Page 16 - Life Insurance Today April 2018

(iv) Conditions for renewal of the contract. Insurer in settling the claim on due date, the life
3. Every insurer shall keep the insured informed on the insurer shall pay interest at a rate, which is 2%
above bank rate from the due date of payment
requirements to be fulfilled regarding lodging of a
or date of receipt of last necessary document
claim arising in terms of the policy and the procedures
from the insured/claimant, whichever is later.
to be followed by him so as to settle claim early.
(v) In respect of free look cancellation, surrender,
14. CLAIMS PROCEDURE IN RESPECT OF A LIFE INSURANCE withdrawal, request for refund of proposal
POLICY deposit, refund of outstanding proposal deposit
1. A life insurer, upon receiving a death claim, shall if any, shall be processed and paid within 15
process the claim without delay. Any queries or days of receipt of request or last necessary
requirement of additional documents, shall be raised document, failing which the insurer shall pay
all together and not in a piece-meal manner, within penal interest at a rate, which is 2% above bank
a period of 15 days of the receipt of the claim. rate from the date of request or receipt of last
necessary document if any whichever is later,
2. (i) A death claim under a life insurance policy shall
be paid or be rejected or repudiated giving all from the insured/claimant.
the relevant reasons, within 30 days from the Explanation: Administration of Health Insurance
date of receipt of all relevant papers and Policies issued by Life Insurers shall also be
required clarifications. However, where the governed by Chapter IV of IRDAI (Health
circumstances of a claim warrant an Insurance) Regulations, 2016.
investigation in the opinion of the insurer, it
(vi) The interest payments referred above in sub
shall initiate the same at the earliest and
regulations (ii), (iii), (iv), (v) shall be paid by the
complete such investigation expeditiously, in
Life Insurer suo moto without waiting for
any case not later than 90 days from the date specific demand from the insured/claimant.
of receipt of claim intimation and the claim shall
be settled within 30 days thereafter. 15. Claim procedure in respect of a General
(ii) If there is delay on the part of Insurer beyond Insurance Policy
the timelines mentioned in sub regulation (i)
1. An insured or the claimant shall give notice to the
above, the insurer shall pay interest at a rate,
insurer of any loss arising under contract of insurance
which is 2% above bank rate from the date of
at the earliest or within such extended time as may
receipt of last necessary document be allowed by the insurer. On receipt of such a
(iii) Except in the case of claims where an communication, a general insurer shall respond
application is made under section 47 of the Act immediately and give clear information to the insured
to the court, if a claim is ready for payment but on the procedures that he should follow. In cases
the payment cannot be made due to any where a surveyor has to be appointed for assessing a
reasons of proper identification of the payee, loss/claim, it shall do so immediately, in any case
the life insurer shall pay interest on the claim within 72 hours of the receipt of intimation from the
amount at the bank rate from the date on insured. Insurer shall communicate the details of the
which claim is ready for payment. appointment of surveyor, including the role, duties
(iv) In respect of Maturity, Survival Benefit claims and responsibilities of the surveyor to the insured by
and Annuities, the Life Insurer shall initiate the letter, email or any other electronic form immediately
claim process by sending intimation sufficiently after the appointment of the surveyor.
in advance or send post-dated cheque or give 2. The insurer / surveyor shall within 7 days of the claim
direct credit to the bank account of claimant intimation, inform the insured / claimant of the
through any electronic mode approved by RBI, essential documents and other requirements that the
so as to pay the claim on or before the due claimant should submit in support of the claim.
date. In case of any delay on the part of the Where documents are available in public domain or

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16 April 2018 Life Insurance Today