Process Of Filing A Death Claim And When It Is Not Payable

The process of filing life insurance death claim is quite simple and straight forward. The first thing to do is to intimate the insurer. The claimant should contact the insurance agent from whom the insurance policy was purchased. He/she will guide you through the process of submitting different documents and the procedure. If the claimant does not know the agent then the insurance company should be contacted directly.
1. Claim intimation: The claimant has to submit the Claim Form to the insurance company. The forms are available with the insurance company’s branch offices or can be downloaded from the insurer’s website. The Claim Form requires information like the insurance policy number, name of the insured, date, place and cause of death, name of the claimant etc.
2. Submission of required documents: The claimant needs to submit the original policy documents and the death certificate. The other documents required are �
a)For natural death/ death due to illness- medical reports, attending physician’s report.
b)For unnatural death/ in accident- autopsy report, police FIR, Panchnama report.
Depending on the sum insured or cause of death, the insurance company may require some additional documents/ certificates.
Once the necessary formalities have been completed, IRDA regulations stipulate that a claim be settled within 30 days from the day all documents are submitted. In case an insurance company needs to conduct further verification, all procedures should be completed within 6 months from the date of claim.
Speedy settlement of claims is a service that a life insurance company is expected to provide, but there are some circumstances when the insurance company can deny the sum insured and the claim is not payable. Some of those reasons are:-
1. If the policy holder, whether sane or insane, commits suicide within one year of the commencement of the policy then no claim is payable.
2. Death occurs under circumstances mentioned in the Exclusions of the policy for e.g. due to participation in a hazardous activity like sky diving.
3. Misrepresentation of facts relating to health- an insurance company can refuse a claim if false/incomplete information is found to be given at the time of purchase of policy. However this can be done only before the �incontestable period’ i.e. within 2 years of policy commencement. If the insurance company proves that certain information provided was done fraudulently, for e.g. someone other than the policy holder takes the medical examination, the death claim can be forfeited even during the incontestable period.
4. One very commonly told fib by prospective policy holders is that they are non smokers when in fact they are not. In a risk cover for critical illness especially, it is very important to disclose the insured’s smoking habits truthfully. Discovery of non-disclosure of the insured being a smoker could lead to the death claim being rejected causing tremendous difficulty for the nominee.
5. If it is found that a person had taken a life insurance policy for another individual with himself/ herself as the beneficiary with the intention of murdering the insured for gain.
A life insurance policy is a contract of �utmost good faith’, meaning that both the insured and insurer are mutually obliged to disclose all facts known to them that are relevant to the policy. It is imperative that the insured honestly discloses all information required while buying an insurance policy to ensure a problem free settlement.