Page 14 - Life Insurance Today February 2018
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(ii) Exclusions specific to the policy which rate from the date of receipt of last
cannot be waived, necessary document
(iii) Exclusions specific to the policy, which can (iii) Except in the case of claims where an
be waived on payment of additional application is made under section 47 of the
premium. Act to the court, if a claim is ready for
payment but the payment cannot be made
2. The insurers may also endeavour to broadly
due to any reasons of proper identification
categorize policy conditions into following, so as
to give clarity and understanding of the of the payee, the life insurer shall pay
conditions to the policyholder: interest on the claim amount at the bank
(i) Conditions precedent to the contract, rate from the date on which claim is ready
for payment.
(ii) Conditions applicable during the contract,
(iv) In respect of Maturity, Survival Benefit
(iii) Conditions when a claim arises, claims and Annuities, the Life Insurer shall
(iv) Conditions for renewal of the contract. initiate the claim process by sending
3. Every insurer shall keep the insured informed on intimation sufficiently in advance or send
the requirements to be fulfilled regarding post-dated cheque or give direct credit to
the bank account of claimant through any
lodging of a claim arising in terms of the policy
and the procedures to be followed by him so as electronic mode approved by RBI, so as to
to settle claim early. pay the claim on or before the due date.
In case of any delay on the part of the
Insurer in settling the claim on due date,
14. Claims procedure in respect of a Life
the life insurer shall pay interest at a rate,
Insurance Policy which is 2% above bank rate from the due
1. A life insurer, upon receiving a death claim, shall date of payment or date of receipt of last
process the claim without delay. Any queries or necessary document from the insured/
requirement of additional documents, shall be claimant, whichever is later.
raised all together and not in a piece-meal (v) In respect of free look cancellation,
manner, within a period of 15 days of the receipt surrender, withdrawal, request for refund
of the claim. of proposal deposit, refund of outstanding
2. (i) A death claim under a life insurance policy proposal deposit if any, shall be processed
shall be paid or be rejected or repudiated and paid within 15 days of receipt of
giving all the relevant reasons, within 30 request or last necessary document, failing
days from the date of receipt of all relevant which the insurer shall pay penal interest
papers and required clarifications. at a rate, which is 2% above bank rate from
However, where the circumstances of a the date of request or receipt of last
claim warrant an investigation in the necessary document if any whichever is
opinion of the insurer, it shall initiate the later, from the insured/claimant.
same at the earliest and complete such Explanation: Administration of Health
investigation expeditiously, in any case not Insurance Policies issued by Life Insurers
later than 90 days from the date of receipt shall also be governed by Chapter IV of
of claim intimation and the claim shall be IRDAI (Health Insurance) Regulations, 2016.
settled within 30 days thereafter.
(vi) The interest payments referred above in
(ii) If there is delay on the part of Insurer sub regulations (ii), (iii), (iv), (v) shall be
beyond the timelines mentioned in sub paid by the Life Insurer suo moto without
regulation (i) above, the insurer shall pay waiting for specific demand from the
interest at a rate, which is 2% above bank insured/claimant.
“Change is inevitable. Progress is optional.”
14 February 2018 Life Insurance Today
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