We regulate the Indian insurance
industry to protect the interests of the policyholders and work for the orderly
growth of the industry.
Fraud affects the lives of innocent people as well as the
insurance industry. Insurance fraud has existed ever since the beginning of
insurance as a commercial enterprise. It takes many forms and may occur in any
areas of insurance.
Hard Frauds and Soft Frauds
An insurance fraud could either be a hard fraud or a soft fraud.
A hard fraud occurs when someone deliberately plans or invents a loss such as a
theft of a motor vehicle or setting fire to property covered by an insurance
policy.
Soft frauds are more common and include exaggeration of legitimate claims by
policyholders. They are also referred to as opportunistic frauds.
Insurance companies, their intermediaries or those pretending to
be either of them may also perpetrate frauds. It is important that fraudulent
activities are eliminated from the industry and it is the duty of all
stakeholders to do their bit in dealing with insurance fraud.
The IRDA has come across certain instances of fraudulent
activities and has issued alerts to the public about them
IRDA’s Mission
Insurance Regulatory and
Development Authority (IRDA) Act, 1999 spells out the Mission of IRDA as:
“... to protect the interests of the policyholders, to regulate, promote and
ensure orderly growth of the insurance industry and for matters connected
therewith or incidental thereto......”
Functions and Duties of IRDA
Section 14 of the IRDA Act, 1999 lays down the duties, powers and functions of
IRDA.
- Registering and regulating insurance companies
- Protecting policyholders’ interests
- Licensing and establishing norms for insurance
intermediaries
- Promoting professional organisations in insurance
- Regulating and overseeing premium rates and terms
of non-life insurance covers
- Specifying financial reporting norms of insurance
companies
- Regulating investment of policyholders’ funds by
insurance companies
- Ensuring the maintenance of solvency margin by
insurance companies
- Ensuring insurance coverage in rural areas and of
vulnerable sections of society
You have bought an insurance
policy but now you have a problem with it. Your insurance company is either
disputing or rejecting your claim and you are wondering where to turn for help.
Don't worry! The Insurance Ombudsman Scheme was created to help consumers in
your position.
When you buy any policy, and
especially a Unit-linked insurance policy (ULIP) it is very important to find
out the terms and coverages it offers. ULIPs are complex policies and it is
worth your time to find out their terms. And it is not difficult, all you have
to do is ask questions and listen to the answers at the time of buying the
policy, as Ranjan discovers.
Insurance is your best friend in
your time of need IF you have been honest and transparent at the time of
filling up your proposal form. If not, you could end up being the loser even
though you have paid for an insurance policy, as Ranjan finds out the hard way.
Cutting corners to save money may
be a prudent financial practice, but not when it comes to insurance. See how
Ranjan loses out in a big way after underinsuring his house with an eye on
saving a relatively small expense in the form of premium.
Your insurance policy turned out
to be not as you had understood and expected it to be? Upset and bitter that
you have a policy that does not suit you? Don't lose heart. You can return the
policy within 15 days of receiving it and get some refund of your premium. Feel
encouraged? Learn along with Ranjan how this is possible!
Filling forms and taking care of
documentation is boring work, right? Maybe, but if it is a proposal form for
insurance that you are filling, it will be to your best advantage to fill it in
yourself meticulously and perfectly. That way your policy will be correct and
you will be relieved at the time of a claim. Ranjan gets a lecture on why he
should not shy away from boring chores like filling proposal forms.
How To Make a Claim - Life
Formalities for a death claim
When a person with a life insurance policy – called a life assured
– dies, a claim intimation should be sent to the insurance company as early as
possible. The assignee or nominee under the policy can do this. So can any
close relative or the agent who handles the policy.
The claim intimation should contain information like the date,
place and cause of death. The insurance agent has the duty to help the life
assured’s family/ assignee to deal with the insurance company to fulfil the
formalities for a claim.
The insurance company will respond to this intimation and will ask
for the following documents:
- Filled-up
claim form (provided by the insurance company)
- Certificate
of death
- Policy
document
- Deeds
of assignments/ re-assignments if any
- Legal
evidence of title, if the policy is not assigned or nominated
- Form
of discharge executed and witnessed
Other documents such as medical attendant's certificate, hospital
certificate, employer's certificate, police inquest report, post mortem report
etc could be called for, as applicable.
Formalities for a maturity claim
Where a life insurance policy is maturing, the insurance company
will usually send intimation to the policyholder along with a discharge voucher
at least two to three months in advance of the date of maturity giving details
like the maturity amount payable.
The policyholder has to sign the discharge voucher – which is like
a receipt – have his signature witnessed and send it back to the insurance
company along with the original policy bond to enable it to make the payment.
If the policy has been assigned in favour of any other person or entity – like
a housing loan company – the claim amount will be paid only to the assignee who
will give the discharge.
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Q.
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What should I look for
before I decide to buy a policy?
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A.
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You must check and see
whether or not there is availability of guarantee of return, what the lock in
period is, details of premium to be paid, what would be implications of
premium default, what the revival conditions are what the policy terms are,
what are the charges that would be deducted, would loan be available etc.
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Category Name :
Conventional Life Insurance
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Q.
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What is the importance
of a proposal and the disclosures made therein?
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A.
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The disclosures made in a
proposal are the basis for underwriting a policy and therefore any wrong
statements or disclosures can lead to denial of a claim.
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Category Name :
Conventional Life Insurance
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Q.
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What are special
medical reports required to be submitted in Life insurance?
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A.
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In case of certain
proposals, depending upon the age of entry, age at maturity, sum assured,
family history and personal history, special medical reports may be necessary
for consideration of a risk. E.g. if the proposer is overweight, special
reports like Electro Cardiogram, Glucose Tolerance test etc could be
required, while for underweight proposers, X-ray of the chest and lungs with
reports could be required.
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Category Name :
Conventional Life Insurance
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Q.
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What is meant by
Paid-up Value in Conventional Life Insurance Policy?
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A.
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After premiums are paid for
a certain defined period or beyond and if subsequent premiums are not paid,
the sum assured is reduced to a proportionate sum, which bears the same ratio
to the full sum assured as the number of premiums actually paid bears to the
total number originally stipulated in the policy. For example, if sum
assured is 1 lakh and the total number of premiums is payable is 20 (20 years
policy, mode of premium is assumed yearly) and default occurs after 10 yearly
premiums are paid, the policy acquires the paid up value of 50,000/-. Paid up
Value = No. of Premiums Paid / No. of Premiums Payable X S.A=10/20 X 100000 =
50000/-. This means that the policy is effective as before except that
from the date the 11th premium was due, the sum assured is 50,000/- instead
of original 1,00,000/-. To this sum assured the bonus already vested
(accrued) before the policy lapsed, is also added. Example if the bonus
accrued up to the date of lapse is 35,000/-, the total paid up value is 50000
+ 35000 = 85000.
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Category Name :
Conventional Life Insurance
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Q.
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How is Surrender Value
calculated in Conventional Life Insurance Policy?
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A.
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Surrender Value is allowed
as a percentage of this paid up value. Surrender value is calculated as
per the surrender value factor, which depends on the premiums paid and
elapsed duration.
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Category Name :
Conventional Life Insurance
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Q.
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How is the Loan on
Policy calculated under Conventional Life Insurance Policies?
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A.
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If the policy conditions
permit grant of loan, loan is sanctioned as a percentage of the Surrender
Value.
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Category Name :
Conventional Life Insurance
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Q.
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What are the
requirements to be submitted in case of a Maturity Claim?
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A.
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Usually the Insurance
Company will send intimation attaching the discharge voucher to the policy
holder at least 2 to 3 months in advance of the date of maturity of the
policy intimating the claim amount payable. The policy bond and the
discharge voucher duly signed and witnessed are to be returned to the
insurance company immediately so that the insurance company will be able to
make payment. If the policy is assigned in favour of any other person the
claim amount will be paid only to the assignee who will give the discharge.
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Category Name :
Conventional Life Insurance
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Q.
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What is meant by
settlement options?
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A.
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Settlement option means the
facility made available to the policy holder to receive the maturity proceeds
in a defined manner (the terms and conditions are specified in advance at the
inception of the contract).
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Category Name :
Conventional Life Insurance
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Q.
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What documents are
generally required to be submitted in case of death of life assured while the
policy is in force?
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A.
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The basic documents that are
generally required are death certificate, claim form and policy bond, Other
documents such as medical attendant's certificate, hospital certificate,
employer's certificate, police inquest report, post mortem report etc could
be called for, as applicable. The claim requirements are usually disclosed in
the policy bond.
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Category Name :
Conventional Life Insurance
Call 7350384222 today
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ency to 60 plus percentage.
