RIVAL CLAIM: If more than one person claims the policy moneys, it is called as Rival Claim. Such rival claimants are advised to approach a court with a request to serve a prohibitory order on the insurers from making the payment. Such an Order from the court should be served on the insurers within a fortnight from the date of insurer's advice to the effect. If the court stays the payment, the insurer has to wait till the court passes final order regarding payment.
LIMITATION PERIOD: Limitation Act, 1963 says that no claim can be made after a period of 3 years from the date of claim or from the date of last correspondence. In life insurance, if a claim arises, whether intimated immediately or not, the amount has to be paid in discharge of the insurer's duties under the contract. If the payment can not be made immediately because the intimation was not given within 3 years from the date of the claim or intimation, the payment has still to be made. The provisions of the Limitation Act do not apply to insurance contracts.
PRESUMPTION OF DEATH: In respect of death claim, proof of death is essential. A death certificate issued by the municipal office or similar local body is the acceptable proof of death. A certificate of burial or cremation can also be obtained. Statements from witnesses to the last rites will be supporting evidence. In the case of accidents or air crashes or on seas or natural calamities, the bodies may not be found. In such cases, insurers rely on statements from the carriers or other authorities with the relevant information. In case of defence personnel, a certificate from the commanding officer of the unit is to be obtained. If a court of enquiry is ordered, its findings should be obtained.
Sometimes a person is reported missing without any information about his whereabouts. The Indian Evidence Act provides for presumption of death in such cases, if he has not been heard of for seven years. If the nominee or heirs claim that the life assured is missing and must be presumed to be dead, the insurers insist on a decree from a competent court. It is necessary that the premiums should be paid till the court decrees presumption of death. The insurer may also act on its own without a decree of the court, if reasonably strong circumstantial evidence exists to show that the life assured could not have survived a fatal accident or hazard. Insurers may as a matter of concession, waive the premiums during the seven years' period.
ACCIDENT AND DISABILITY BENEFITS: These benefits are conditional on conclusive evidence, that all the eligibility conditions are satisfied and that the exclusions do not apply. The conditions are that –
- the accident must be caused by outward, violent and visible means, not self inflicted
- the death must be a result of injuries caused by that accident
- the death must occur within 120 days or such other period as may be
The exclusions may be –
- intentional self injury, attempted suicide, insanity, immorality, intoxication
- accident while engaged in civil aviation or aeronautics, other than as a passenger
- injuries resulting from riots, civil commotion etc.,
Claim settlement would require the following documents as evidences -
- First information report (FIR)
- Panchnama of accident site
- Police report
- Post mortem report
- Chemical examiner's report, in case of poisoning, drugs, narcotics, etc.
- Hospital reports, if any
CRITICAL ILLNESS CLAIMS
The benefits would be payable on satisfactory evidence, in the nature of hospital and other medical reports, that the conditions of criticality, waiting period and illness are met.
IRDA REGULATIONS: IRDA has set forth following guidelines for Insurers regarding settlement of Claim -
- the insurer should ask for all the requirements in the case of a death claim at one time and not piecemeal.
- the decision to admit or to repudiate should be made within 30 days of receipt of all papers
- If an investigation is necessary, it should be completed within 6 months
- Interest at 2% over the Bank rate, will be payable for delays in settling the death claims
- Interest at the Savings Bank rate will be paid if the insurer is ready to pay but the claimants are not ready to collect