Death is somethivng which is an unpredictable event. It is always better to get a life insurance so as to financially secure future of loved ones. In case an unfortunate event occurs, nominee need to apply for a claim.
However, it may happen that claim is rejected due to provisions of section 45 of Insurance Act.
Section 45 of Insurance Act: If insured event occurs within 3 years of policy commencement or reinstatement then insured event need to investigate case to curb malpractices of a wrong entry among pool of policy holder.
It is important to note that claim cannot be rejected after 3 years of-policy commencement or reinstatement on ground of non-disclosure of material facts. However claim can be rejected after 3 years on ground of fraud in insured event or involvement in criminal activity.
Therefore, it is advisable to be aware of the reasons for claim rejection of early death before filling a death claim.
Common Reasons of Death Claim Rejection:
Non-disclosure of Material facts
Non-disclosure or concealing important facts, at the time of purchasing an insurance policy, might help you to get a policy and that too, at a lower premium, but at the time of death, your claim can be denied on the grounds of non-disclosure of material facts. Hence, it is necessary to give your correct details to your insurer. Given below are the list of material facts which should be declared with utmost honesty:
- Medical History – all information related to your health should be declared.
- Occupation – Nature of work is important and should be declared.
- Income – Sum assured has to be in proportion to your age and income earned. High sum assured to a person who is earning less will be considered as moral hazard.
- Habits – like alcohol consumption, tobacco, cigarette, etc.
- Family history – In case your parents are suffering from any critical disease or died early.
- Details of insurance policy: All details relating to application, rejection, lapse, premium paid, sum assured.
- Height and weight
- Travel history to dangerous countries like Sudan.
- Hobbies like adventurous sports like para gliding.
Suicide
Claim is not payable if death has happened due to suicide in first year of policy commencement or reinstatement.
Unpaid-Premium
Claim can be rejected if premium is not paid but nominee must understand the following:
- In term insurance – there is a grace period of 30 days for policy under all mode except monthly mode where only 15 days grace is allowed. So claim is payable if death has happened under grace period but unpaid premium amount will be charged from the death claim.
- In ULIP – Same as term insurance
- Participating Plan – As per new IRDA rules, each Par plan generate a surrender value after 2 years hence reduced sum assured is applicable for all claims.
Hence, it is important that all premiums are paid on time.
Nominee Details
Sometimes a policyholder forgets to provide or update the details of a nominee. It would be difficult for the insurer to identify the rightful person to give the claim money and therefore life insurance claim in death can be delayed because Insurance Company may demand Court Succession certificate.
Nomination gives only a right to claim the money but nominee may not be a beneficiary. Hence, claims are delayed when there is a family dispute and company may demand court succession certificate.
Criminal Activity
Insurance companies may reject a claim if death has happened under a criminal activity.
Here is a genuine case where Insurance Samdhan helped the family of the deceased
A handicapped brother-in-law of Mrs. Saniya (for this blog only), purchased a life insurance policy and made Mrs. Saniya’s daughter, his nominee.
He has declared all his health condition at the time of policy commencement and insurance company accepted the Proposal. But insurance company rejected the death claim on ground of non-disclosure of health condition.
Family tried but lost all hopes though life insured has taken insurance to secure financial future of the child. Subsequently, her daughter watched Shark Tank and learned about Insurance Samadhan. On June 22, 2022, her daughter approached us for help. We guided the mother-daughter to fight the case by helping them in writing mails with the required pointers and they received their claim money within 4 days.
What is the process of Death claim?
A nominee, a legal representative, a relative or any third person can give a death intimation of an insured to the insurance company. The company will give a claim form to the person. The person needs to fill the form and attach some documents before submitting it.
Documents needed for death claim in Insurance
You needs to attach following documents with the notice:
- Death Certificate
- Original Policy Document
- Police FIR Report, if applicable
- Post-mortem Report – applicable only in case of unnatural death
- Hospital Records
- Age proof of deceased person
- Nominee Details ( ID Proof)
- Bank details of nominee
Attach these documents with a claim form given by the insurance company and then submit it. The company will verify the documents and investigate the death case. After successful investigation, the company will decide whether to accept it or deny the claim.
If you have a similar issue related to insurance, you can reach us out on WhatsApp, e-mail or via our website. We would be really interested to guide you.
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I had a query regarding term insurance is that if someone has started drinking habit after 3-4 years of policy started, should they have to inform insurance company? Can company reject the claim on the basis of that insured person did not inform to the company about drinking habit?
Dear Pavan,
All information prior to the policy purchase needs to be disclosed. If you have started drinking post the purchase then it need not be disclosed.
Thank you!