Claims Settlement
Claim questions test timelines, documents, the Section 45 bar and the suicide clause - the difference between a claim at year 2 and year 4 changes the answer entirely.
Death claim workflow
- Intimation, claim form, death certificate, original policy, nominee's identity and bank details, hospital and medical records. For accidental or unnatural death, add FIR, post-mortem and police report. For presumptive death, a court declaration after seven years' absence is needed.
- Early claim (within three years of issue or revival) is investigated as a matter of routine.
- Section 45: after three years from issue, revival or rider addition, a policy cannot be called in question on the ground of misstatement; the insurer must prove fraud.
- Suicide: death by suicide within 12 months of issue or revival limits the payout to at least 80% of premiums paid (Insurance Laws (Amendment) Act, 2015), not the sum assured.
- Timelines: settlement within 30 days of the last necessary document; if investigation is required, within six months; delay attracts interest at 2% above the bank rate.
Worked example
Death in policy year 4 from a heart attack; the file shows a pre-proposal hospitalisation for chest pain. Reasoning: the policy is beyond three years, so Section 45 applies - the insurer must prove fraudulent suppression, not mere omission. Unless intent to deceive is established, the claim is payable. If the same death had occurred in year 2, material non-disclosure would justify repudiation.
Traps
Quoting 100% of premiums paid in a suicide claim - the statutory floor is 80%. Treating the nominee as the owner of the money. Assuming every death needs a post-mortem. Believing the insurer may take unlimited time to investigate.