 , Indisputable clause :no policy can be called back by insurer

Insurance act post 2 years , on reason of asking for more information from
1938 the insured , unless the insurer shows statement was of
inaccurate or suppressed facts .

Insurer has to prove . Only after obtaining the proof , can an

Insurer repudate the policy after two years period .

Presumption of Missing person case , waiting period is 7 years for settling

Death death claim from the date of FIR and court decree .
Premiums need to be paid for these 7 years

Claim Regulation 8 of IRDA , 2002

Procedure # Policy should state the primary documents which are
normally reqired at the time of claim
# 15 days period for insurer to ask for any other information
from date of receipt of claim . No piece meal basis asking of
documents .
# claim to be paid or disputed within 30 days from the date
 of receipt of all required documents & clarification .
# In case of any investigation required , then insurance
company to complete the same within 6 months of receipt of
claim .
# subject to provision in sec 47 , where claim is ready to be
paid , but is not paid due to any reason of proper
identification of payee , the insurer will have to pay interest
as per the rate applicable of scheduled bank ,( effective from
30 days from the date of receipt of claim document )
# In case of delay from insurer in settling the claim , insurer
has to pay 2% intrest rate above the bank rate prevalent at
beginning of the financial year .

Riders A provision added through endorsement . Provides

supplementary benefits or to increase the amount of death
benefit provided by the policy .
Critical Covers critical illness . In case of diagnosis
Illness during the tem of the plan , Rider benefits are
riders paid to the life assured and the rider benefit
comes to an end .
Accident In case of death happening due to accident , the
death n rider amount is paid to the nominee along
benefit with the base plan benefits
Waiver of In case of disability during the trem of the
premium plan , future premium is waived off and the
policy will continue with all benefits as per the
initial contract
Disability In case of permanent disability, the insurer will
rider either pay rider amount in full or in part to the
life assured