There are two main types of life assurance claims - maturity claims, which are paid out when the policy reaches maturity, and death claims. When settling any claim, the life office must ensure payment is made to the correct person who has legal title to the policy and its proceeds. This requires claimants to prove their title by producing all necessary documentation such as the policy document, assignments if assigned, grants of representation for deceased policies, or death certificates for death claims.

1. Life Assurance Claims
• There are two types of claims:
 Maturity
 Death .
 In settling claims, a life office must ensure that
every claim is paid to the right person.
 In certain circumstances, the life office must
safeguard interests of third parties.
 The claimant has duty to prove title and must
produce all the documents-called the documents
of title –required to prove title

2. • At the time of effecting the policy the title to the
policy monies is normally vested in the assured.
• The title can be transferred to another person in
two ways only: by either assignment or operation
of the law.
• An assignment will be effective to transfer the
title only if it is in writing and is executed in
accordance with the provisions the Insurance
Act.
• the assignment must be duly stamped and must
convey the right to sue for the whole of the
policy monies, either unconditionally or by way
of security.
• A notice of the assignment must be given to the
life office.

3. • The title to the policy is transferred by the operation
of law to the legal personal representatives of the
assured on the death of the assured, or to the
trustees of the assured on the assured being
adjudged bankrupt.
• In general all claims settlement are subject to the:
 Payment of all the premiums;
 Production of the policy document
 Proof of the title -onus of which is on the claimant
 Proof of death in case of a death claim; and
 Proof of age in case of a death claim.

4. • On every maturity claim, the life office’s form of
discharge must be signed by the person with the
title to the policy, for only the person with the title
can give the life office a good discharge.
• The production of the policy will be required and
this will be sole proof of title if the claimant is the
assured and the policy has never been
assigned.
• If the policy has been assigned, the relevant
deed or deeds of assignment have to be
produced.
• For a trust policy, any deed of appointment or
retirement of trustees will be produced and all
the trustees have to sign the discharge.
• If any trustee died, his or her death certificate
will be required.

5. • The life office must deal with the person who has
legal power to sue, even if that person will
ultimately not keep all of the payment.
• For example: if the policy is mortgaged, the office
must pay the mortgagees, even though the amount
of the debt owed to them is less than the sum
assured.
• If there is any balance left after the mortgage debt
has been repaid, it is the duty of the mortgagees to
pass the balance to the mortgagor.
• The life office is not concerned whether this is
done.
• If the policy is under trust, the life office must get
the discharge from the trustees, as legal owners,
even though they may pass the money to the
beneficiaries.

6. • Death Claims
• When a death claim occurs, the
correspondence will normally be initiated by the
claimant, or lawyers for the estate, who will
write to the life office informing it of the death
and inquiring on the payable amount.
• The life office’s initial reply will state the payable
amount, subject to the admission of liability.
• The life office will then require that claim forms
be filled and that the proof of death, normally a
death certificate from the registrar of births and
deaths issued

7. • When this has been done the validity of the
claim can be assessed to ascertain if the cause
of death is covered.
• Once the life office is satisfied that the claim is
valid, the claimant must be requested to prove
his or her title.
• Proof of age must be obtained if age was not
admitted, and before making payment, the life
office will require that the claimant sign a form of
discharge.

8. • Proof of Title
• The proof of title required before a claim is paid
differs relative to policies.
• In this connection:
• If a policy is a life of another contract, payment
will made to the assured on the production of the
policy document.
• If a policy is a trust policy, payment will be made
to the trustees on their production of the policy
document.

9. • If the claim is made by an assignee, both the
policy and the deed of assignment must be
produced.
• If the policy is an own life policy that has not
been assigned, payment will be made to the
deceased’s estate.
• The estate is represented by the legal personal
representatives who must prove their title by
producing the appropriate grant of
representation issued by the High Court.
• Legal personal representatives may be either
executors or administrators who must produce a
grant to prove their title.
• There are two kinds of grants: probate and
letters of administration.

10. • In a grant of probate the deceased leaves behind a
valid will naming executors.
• In a grant of letters of administration the deceased
leaves behind no valid will.
• The Public Trustee can receive claim monies on
behalf of an estate and give a valid discharge to the
life office, provided the Public Trustee produces a
grant to prove title.

11. • Proof of Age
• Proof of age is required on death claims.
• The proof of age is important in that premiums
are based on the age of the life assured.
• If the age then differs from the one stated on the
proposal form, the claim amount would be
adjusted appropriately
• Consequently, most life offices prefer age to be
admitted at the inception of a policy.
• Since sometimes this does not happen, a proof
of age may be required on a death claim.

12. • Age is normally proved by the production of an official
birth certificate, in whose absence these documents
are acceptable as evidence in proof of age:
• Baptismal certificates,
• Passports,
• National identity cards, or
• Affidavits.
• .

13. • Suicide
• Offices do not normally pay a claim if the life life
assured commits suicide within 1 or 2 years of
the commencement of risk.
• Notwithstanding this, interests of third parties
must be safeguarded

14. • Lost Policies
• If a policy is reported lost and/or destroyed, a life
office may issue a duplicate policy
• The loss of the policy is inconvenient, but not
crucial as the policy is not the contract itself, but
merely evidence of it.
• Non-production of a policy, however, may amount
to a constructive notice to the life office that a third
party has an interest in it.
• The life office therefore will need to be in a position
to rebut any allegation of constructive notice of a
third party interest.

15. • For this reason the company will require a proper
search to be made, and inquiries undertaken to or of
people who might hold the policy or know of its
whereabouts-for example, the assured’s bank,
lawyers, or accountants.
• The life office’s files should be checked for indications
as to the policy’s whereabouts.
• Often the policy is found through the search.
• If the policy is not found, and the office is satisfied that
it is genuinely lost, it may ask the claimant to execute
a statutory declaration, setting out the circumstances
of the loss and stating that the policy has not been
assigned or charged.

16. • Not all offices will insist on a statutory
declaration.
• The claim can then be paid on the
completion of an indemnity form making
payment without the production of the
policy.
• Lost policy procedure will also apply to
surrenders and loans, as well as other
claims

17. • Payments to Court
• When a life office cannot get a satisfactory
discharge for policy monies, it can pay the
money to a court of law
• Surrenders
• A request for surrender value is not strictly
speaking a claim.
• It must be treated in the same way as relates to
a proof of title, however.
• The surrender value will be quoted, subject to
the payment of all due premiums and production
of a proof of title.

18. • A life office will require the normal proof of title
and a discharge from the policyholder.

19. • Loans
• It is common for life offices to allow loans on the
security of policies issued by them.
• The usual maximum loan is 90% or 95% of the
surrender value, and, therefore, loans can only
be taken where there is surrender value.
• The borrower has to prove his or her title to the
policy in the normal way and complete a
mortgage deed.
• .

20. • In practice, as long as premiums and
interest are paid, most life offices will allow
a policy loan to remain outstanding until a
policy becomes a claim or is surrendered.
• In this event the loan, together with any
outstanding interest, would be deducted
from the claim payment made.

21. • Group life Claims
• As in other classes of insurance, claims made
under group policies must be proved by the
assured to the satisfaction of the assurer.
• Under group life policies, there are mainly two
types of claims: invalidity and death.
• Invalidity Claims
• Invalidity claims would arise from the Group
Disability Income Insurance (GDII) or group
permanent health insurance policies.
• The GDII claims differ from other life assurance
where admittance is a once-and-for all
procedure, for they involve the initial claim
processing and the ongoing monitoring
throughout the duration of the disability.

22. • Death Claims
• Death claims are mostly submitted under group
life assurance policies.
• When such a claim is notified it is necessary to
obtain:
 completed claim forms which should contain all
the information the assured requires;
 Proof of death in the form of a production of a
death certificate issued by the Registrar of Births
and Deaths; and

23. Certificates issued by the doctor who lastly
attended the deceased prior to his/her
death may be required, especially when
the sums involved are high.
• Once liability for a claim has been
admitted, a discharge form is issued to the
assured to sign and return to the
representative of the assured for the claim
chaque to be released