Presented By: Shalvi mahajan

Life Insurance can be termed as an agreement between the policy holder and the insurer, where the insurer for a consideration agrees to pay a sum of money upon the occurrence of the insured individual's or individuals' death or other event, such as terminal illness, critical illness or maturity of the policy.

A claim is the payment made by the insurer to the insured or claimant on the occurrence of the event specified in the contract, in return for the premiums paid for the insured. A claim is the demand that the insurer should redeem the promise made in the contract. The insurer has then to perform his part of the contract i.e. settle the claim, after satisfying himself that all the conditions and requirements for settlement of claim have been completed.

Death

claims

Maturity

claims

If the insured dies before the expiry of the term of the policy , it is called as death claim.
The

death of the life assured has to be intimated in writing to the insurer. may be done by the nominee, assignee, a relative of the life assured ,the employer, agent or development officer.

It

 Particulars

like - policy no. , - name of the life assured , - the date of death , - the cause of death & - the relationship of the informant to the deceased are to be mentioned.

 The

intimation must satisfy two conditions :

(a) it must be from a concerned person. (b) must established beyond doubt , the identify of the deceased person as the life assured under the policy.

The facts required to be submitted by the claimant are:

- date of death , - reason & place of death & - full details of policies held by the life assured should also be submitted.

 Non-early

death claims

Early

death claims

Non-early death claims refers to death of the life assured occurring after 3 years from the date of commencement of policy or date of last revival. If the policy is in force till death by regular payment of premiums ,full sum assured is payable along with bonus (if it is with a profit policy).

 Policy

document Death certificate from the appropriate authority Legal evidence of title, if the claimant is not an assignee/nominee Abridged claim form Discharge form duly signed

Assignment/reassignment deed, if any Age proof, if age is not already admitted.

once these documents are received and if they found in order , claim is settled and payment is made to the person entitled to.

Early death claims refer to the death of the life assured occurring within 3 years from commencement of policy.

 Statement

from the medical attendants who last treated the deceased life assured. Certificate of treatment issued by the hospital authorities where the deceased was treated last. Certificate of the employer if the deceased person was an employee. Certificate of cremation signed by a person who attended the funeral of the deceased.

In case of accidental death - where death takes place - the death has to be reported to the police i.e. FIR copy - post-mortem report (if conducted only) an enquiry is conducted to determine the genuineness of claim. On the basis of these , the decision to settle accidental benefits are taken.

Suicide or attempted suicide or intentional self-inflicted injury Under influence of drugs or alcohol, narcotics not prescribed by a Medical Professional. War, Invasion, Civil War, Riots, Revolution or any war like operation. Criminal or unlawful act Service in the military or police Flying activity other than as a paying passenger. Racing vehicle.

Maturity claims are payable as per the terms of the policy. These policies are generally endowment policies including money back policies. The amount payable at the time of maturity includes sum assured and bonuses/incentives.

Policy document Age proof ,if the age is not already admitted. Discharge form issued by the office.

On receipt of these documents post dated cheque is sent by post so as to reach the policyholder before the due date. The gross amount consists of Basic sum assured and bonus if any.

The amount of claim will be any of the following:

Sum assured Surrender value Paid-up value

The term surrender value refers to the amount of money which the insurer agrees to pay in case the life assured decides to surrender his policy before its maturity. According to Life insurance corporation of India, a policy acquires surrender value only after payment of two or three years premium. In this regard , some insurance companies guarantee a minimum surrender value of 40% of the total premium paid.

If a policy holder discontinues the payment of premium after atleast 2 years premiums have been paid and subsequent premium is not paid, the policy does not become void, but continues as a paid-up policy.

Paid-up value = no. of premium paid * sum assured no. of premium payable