Sun Life Financial Inc. is an international financial services company known primarily as a life insurance company operating in over 50 countries. It provides a variety of insurance products including life, health, disability, critical illness, and long term care insurance. Sun Life uses an underwriting process to evaluate risks and classify policyholders to determine appropriate premiums. It has a strong claims management process that involves assessing claims, processing payments, and detecting fraud. While Sun Life is highly rated and has a large customer base, it faces challenges from increased competition and needs to improve its underwriting and claims processes to reduce costs and enhance customer loyalty.

2. Dav
raj
Sadam
Ayub
M.
Abdullah
Naveed
Iqbal
Mi12MBA056 Mi12MBA073
Mi12MBA045
Mi12MBA038

3. • Insurance…?
• Assurance
• What is
• Products
• Underwriting
• Claim management/Handling
• SW0T Analysis
• Recommendations
Purpose of Presentation!

7. Sun Life Financial Inc. is an international financial services
company known primarily as a life insurance company, but also
has a strong presence in investment management with over
$494, established in 1871
In World WAR II, the British Crown Jewels as well as the gold
reserves of several European countries were moved to what is
now known as the Old Sun Life Building for safekeeping.

8. • A multinational Company
• Working in more than 50
countries
• 1st company of Canada having
largest customer base in Life
insurance
• 1st priority of public due to
good repute
• Largest company with regard
to its Capital base
• Canadian $640 billion

10. Sun
life
Life
Insurance
Health
insurance
Disability
insurance

11. Life Insurance
Sun Life Term Insurance
Universal Sun Life Insurance
Work Place Life Insurance

12. • Term life insurance provides temporary protection for temporary needs.
It also has some flexibility, so you can adjust your insurance as your
needs change.
• It provides several guarantees.
• you can choose between:
• Term life insurance - provides coverage for one person Joint term life
insurance - one policy that covers 2 people who share a joint risk (e.g. a
mortgage
• Simplest form of insurance
• Sun will pay Sum assured on occurrence of Death
• Simple and easy to understandable conditions
• No maturity value and no Loan Value
Sun life Term insurance

13. An all-in-one way to protect and build your money
Universal Life insurance is one solution that combines 2 important aspects of
financial planning:
• Permanent insurance protection for lifelong peace of mind, plus
• Investment account options that can grow your savings, tax-deferred
universal Sun life

14. • We believe that a healthy workforce is integral to the
success of any business. That’s why we offer the products
and services you need to help keep you and your family
healthy. Consider it an investment into your well-being.
Work Place Life Insurance

15. Health & dental
 Dental
 Drugs
 Hospital expenses in your province
 Vision care
 Paramedical services and equipment
 Travel
Work Place Life Insurance

16. Personal
health
Insurance
Disability
Insurance
Critical
illness
Insurance
Long term
Care
Insurance
Health Insurance

17. Personal health insurance provides affordable
coverage for:
• unexpected health expenses
• many ongoing health-related services not covered
by provincial plans.
Basic Plan
Standard
Plan
Enhanced
Plan
Personal
health
Insurance

18. • Disability insurance is designed to protect you from the
possible loss of income due to any mishap with you
during normal life events .
• When you're unable to work as defined by the
coverage you've chosen
• You receive a recurring monthly payment
• It replaces a portion of your income if you're unable to
work
Disability
Insurance

19. • Critical illness insurance offers help paying costs associated
with life-altering illnesses. If you become sick with an illness
covered by your policy and survive the waiting period, you
receive a lump sum cash payment
• Expenses related to coping with and recovering from a
serious illness
• When you are diagnosed with and meet the requirements
of a covered condition
• You receive a lump sum cash payment

20. • Cost of your care over a lengthy
period
• When you're unable to perform
two or more activities of daily
living or require continual
supervision due to deterioration
in mental abilities
• Reimburses your expenses or pays
a benefit
• May be a regular recurring
payment or a reimbursement style
plan to cover the cost of care
Long term
Care
Insurance

21. Sadam Ayub Mi12mbA073

22. Underwriting

23. What is underwriting?
• Underwriting is the process of
– Examining, accepting or rejecting insurance risks, and
– Classifying those selected, in order to charge the appropriate
premium for each.
• The purpose of underwriting is to spread the risk among a pool
of insured in a manner that is equitable for the insured and
profitable for the insurer.
What is underwriting?

24. Underwriter
B
C
D
A
Evaluates
risk
Accepts Applications
Declines
Applications
Determines appropriate premium
The decision to provide
insurance coverage or
not is commonly
referred to as an
underwriting decision
These decisions greatly affect the success or failure of an
insurance company
How Underwriting done at Sun Life?

25. 1. Occupation
2. Avocation
3. Hobbies
4. Residence
5. Moral Hazard
1. Insurable
Interest
2. Income
Protection
3. Persistency
4. Net Worth
1. Build
2. Habits
3. Personal Medical
History
4. Family Medical
History
Risk Factors in Life Insurance
• The various risk factors to be assessed prior to underwriting
decision are:
1. Medical 2. Financial 3. Personal
Life Insurance Risk Factors
321
Risk Factors in Life Insurance

26. 7
Factors
F1
F6
F2
F3
F7
Age
Gender
Build
Lifestyle Habits
F5 F4
Family Medical
History
Personal Medical
History
Factors affecting Medical Underwriting

27. • Application Form
• Medium Of Relationship
• Medium Between Insured And Insurer
• Representative Of Both Parties
• Accurate Information
• Helper In Decision Making
Application form filling

28. • Name
• Address
• Marital status
• Age
• Date of birth
• Nationality
• Application and
nominee details
Elements in Application Form
• Hazardous risk questions
• Aviation / Armed forces
question
• Covers with other companies
• Smoking , alcohol
• Health questions
• Occupation

29. • Financial Questionnaire
• Assets Liability Statement
• Juvenile Questionnaire
• Housewife Questionnaire
• Mode Of Payment
Some Important Aspects

30. • Two categories:
• Gainfully employed women with
earned income / unearned income,
pays income tax, single or married,
good educational and social
background.
• Assessment of this category of female
is per normal any earning individual.
• Non-working woman, dependent on
husband.
• This group is referred as 'Housewife'.
• This category is again classified in to 2
categories depending on the
Husband’s insurance status.
 Maximum Sum Assured (Life) available to each category:
Category 1
Category 2
Husband has Life insurance Husband has no Life insurance
Subject to normal
underwriting
Lesser of 10x husband’s annual income or Rs.
1,000,000
Lesser of 5x husband’s annual income or Rs.
1,000,000
Female life underwriting

31. M. Abdullah Mi12MbA057

32. Claim Handling

33. • Claim
• Claim reporting
• Receipt of claim
• Claim files and procedure
• Fraud
• Settlement
Claim Handling And Settlement

34.  HOD Claims assesses whether the claim is payable
under the terms and conditions of policy and if
payable what should be the quantum of claim.
 Claim Management Procedure
It consists of following steps;
 Claims reporting
 Receipt of claim by the insurance company
 Claim files & procedures
 Fraud detection & prevention
 Claim processing
 Claim payment
Claim

35.  When claim arises, insured has following duties:
 To try to minimize the loss
 To report the claim timely
 To cooperate in investigation
 To provide official documents
 To authorize the insurance company to conduct
inspection
To fill an appropriate claim form
CLAIMS REPORTING

36. After receiving intimation of claim, the insurance
company must;
 Send an acknowledgement to the insured
 Inform the insured, in case of any delay
 Ask for documents required in settling the claim
RECEIPT OF CLAIM

37. Once a claim has been filed, it must contain following documents;
 Intimation letter
 Claim form duly filled and signed by insured
 Summary sheet showing review of the claim
 Date of loss and Reporting date
 Description of claim
 Assessment date
 Copy of loss adjuster’s and investigator’s report
 Estimated cost of damage
 Amount of payment
Claim Files & Procedure

38. Fraud…?
In case of fraudulent
intention found, claim can
be repudiated.

39. Settlement Of Claims
• Payment of money
• Paying for repairs
• Replacement
• Reinstatement
A claim can be settled in following ways

40. Dav Raj Mi12MbA041

42.  Strong and well capitalized company
 Large customer base
 Innovative products
 Customer loyalty
 Effective advertisement
 Less cost due to
line authority
 Brand name
How Much Strong Are We?

43. Standard &
Poor’s
Moody’s A.M. Best DBRS
Sun life
Assurance
company
AA-
Very strong
AA
Excellent
A+
Superior
IC-1
Superior
Sun life And
health
insurance
company (U.S)
AA-
Very strong
A
Strong
A+
Superior
Not rated yet
Rating of Sun Life

44.  Work Inefficiencies
 Low premium income due
to more competition
 Economic recession
 More Fraudulent claims
 Adverse underwriting by agent
Drawbacks

45. Opportunities
 Expand business worldwide
 Improve online marketing
 Correcting underwriting cycle
 Start programs of insurance
awareness
 Special discount and free gifts
 More and more advertisement
 Effective Customer relation system

46.  High Operating cost
 Low cost products by competitors
 Over all world recession
 Dumping from fresh entrance
 Changing laws about healthcare
Threats

47. Summing up!
No doubt sun life insurance is one of the leading
players of insurance sector. But there are some
grounds on which is performance is not according
to its expectations. Reasons may includes more
fraudulent claims settlement. We can say if the
claim settlement department work effectively the
company may become Top insurance company of
world.
More over , underwriting management system is
doing according to rules , that’s why premium
charge accordingly. Customers want discount but
Sun life refuse, its also a cause of low
development.
Reasonable rebate should be given to regular
customers