Understanding Claim Settlement Ratio

In the claims findings if it is established that there had been a material suppression of facts pertaining to the proposal information, which would have impacted the assessment of risk, if disclosed at the proposal stage, then it may lead to repudiation of the claim.

If documents submitted at the Proposal / Claims stage are not genuine, it would also lead to claim repudiation.

Hence it is very important to read through the Proposal form and submit factual details at the proposal stage and provide genuine Know Your Customer requirements to ensure that in case of the unfortunate event of death, the claim always gets paid.

The IRDAI (Insurance Regulatory and Development Authority of India) guidelines state that a claim will have to be paid within 30 days from the date of receipt of all claim documents.

In case the claim warrants an investigation, then the insurance company has to complete the investigation not later than 120 days from the time of making the claim.

Moreover, if a claim is ready for payment but the payment cannot be made because of conflicts or insufficiency of proof of title, then the insurer may apply to pay the amount into the Court, or, such an amount will earn interest at the prevalent rate applicable to a savings bank account.

Once the payment is credited to the Beneficiary's Account successfully, Claims Dept would send a communication letter and mailer to the Customer with the details of the electronic transfer.

If the Karta under the Policy has expired, then claim documents needs to be filled by new Karta of HUF and the standard set of claim requirement needs to be submitted depending on early /non-early claim.

If the policy is issued under the Keyman Insurance Policy, then standard set of claim documents needs to be submitted by the Employer depending on early /non-early claim and the claim monies would be disbursed in favor of the Employer.

If the Nominee has also expired, then Claimant's statement can be filled by the nearest blood relative who is claiming for Policy monies. However they would need to furnish legal documents as required by the Claims Dept to disburse the claim proceeds in their favor.

If the nominee is minor and there is no appointee, then claim forms needs to be filled by the individual who is custodian of the minor nominee. However they would need to furnish the legal documents as required by the Claims Dept to disburse the claim proceeds.

Transfer of part/full death claim proceeds in new business is not allowed.

Claimant should submit the Original cheque along with the written statement stating the reason for re-issuance and payment option alongwith the documentary proof of Bank details to nearest Aditya Birla Sun Life Insurance Branch.

Ps: For cases wherein cheque is lost then requirement of Original cheque is not applicable.

Please refer the glossary below of the various requirements called for:

Claimant's Statement: - It is required to be completed by the person entitled to policy moneys.

Medical Attendant Certificate: - It is to be filled by the doctor / hospital who attended on the life assured during his / her terminal illness or who certified his / her death. In case the Life Assured was not having any terminal illness prior to death and death was not certified by any doctor then it needs to be completed by the life assured's family physician.

Employer's Certificate: - This has to be completed by the employer of the deceased.

Indemnity bond for loss of Original Policy Document: - To be submitted where the Original Policy Document is lost / misplaced

FIR: - FIR stands for First Information Report which is a written document prepared by Police Authorities generally when a complaint is lodged with the police by the victim of a cognizable offense or by someone on his or her behalf, but anyone can make such a report either orally or in writing to the police.

Post Mortem Report: - An examination of a dead body to determine the cause of death.

Application for dispensing with Legal Evidence of Title: - Application for dispensing with Legal evidence of title is only called if the policy was not nominated or Nominee has expired or if there is no appointee. The document is to establish the existing legal heirs of the deceased Life Assured. The document needs to be executed on a Non-Judicial Stamp Paper of Rs. 200/- and should be attested by Notary Public.

Guardianship Certificate: - It's a Certificate issued by judicial authority to a legal guardian who has the legal authority to care for the personal and property interests of the Minor Nominee Succession Certificate.

Legal heirs Certificate: - A Legal Heirship Certificate is issued by a Judicial Authority. Prior to the issuance of the Legal Heirship Certificate, a summary enquiry is undertaken by the Judicial Authority, through his or her functionaries, to ascertain the legal heirs of the deceased, so far as may be possible. A certificate is issued on the basis thereof.