Life insurance claim rejection
Life insurance claim rejection
Life insurance claim rejection Paavani & Associates help interpret various insurance clauses, fill out related forms, represent you in various stages of Hospitalization. more
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Life insurance claim rejection
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Life insurance claim rejection

Claim Procedures Under Life Insurance

Life insurance claim rejection

Under LIC, claims can arise on maturity of policy or death of the policyholder. The LIC sends intimation at least 2 months before the maturity date. If the notice of maturity is not received and the date of maturity is known to the policyholder, then the policyholder can take the necessary steps to get the due Maturity amount.

Claims Procedure on Death (accidental or natural)

Intimation about death of policyholder should be given to LIC by any relative/ nominee/ assignee of the deceased policyholder which should contain the information:

Death certificate
Date, reason & place of death
Policy Number/s

Claims Procedure on Maturity

On maturity of policy, the policyholder has to submit certain requirements:

  • Submit the policy document (if not in the custody of LIC as security for loan) to the concerned branch office as mentioned on the policy
  • Collect discharge form no. 3825, put a revenue stamp & sign it, also get your signature attested by a witness and submit it to LIC
  • Submit a proof of age document (if age has not been admitted earlier)
  • Submit Assignment/ Re-assignment Deed, if any
  • Existence certificates in case of Children's Deferred Assurance and Pure Endowment policies

On Death (accidental or natural)

  • If the policyholder or Life Assured dies during the term of the policy, a death claim arises. Death claims are of two types:

Early Death Claim
- Claims arising within 2 years after date of risk/ revival/ reinstatement are termed as Early Claims or "Premature Claims". They can be classified into two groups:

  • Those having arisen within 2 years from the date of acceptance or risk or revival
  • Those having arisen after 2 years but within 3 years of acceptance of risk or revival

Non Early Claim - Claims arising more than 2 years after the date of risk/ revival are called as Non-Early Claims. However, the policy should be in force for at least 3 years at the time of death of Life Assured. For claiming the benefit, the nominee or any person related may apply to Insurance Company and the following documents are required further for settlement of claim:

  • Policy Document
  • If death has occurred due to an accident, then Police Panchnama & Senior Divisional Manager's verdict are required
  • Medical attendant's report (In proforma given by the insurance company)
  • Claimant's statement (In proforma given by the insurance company)
  • Death certificate
  • If the Life assured has been working before his or her death then the employer's certificate for last 5 years relating to leave record along with details of medical leave taken and reasons supported with photocopies of certificates issued by medical practitioner
  • The following documents should be submitted if death occurs after 3 years from the date of risk covered:

  • Policy Document
  • Death Certificate
  • Documentary evidence of age if the age was not admitted at the time of issuing the policy
  • Claimant's statement (Claim Form 'A')
  • Evidence of Title to the deceased's estate if policy is not nominated, assigned or issued under MWP Act
  • If death is due to an accident the Police Panchnama, Senior Divisional Manager's verdict for claiming Double Accident Benefit

Ex-gratia Settlement of Death Claims

Ex-gratia Settlement of Death Claims are not a right claim but on grounds of humanity, presently LIC is giving such claim amount for the policies which are not in force but

  • If Death occurred after the expiry of grace period of premium due date then Full Sum Assured along with the bonus will be payable as Ex-gratia settlement
  • If Death occurred after three months but less than six months after the expiry of first unpaid premium date then half of the Sum Assured without bonus will be paid as Ex-gratia
  • If the death occurred between six months and one year from the due date of the first unpaid premium date, then claim may be considered to the extent of the proportionate notional paid-up value on the basis of actual premium paid

Double Accident Benefit

The Insurance Company is not liable for any loss or damage after the expiry of 12 months from the date of loss unless the claim itself is the subject of pending action or arbitration.

If the insurance company disclaims liability then such claims have to be made the subject matter of a suit in a court of law within 12 calendar months from the date of the disclaimer. In case the dispute refers only to the amount of payment claimed then the matter has to be compulsorily referred to arbitration as per the provisions of the Indian Arbitration Act.