T.Y BANKING & INSURANCE (SEM-VI)
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“TO STUDY ABOUT CLAIM MANAGEMENT IN
LIFE INSURANCE”
IN PARTIAL FULLFILLMENT FOR THE AWARD OF
THE DEGREE OF BACHELOR OF BANKING
INSURANCE
PREPARED BY
JEET GANGAR
ROLL NO. 05
T.Y.B&I
MATRUSHRI KASHIBEN MOTILAL PATEL COLLEGE
OF COMMERCE AND SCIENCE
THAKURLI (E) - 421201
GUIDE
Mrs. LEKHA VISARIA.
UNIVERSITY OF MUMBAI,
MUMBAI- 400028
Year 2013- 2014
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ACKNOWLEDGEMENT
In this section, the researcher acknowledges the
assistance and support received from individuals
and organizations in conducting the researcher. It
is thus intended to show his gratitude. Good taste
calls for acknowledgement to be expressed simply
expressed and nicely.
I take this opportunity to thank all of them who
played a major role in completing this project.
I express my deep gratitude towards Prof. MRS.
LEKHA VISARIA course coordinator for
encouraging me to work on this project.
I also thank our in charge Principal Mrs. Lekha
Visaria for her continuous encouragement to our
activities.
I must especially record my sincere thanks to my
family members and all my friends for their constant
support.
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ABSTRACT
.
The field of insurance has taken a giant leap at the
threshold of twentieth century. Insurance have become an
integral part of life of man all over the globe. The proverb
‘Need is the mother of invention’ is proving equally correct
in case of insurance. Insurance have already had a
considerable impacton many aspects of our society.
Claims management is another important aspecton
insurance. It is complexin nature that is true but it is a
driving force to plant confidence in the hearts of people.
Claim management is one of the most challenging
business processesin the insurance industry. With the
number of stakeholders involved, the dependencies and
the logistics,there is a need is to eliminate manual
interventions. For many organizations, claim management
and administration is viewed solely as a service
operation. Claim management is expected to run the
claim processefficientlyand keep expenses low, but little
attention is given to leveraging high impact opportunities
afforded through effective data management. In fact, the
data captured in the claim process,which all too often are
T.Y BANKING & INSURANCE (SEM-VI)
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underutilized, are rich in valuable information for those
who know how to extract and analyze it.
Claim management is an expert system which generates
the rules and regulations for the assessmentof general
damages using the key information contained in medical
reports, surveyor report, loss assessor’s reports,
claimant’s petition and the procedures or conditions and
warranties contained in the policy document. The claims
management regulates the payment of general damages
and also payment of the loss of future earnings.
This project is just a gist about hoe the insurance
companies settle the claims, the procedure that is
followed,and the intermediaries that are involved in the
process and so on. This project throws light on various
aspects on claims management and the problems faced
by them
T.Y BANKING & INSURANCE (SEM-VI)
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INDEX
SR.NO PARTICULER PAGE.NO
CHAPTER.1 INTRODUCTION 11
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.9
BACKGROUND OFTHE
TOPIC
PLACING RESEARCH
PROBLEM
STATING NEEDSFOR
SURVEY
TITLE OF THE STUDY
OBJECTIVESOF THE
STUDY
NULL HYPOTHISES
HYPETHOESIS
DEFINITION OF
IMPORATNTTERMS
12
18
18
19
19
20
20
20
T.Y BANKING & INSURANCE (SEM-VI)
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1.10
1.11
1.12
1.13
1.14
1.15
ASSUMPTION OF THE
STUDY
REVIEW OF LITERATURE
METHODOLOGY
RESEARCH QUESTION
SIGNIFICANCE OFTHE
PRESENTSTUDY
SCOPE OF THE PRESENT
STUDY
21
21
23
24
24
24
CHAPTER.2 CASE STUDY 26
CHAPTER.3 RESEARCH
METHEDOLOGY
34
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3.1
3.2
3.3
3.4
3.5
3.6
3.7
3.8
3.9
3.10
RESEARCH METHOD
SOURCE OF DATA
RESEARCH AREA
METHOD USE FOR
DECIDING SAMPLE PLAN
SAMPLING PLAN
VALIDATION OF TOOL
DATA COLLECTION
INSRUMENT
RATING SCALE
RESEARCH PERIOD
DATA PROCESSING AND
ANALYSISPLAN
35
35
36
36
36
36
36
37
37
37
T.Y BANKING & INSURANCE (SEM-VI)
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CHAPTER.4 DATA ANALYASIS &
INTERPRITENTION
38
CHAPTER 5 SUMMERY OF FINDING
& CONCLUSION
53
CHAPTER 6 SUGGESTION 58
BIBLIOGRAPHY 60
ANNEXURE 61
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Chapter-1
INTRODUCTION
1.1) Background of the study:-
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Insurance is a promise of compensationforspecific
potential future losses in exchanges for a periodic
payment. Insurance is designed to protectthe financial
well-being of an individual, company or other entity in
case of unexpected loss. Agreeing to the terms of an
insurance policy creates a contract between the insured
and insurer. In exchange for payments from the insured
(called premium), the insurer agrees to pay the policy
holder a sum of money upon the occurrence of a specific
events.
There are two types of insurance. They are- Life
Insurance and General Insurance. General Insurance
comprisesof insurance of property against fire, burglary
etc. Personal Insurance such as Accidentand Health
Insurance, and Liability Insurance which covers legal
liabilities.
Personal Insurance covers include policies forAccidents,
Health etc. Products offering Personal Accidentcoverare
benefitpolicies.A Health Insurance Policy can provide
financial relief to a personundergoing medicaltreatment
whether due to disease or any injury. Accidentand Health
Insurance policies are available for individuals as well as
groups.
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1.1.1) Introduction to Life Insurance:-
Human life is subjectto risks of death and disability due to
natural and accidental causes.When human life is lost or
a personis disabled permanently or temporarily, there is
a loss of income to the household. The family is put to
hardship. Sometimes,survival itself is at stake for the
dependants.Risks are unpredictable. Death/disability
may occur when one least expects it. An individual can
protecthimself or herself against such contingencies
through life insurance.
Though human life cannot be valued, a monetary sum
could be determined which is based on loss of income in
future years. Hence in life insurance, the sum assured is
by way of a benefitin the case of life insurance.
It is the uncertainty that is risk, which gives rise to the
necessityfor some form of protectionagainst the financial
loss arising from death. Insurance substitutes this
uncertainty. The primary purpose of life insurance is the
protectionof family. Insurance in its various forms
protects against such misfortunes by having the losses of
the unfortunate few paid by the contribution of the many
that are exposedto the same risk. This is the essence of
insurance- the sharing of losses and substitute of
certainty for uncertainty.
There are a variety of life insurance products to suits to
the needs of various categories of
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People-children,youth, women, middle-aged persons,old
people;and also rural people,etc. life insurance products
could be purchased from registered life insurers notified
by the IRDA. Insurers appoints insurance agents to sell
their products should receive properadvice from
insurance agents/insurers so that a right products could
be chosento suit particular financial needs.
1.1.2) Claim in Insurance
An insurance claim is the actual application for benefits
provided by an insurance company. Policy holders must
first file an insurance claim before any money can be
disbursed to the hospital or repair shop or other
contracted service. The insurance company may or may
not approve the claim, based on their own assessmentof
the circumstances.Individual who take out home, life,
health, or automobile insurance policies must maintain
regular payments called premiums to the insurers. Most
of the times these premiums are used to settle another
person’s insurance claim or o build up the available
assets of the insurance company.
When claims are filed, the insured has to observe the
settled rules and procedures and the insurers has also to
reciprocated in a similar manner by undertaking
appropriated steps for speedydisposalof claims. It is true
that claims settlements is complexin nature, but it is the
driving force to plant confidence in the hearts of people,
in general and beneficiaries inspecifies.Insurance claim
is a right of insured under a contract of insurance.
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Insurance contract is a contract by which one party called
the insurer promise to save the other party, the insured on
the payments of considerationknown as the premium.
The insurer promises to save the insured are
nominees/assigneesof the insured on happening of event
or risk insured. Disputes crop up in the payment of claim
when the insurer and the insured understand the process
of claims payments in a differentway. Claims settlement
is an integral part of the insurance business which is a
service industry and its growth is interwoven with the
people,the customers and consumers of service.It is
inevitable for the insurance company to protectand guard
the interest of the policyholders.An insurance claim is the
only way to officiallyapply for benefits under an insurance
policy, but until insurance company has assessedthe
situation it will remain only a claim, not a pay-out.
1.1.3) Claim Management
Many insurers have recognized the need to improve the
efficiencyof their claims management process.They
have streamlined processes,eliminated paper-based
forms and redistributed work to match the demands to
skills. The objectives of their efforts are to lower costs,
while also increasing overall throughput. Efficiency
improvements make tasks quicker and less costly
execute. However, to realize even greater improvements
in the claims handling process,insurers must also focus
on the effectivenessof their claims decision.
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Claims handling costs typically represents 10% to 15% of
net earned premium; in contrast, claims represent40% to
65%. Insurers that expand their focus to include effective
as well as efficientclaims processing will find a far longer
poll of saving opportunities. Technologycan play a
significant role by providing integrated channels for
communication and collaboration. This would help the
insurance company increase employee productivity by
reducing cycle time and defectrate and also increaser
employee participation and compliance.
Claims Processing sometimesinvolves collating and
sharing large amounts of information among multiple
parties involved in a claim, from bodyshops to adjusters
to investigators to lawyers and doctors to claimants and
regulator. And it involves the knowledge of experienced
adjusters to determine be the fair and appropriate
outcome of a claim. In fact, losses and loss expenses
absorb 80% of premium collected by carriers.
Service representatives and claims adjusters need to
access data from multiple sources when processing or
assessing a claim, which delays settlements time and
increases costs.Manual steps reduce transparency of the
claims process and raise the risk of fraud, manipulation or
simply human error. Customerretention is also a
challenge- experts say that 75% of customers leave their
insurer due to claims issues.
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1.1.4) Prodecure of cliam management in
life insurance:-
INSURER
On Recepit of Claim, Verify
the claim
Review the Claim application
Respond to Claimant
Claim Investigation
Claim negotiation
Claim settlement
Claim payment
INSURED
Type of Suffering Loss or The
Damage
Understanding and Identyfing
the Cause of Action
Infoming or Giving Notice of
Claim or Loss to Insurer
Providing Sufficient Proof of
Loss to Insurer
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1.2)Placing the research problem:-
The major role made by insurance programme is
the indemnification of risk averse individual who mightly
adverse affectedby natural probablistic phenomenan.
Customerservice has great importance in the insurance
company. While the coverage of insurance industry is
expanding day by day. This is because customer
demanding insurance in todays world.
This can be achieved through speed,service quality and
customersatisfaction. These elments are going to be key
differentiators foreach insurance company success.
1.3)Stating the need for survey:-
Insurance users pay premium, year after year,
trusting their policies tp protecttheir lives or business in
the event of a loss. However, there are innumerable
instances where a genuine insurance users with a
genuine loss and a seeminglyvalid claim, has been
denined his claim amount in full or part. This happen
because the insurance company is not able to estiamte
the total amount of the claims. In life insurance claims the
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insurance company tries to reject the claims without
knowing the causes of death or loss of the person.
1.5) Title of the study: -
To Study about Claim Management in Life Insurance.
1.6) Objective of the study:-
 To study claim management in Life Insurance.
 To find out problem while taking insurance by
people.
 To find out problem arising while claim settlementof
life insurance.
 To find out overall satisfactionabout life insurance.
1.7) Null Hypothesis:-
Some people are not aware about claim
management in life insurance & not also avail the claim
management in life insurance.
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1.8) Hypothesis:-
Majority personare aware about claim management in life
insurance facility and they also take benefitof claim
management in life insurance.
Majority personare aware about claim management
in life insurance facility and they also take benefitof claim
management in life insurance.
1.9) Definition of important terms:-
 Definition of life insurance
Life insurance is a contract between two parties
whereby one party agree to pay to the other party, a
certain amount of money is premium to make the good
loss of life arising out of an uncertain event in which
insured has interest.
 Definition of claims
A claim is a right of insured to receive the amount
secured under the policy of insurance contract
promised by insured.
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1.10) Assumption made for present
study:-
 Customerquires are solved by insurance company
personnelimmediately.
 All people are engaged in claim management in life
insurance.
 It is assume that majority of customerare aware
about claim management in life insurance.
1.11) Review of Literature:-
According to complaints Sunanda Kanthale, her husband
Manoharrao kanthale who worked as a stores
superintendent with the Amravati policy for Rs 20,000 on
November28, 1992. The policy which was a non-medical
one was scheduled to mature on November24, 2004,she
said. Unfortunately Manoharrao passed away on October
22. 1993,10 months and 25 days from the date of
purchasing the instrument.
Being the nominee in the policy, she asked for her claim
for an account of Rs 40,000 (under double benefit
provision in accidentcases) and made an application to
the Akola branch manager of LIC.The senior manager of
LIC (Amravati Division) however refused to settle the
claim vide his letter dated August 4, 1994.As the policy
was a non-medical one, the reason given by the official
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for not settling the claim was also a bogus one, she
alleged. Sunanda then wrote to the area manager of LIC,
Mumbai, justifying her claim. The Mumbai office too (vide
letter dated April 20, 1995)refused to settle the claim,
Kanthale added.
She then lodged a complaint with Akola District
Consumers Grievances redressed forum.In the
complaints, she applied to the forum to issuer the
necessarydirectives to the LIC for paying Rs 40,000
along with 18% interest, a compensationof Rs 50,000
towards mental tension caused and Rs 1,000 towards
legal expenses.
Defending the stand taken by the company, the LIC
refuted all the allegations made by Sunanda.
Manoharrao, who held the policy, had kept the
information about his health a secretwhile purchasing the
instrument, the company alleged.
The forum referred to columns 14 and 26 in the
application for where the policy purchaser had made
statements about his health. The form was duly signed by
Dr. B R Jain, the forum said. The LIC officials produced
proofs before the forum regarding heart disorderof the
policy holder and sick leave availed by him after taking
the policy. However, they could not prove that Manohar
was not well on the day of purchasing the policy.
The District ConsumerGrievances RedressalForum has
directed Senior Divisional Manager of Life Insurance
Corporation (LIC)Amravati, Area Manager, Mumbai and
Branch Manager, Akola, to pay Rs 20,000 to Sunanda
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Kanthale towards insurance claim besides intereston the
amount from October22, 1993,till the date of payments
at a rate of 12%. The forum has also directed LIC to pay
compensationof Rs 10,000 to the woman for causing
mental tension to her during the 4 years, after her
husband’s death, in releasing the insurance amount.
If the insurance company failed to pay the compensation
within two months from the date of receiptof copyof the
judgment, the company will be liable to pay interest at a
rate of 18% on the amount till final payments besides
legal expenses of Rs250,the forum ruled. The forum also
ruled that through the compensationamount, demanded
by the complaints, appeared,considering the troubles she
had to face in the last four years for settlementof claim,
the company should pay her Rs 10,000 towards
compensation.
1.12) Methodology:-
The researcher approaches to 50 respondents in
Dombivli area. All 50 respondents respond to the
questionnaire. The final study of projectwas done through
based on these 50 respondents.The analysis of data was
done with help of mean percentage and excel sheet.
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1.13) Research Question:-
Which service provide under claim management in life
insurance?
1.14) Significance of the study:-
 The researcher needs to know procedure of claim
management in life insurance.
 The researcher want to know which facilities is avail
by customer of claim management in life insurance.
1.15) Scope of the present study:-
The survey method has been followed for the study well
structure questionnaire to elicit the necessarydata and get
filled the details from the respondent. The study will also
help to identify the customer satisfaction toward the claim
management in life insurance.
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Chapter-2
CASE STUDY
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(1)
Life insurance Corporation of India v/s Mrs. Sunanada
kanthale
According to complaints Sunanda Kanthale, her husband
Manoharrao kanthale who worked as a stores
superintendent with the Amravati policy for Rs 20,000 on
November28, 1992. The policy which was a non-medical
one was scheduled to mature on November24, 2004,she
said. Unfortunately Manoharrao passed away on October
22. 1993,10 months and 25 days from the date of
purchasing the instrument.
Being the nominee in the policy, she asked for her claim
for an account of Rs 40,000 (under double benefit
provision in accidentcases) and made an application to
the Akola branch manager of LIC.The senior manager of
LIC (Amravati Division) however refused to settle the
claim vide his letter dated August 4, 1994.As the policy
was a non-medical one, the reason given by the official
for not settling the claim was also a bogus one, she
alleged. Sunanda then wrote to the area manager of LIC,
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Mumbai, justifying her claim. The Mumbai office too (vide
letter dated April 20, 1995)refused to settle the claim,
Kanthale added.
She then lodged a complaint with Akola District
Consumers Grievances redressed forum.In the
complaints, she applied to the forum to issuer the
necessarydirectives to the LIC for paying Rs 40,000
along with 18% interest, a compensationof Rs 50,000
towards mental tension caused and Rs 1,000 towards
legal expenses.
Defending the stand taken by the company, the LIC
refuted all the allegations made by Sunanda.
Manoharrao, who held the policy, had kept the
information about his health a secretwhile purchasing the
instrument, the company alleged.
The forum referred to columns 14 and 26 in the
application for where the policy purchaser had made
statements about his health. The form was duly signed by
Dr. B R Jain, the forum said. The LIC officials produced
proofs before the forum regarding heart disorderof the
policy holder and sick leave availed by him after taking
the policy. However, they could not prove that Manohar
was not well on the day of purchasing the policy.
The District ConsumerGrievances RedressalForum has
directed Senior Divisional Manager of Life Insurance
Corporation (LIC)Amravati, Area Manager, Mumbai and
Branch Manager, Akola, to pay Rs 20,000 to Sunanda
Kanthale towards insurance claim besides intereston the
amount from October22, 1993,till the date of payments
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at a rate of 12%. The forum has also directed LIC to pay
compensationof Rs 10,000 to the woman for causing
mental tension to her during the 4 years, after her
husband’s death, in releasing the insurance amount.
If the insurance company failed to pay the compensation
within two months from the date of receiptof copyof the
judgment, the company will be liable to pay interest at a
rate of 18% on the amount till final payments besides
legal expenses of Rs250,the forum ruled. The forum also
ruled that through the compensationamount, demanded
by the complaints, appeared,considering the troubles she
had to face in the last four years for settlementof claim,
the company should pay her Rs 10,000 towards
compensation.
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(2)
Life insurance Corporation of India v/s Neelam Metha
The case arose following the refusal of LIC to pay the
insurance money following the death of her husband
Mahendrabhai Metha. LIC had repudiated the life policy
alleging that he had hid from it that he was suffering from
diabetes at the time of taking the insurance policy in
December1993.On 6 November1994 he died following
a heart attack. Neelam told the consumerforum that she
came to know that her husband had a life policy with LIC
3 months after his death, when she started receiving
‘forms one after another to be filled through LIC agent’.
She then filled up all the relevant papers.
She also formally informed LIC about death of her
husband and claimed the insurance money. Thereupon,
LIC intimated her that the claim for her husband’s
insurance policy was repudiated because the life assured
had ‘deliberately’ withheld information regarding his ‘pre-
existing illness which was diabetes’and which, it said,
had led to his death. It also alleged that because of this
T.Y BANKING & INSURANCE (SEM-VI)
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disease he had been hospitalized before his death and
that he was a insulin-dependent diabetic. Neelam
represented to both the Bhavnagar and Ahmebad office
of LIC and later to its zonal office in Mumbai urging them
to recommend herclaim to the review committee.
This request was made in September1996 till now no
decisionhad been taken and the ‘matter is still under
consideration’. She also denied that her husband was a
diabetic or that he had been hospitalized for this. He had
not been treated for any ailment during the 5 years
preceding his death, she asserted.The forum comprising
its president,K.D. Desai, members LeenaDesai and
Malaybhai Kantharia, found that LIC has failed to prove
that Mr. Metha had made false statement and
misrepresentation about his health.”The burden of proving
that there was a suppressionof material fact and that it
was made fraudulently” lied on LIC and it had failed to
prove it, the forum observed.LIC therefore was legally
and morally duty-bound to pay the claim, it said.
Consumerdisputes redressalforum, Ahmedabad,has
directed LIC of India to pay up Rs. 50,000 plus 12%
interest for 7 years, as insurance money due to after her
husband’s death. The forum also ordered payment of Rs.
5000 for causing mental agony, hardship and
inconvenience to Neelamben. It granted Rs. 3000 as cost.
T.Y BANKING & INSURANCE (SEM-VI)
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(3)
Life insurance Corporation of India v/s Lily Rani Roy
The petitioner has purchased a life insurance policy from
the appellate and premiums were paid regularly. The
maturity of the said policy was in 1978.Because of some
personal reasons the claim was not filed. The petitioner
had filed the claim after 13 years of its maturity. The LIC
of India rejected the payment on a plea that claim is time
barred claim and as such the claim will not be paid.
The petitioner has filed a complaint with consumercouncil
with a requestto direct the LIC for the payment of the
maturity claim as the policyholderhad paid the entire
premium till the date of the maturity and has the right to
receive the claim amount. Assured held LIC guilty under
ConsumerProtection Act, 1986 Section(I) (g) for
deficiencyin service.
But, the LIC of India pleaded that the Corporation will be
maintaining the records fora period of 5 years only and
the Corporation has received the claim notice from the
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petitioner in 1990 which is far beyond the time. The LIC
also produced a photo copy of the maturity claim payment
registershowing the payment of the complainant’s
money.
After examining all the facts, the State forum has declared
that the petitioners cannot claim the payment of policy as
it is already time barred. On the decisionof the State
Commission,the petitioners filed a petition with the
National Commission.
The National Commission,after verifying the terms of the
policy, has opined that through the payments of claim is
time barred, the insurance company should have given
notice to that effector should include a clause in the
policy documentstating that the time barred maturity
claims will not be paid. As the Corporation has filed to
bring this information has filed to bring this information to
the notice of the policyholderor failed to create the
awareness among the policyholders,it has failed in its
duties and as such it is liable to pay the claim to the
petitioners. Thus, the National Commissionhas ordered
the payment of time barred maturity claims.
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Chapter-3
RESEARCH METHOLODOGY
T.Y BANKING & INSURANCE (SEM-VI)
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3.1) Research Method:-
Researcherdecidesto survey in thane(w) .The
researcherused the survey method for presentstudy.
3.2) Source of Data:-
Primary data and secondary data are collected for
presentresearch study.
a) Primary data-
The researcher collected the primary data personally
through face to face interaction and also with observation
method.
b) Secondarydata-
The secondary data was collected throughvarious ways
that is
 Internet- www.investopedia.com
www.wikiipedia.com
 Newspaper-The economics times
T.Y BANKING & INSURANCE (SEM-VI)
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3.3) Research Area:-
The researcher has made research in Thane(w).
3.4) Method Use for Deciding the Sampling Plan:-
The sample constituted of 50 respondents.The sample
size was 50, the elements for samples i.e. the responds
selected through selective sampling method.
3.5) Sampling Plan:-
The approach was made to the respondents twice times.
At the 1st
visit out of 50, 17 respondents responded
perfectly and then 13 responded through telephone 20
responded after approaching twice time through
appointment.
3.6) Validation of Tool:-
The tool was send to professor,insurance official,to
verify their validity & correctionwhere made after
receiving their suggestionthe tool was then finalized.
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3.7) Data Collection Instruments:-
The types of instruments used for data collectionwere
through surveying, internet, approaching to insurance
agents and to customer to know about claim management
in life insurance..
3.8) Rating Scale:-
Liker scale used for quantitive analysis.
3.9) Research Period:-
The research has made during the month of march 2019
3.10) Data processing& Analysis of Plan:-
The data processing & analysis with the help of mean
percentage method and bar diagram.
T.Y BANKING & INSURANCE (SEM-VI)
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Chapter-4
DATA ANALYSIS AND
INTERPRETATION
T.Y BANKING & INSURANCE (SEM-VI)
36
Q.1. From which company you have taken life insurance
policy?
TABLE
NO
PARTICULAR HDFC ICICI LIC Others
1 RESPONSE
RECEIVED
03 13 24 10
2 TOTAL
RESPONDENT
50 50 50 50
Interpretation:- Fromtheabovediagram, we can see that
06% people use HDFC, 26% useICICI, 48% useLIC, 20%
use others.
06%
26%
48%
20%
0
10
20
30
40
50
60
70
80
90
100
HDFC ICICI LIC Others
T.Y BANKING & INSURANCE (SEM-VI)
37
Q.2. Are you aware of claim settlement?
TABLE NO PARTICULAR Yes No
1 REPONCE
RECEIVED
50 0
2 TOTAL
RESPONDENT
50 50
Interpretation:- Fromtheabovediagram, we can say that all the
people are awareof claim settlement.
100%
0%
0
10
20
30
40
50
60
70
80
90
100
Yes No
T.Y BANKING & INSURANCE (SEM-VI)
38
Q.3. From where did you know about claim settlement?
TABLE NO PARTICULAR While takingpolicy Aftermaturity
1 RESPONSE
RECEIVED
50 0
2 TOTAL
RESPONDENT
50 50
Interpretation:- Fromtheabovediagram, we can say that people
know claim settlement while taking the project.
100%
0%
0
10
20
30
40
50
60
70
80
90
100
While taking
policy
After maturity
T.Y BANKING & INSURANCE (SEM-VI)
39
Q.4. Have you applied for any claim?
TABLE
NO
PARTICULAR Yes No
1 RESPONSE
RECEIVED
23 27
2 TOTAL
RESPONDENT
50 50
Interpretation:- Fromtheabovediagram, we can see that 46% of
people say that have claim while 54% people say isn’t.
46%
54%
0
10
20
30
40
50
60
70
80
90
100
Yes NO
T.Y BANKING & INSURANCE (SEM-VI)
40
Q.5. How many times you approach in insurance office for
inquiry about claim?
TABLE NO PARTICULAR 1 time 2 times 3 timesor
more
1 RESPONSE
RECEIVED
10 20 20
2 TOTAL
RESPONDENT
50 50 50
Interpretation:- Fromtheabovediagram, we can say that 10% of
people go 1 time, 40% of people go 2 times, 40% of people go
3 times or more.
10%
40% 40%
0
10
20
30
40
50
60
70
80
90
100
1 time 2 times 3 times or more
T.Y BANKING & INSURANCE (SEM-VI)
41
Q.6. Where has your queries solved?
TABLE NO PARTICULAR By insurance
companies
Personally
1 RESPONSE
RECEIVED
34 16
2 TOTAL
RESPONDENT
50 50
Interpretation: - Fromtheabovediagram, we can say that 68%
of people quires solved by insurancecompanies while 32%
solvetheir quires personally.
68%
32%
0
10
20
30
40
50
60
70
80
By insurance
companies
Personally
T.Y BANKING & INSURANCE (SEM-VI)
42
Q.7 From which company you have settle your claim?
TABLE
NO
PARTICULAR HDFC ICICI LIC Others
1 RESPONCES
RECEIVED
03 13 24 10
2 TOTAL
RESPONDENT
50 50 50 50
Interpretation:- Fromtheabovediagram, we can say that 3% of
people se HDFC, 26% uses ICICI, 48% uses LICand 20% uses
others.
06%
26%
48%
20%
0
10
20
30
40
50
60
70
80
90
100
HDFC ICICI LIC Others
T.Y BANKING & INSURANCE (SEM-VI)
43
Q.8. How is the procedure forclaim settlement?
Interpretation:- Fromtheabove diagram, we can say that 36%
people says thatIs easy while 64% don’t.
TABLE
NO
PARTICULAR Easy Length
1 RESPONSE
RECEIVED
18 32
2 TOTAL
RESPONDENT
50 50
36%
64%
0
10
20
30
40
50
60
70
80
90
100
Easy Length
T.Y BANKING & INSURANCE (SEM-VI)
44
Q.9. How much time required for settling the claim?
TABLE
NO
PARTICULAR 15 Days 1 Month 2 Months
or more
1 RESPONSE
RECEIVED
15 21 21
2 TOTAL
RESPONDENT
50 50 50
Interpretation:- Fromtheabovediagram, we can say that 16% of
people required to settle the claim since 15 days, 42% since2
months and 42% since2 months or more.
16%
42% 42%
0
10
20
30
40
50
60
70
80
90
100
15 Days 1 Month 2 Months or
more
T.Y BANKING & INSURANCE (SEM-VI)
45
Q.10. Do you get any problem while settling the claim?
TABLE
NO
PARTICULAR Yes No
1 RESPONSE
RECEIVED
30 20
2 TOTAL
RESPONDET
50 50
Interpretation:- Fromtheabovediagram, we can say that 60%
people says yes while40% don’t.
60%
40%
0
10
20
30
40
50
60
70
80
90
100
Yes No
T.Y BANKING & INSURANCE (SEM-VI)
46
Q.11. Are you satisfy with facilities provided by company?
TABLE NO PARTICULAR YES NO
1 RESPONSE
RECEIVED
29 21
2 TOTAL
RESPONDENT
50 50
Interpretation:- Fromtheabovediagram, we can say that 58% of
people are satisfy with servicewhile 42% don’t.
58%
42%
0
10
20
30
40
50
60
70
80
90
100
Yes No
T.Y BANKING & INSURANCE (SEM-VI)
47
Q.12.Is your claim accepted bycompany?
TABLE NO PARTICULAR YES NO
1 RESPONSERECEIVED 40 10
2 TOTAL RESPONDENT 50 50
Interpretation:- Fromtheabovediagram, we can say that 80% of
claims were accepted while 20% don’t.
80%
20%
0
10
20
30
40
50
60
70
80
90
100
Yes No
T.Y BANKING & INSURANCE (SEM-VI)
48
Q.13. Is your claim rejected by company?
TABLE NO PARTICULAR YES NO
1 RESPONSE ERCEIVED 10 40
2 TOTAL RESPONDENT 50 50
Interpretation:- Fromtheabovediagram, we can say that 20% of
claims were rejected while 80% don’t.
20%
80%
0
10
20
30
40
50
60
70
80
90
100
Yes No
T.Y BANKING & INSURANCE (SEM-VI)
49
Q.14. Do you have any complain against claim
settlement?
TABLE NO PARTICULAR YES NO
1 RESPONSERECEIVED 33 17
2 TOTAL RESPONDENT 50 50
Interpretation:- Fromtheabovediagram, we can say that 66% of
people having problem while 34% don’t.
66%
34%
0
10
20
30
40
50
60
70
80
90
100
Yes No
T.Y BANKING & INSURANCE (SEM-VI)
50
Chapter-5
SUMMARY OF FINDINGS AND
CONCLUSION
T.Y BANKING & INSURANCE (SEM-VI)
51
Summaryof Findings:-
1. Majority of people having their life insurance policy
in LIC.
2. Majority of people are aware about claim
settlement.
3. Majority of people know about claim settlement
while taking policy.
4. Majority of people have not applied for claim.
5. Majority of people gone 2 times, 3 times or more
than that for inquiry about claim.
6. Majority of people have solved their queries by
insurance companies.
7. Majority of people have settled their claim through
LIC.
8. Majority of people says that procedure is length for
claim settlement.
9. Majority of people required 1 or 2 month or more
than that for settling the claim.
10. Majority of people gets problem while setting a
claim.
11. Majority of people are satisfy facilities provided by
companies.
T.Y BANKING & INSURANCE (SEM-VI)
52
12. Majority of people claim are accepted by
companies.
13. Majority of people claim are not rejected by the
companies.
14. Majority of people have complaints regarding
claim settlement.
T.Y BANKING & INSURANCE (SEM-VI)
53
Conclusion:-
The insurance business is major service oriented
business in the world. The service offered by the industry
is well recognized and utilized by the general public and
commercialsectorof the world. The life insurance
business has covered nearly 40% of the population of the
world. Global players with strong brand in the insurance
company today set p there back office operationin low
costcountry, manage capital on the global basis, make
use of their specialskills worldwide and use their superior
managerial ability to secure leadership positions in the
industry.
The claim management in an integral part of insurance. It
involves the strong, processing and transmission of
information relating to settlementof insurance claims. The
use of Information Technology also plays an important
role in claim settlement.In managing the claims handling
the function, insurers seekto balance the elements of
customersatisfaction, administrative handling expenses,
and overpayment leakages. As part of this balance act,
fraudulent insurance practices are a major business risk
that must be managed and overcome.Disputes between
insurers and insured over the validity of claims or claims
T.Y BANKING & INSURANCE (SEM-VI)
54
handling practices occasionally escalate into litigation
which should be solved with due care.
In the fast scenario it will not be enough if companies
have the futuristic strategies.Implementationof the
strategies,effectivelyadapting them to ongoing changes
can spell success.The success of claim management
depends on the satisfaction of the customer. The
customers are attracted to an insurance company by its
state of art claim service. Therefore,before designing an
IT system for claim management, customer’s
expectations are to be taken into account. The customers,
their needs,knowledge of how the market works, and
what they want, these are the things that are important for
an insurance company for serving the customers in a
better manner through better technology.
T.Y BANKING & INSURANCE (SEM-VI)
55
Chapter-6
SUGGESTION
T.Y BANKING & INSURANCE (SEM-VI)
56
 Companies should provide better facilities for claim
settlement.
 Company’s procedure regarding claim management
should be easy.
 Companies should take short time while settling the
claim.
 Companies should not rejected the claim without
knowing the reason properly.
 Companies should give better knowledge regarding
claim settlement.
 Companies should solve the queries properly
regarding claim settlement
 Companies should satisfy the consumer needs.
T.Y BANKING & INSURANCE (SEM-VI)
57
BIBLIOGRAPHY
 WEBLIOGARPHY:-
www.investopedia.com
www.wikipedia.com
 BIBLIOGARPHY:-
The Times of India
Magazines
T.Y BANKING & INSURANCE (SEM-VI)
58
ANNEXURE
T.Y BANKING & INSURANCE (SEM-VI)
59
Questionnaire for customer
Name: ______________________________________
Education:____________________________________
Q.1. From which company you have taken life insurance?
 HDFC
 ICICI
 LIC
 Others
Q.2. Are you aware about claim settlement?
 Yes
 No
Q.3. From where did you know about claim settlement?
 While taking policy
 After maturity
Q.4.Have you applied for any claim settlement?
 Yes
 No
Q.5. How many times you approach in insurance office for
inquiry about claim?
 1 time
 2 times
 3 times or more
T.Y BANKING & INSURANCE (SEM-VI)
60
Q.6. Where has your quires solved?
 By insurance companies
 Personally
Q.7. From which company you have settle your claim?
 HDFC
 ICICI
 LIC
 Others
Q.8. How is the procedure of claim settlement?
 Easy
 Length
Q.9 How much time required for setting the claim?
 15 Days
 1 Month
 2 Months or more
Q.10. Do you get any problem while setting the claim?
 Yes
 No
Q.11. Are you satisfy with facilities provided by company?
 Yes
 No
Q.12. Is your claim accepted by company?
 Yes
 No
T.Y BANKING & INSURANCE (SEM-VI)
61
Q.13. Is your claim rejected by company?
 Yes
 No
Q.14. Do you have any complaint against claim
settlement?
 Yes
 No
Sign:
__________

Blackbook project

  • 1.
    T.Y BANKING &INSURANCE (SEM-VI) 1 “TO STUDY ABOUT CLAIM MANAGEMENT IN LIFE INSURANCE” IN PARTIAL FULLFILLMENT FOR THE AWARD OF THE DEGREE OF BACHELOR OF BANKING INSURANCE PREPARED BY JEET GANGAR ROLL NO. 05 T.Y.B&I MATRUSHRI KASHIBEN MOTILAL PATEL COLLEGE OF COMMERCE AND SCIENCE THAKURLI (E) - 421201 GUIDE Mrs. LEKHA VISARIA. UNIVERSITY OF MUMBAI, MUMBAI- 400028 Year 2013- 2014
  • 2.
    T.Y BANKING &INSURANCE (SEM-VI) 2 ACKNOWLEDGEMENT In this section, the researcher acknowledges the assistance and support received from individuals and organizations in conducting the researcher. It is thus intended to show his gratitude. Good taste calls for acknowledgement to be expressed simply expressed and nicely. I take this opportunity to thank all of them who played a major role in completing this project. I express my deep gratitude towards Prof. MRS. LEKHA VISARIA course coordinator for encouraging me to work on this project. I also thank our in charge Principal Mrs. Lekha Visaria for her continuous encouragement to our activities. I must especially record my sincere thanks to my family members and all my friends for their constant support.
  • 3.
    T.Y BANKING &INSURANCE (SEM-VI) 3 ABSTRACT . The field of insurance has taken a giant leap at the threshold of twentieth century. Insurance have become an integral part of life of man all over the globe. The proverb ‘Need is the mother of invention’ is proving equally correct in case of insurance. Insurance have already had a considerable impacton many aspects of our society. Claims management is another important aspecton insurance. It is complexin nature that is true but it is a driving force to plant confidence in the hearts of people. Claim management is one of the most challenging business processesin the insurance industry. With the number of stakeholders involved, the dependencies and the logistics,there is a need is to eliminate manual interventions. For many organizations, claim management and administration is viewed solely as a service operation. Claim management is expected to run the claim processefficientlyand keep expenses low, but little attention is given to leveraging high impact opportunities afforded through effective data management. In fact, the data captured in the claim process,which all too often are
  • 4.
    T.Y BANKING &INSURANCE (SEM-VI) 4 underutilized, are rich in valuable information for those who know how to extract and analyze it. Claim management is an expert system which generates the rules and regulations for the assessmentof general damages using the key information contained in medical reports, surveyor report, loss assessor’s reports, claimant’s petition and the procedures or conditions and warranties contained in the policy document. The claims management regulates the payment of general damages and also payment of the loss of future earnings. This project is just a gist about hoe the insurance companies settle the claims, the procedure that is followed,and the intermediaries that are involved in the process and so on. This project throws light on various aspects on claims management and the problems faced by them
  • 5.
    T.Y BANKING &INSURANCE (SEM-VI) 5 INDEX SR.NO PARTICULER PAGE.NO CHAPTER.1 INTRODUCTION 11 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.9 BACKGROUND OFTHE TOPIC PLACING RESEARCH PROBLEM STATING NEEDSFOR SURVEY TITLE OF THE STUDY OBJECTIVESOF THE STUDY NULL HYPOTHISES HYPETHOESIS DEFINITION OF IMPORATNTTERMS 12 18 18 19 19 20 20 20
  • 6.
    T.Y BANKING &INSURANCE (SEM-VI) 6 1.10 1.11 1.12 1.13 1.14 1.15 ASSUMPTION OF THE STUDY REVIEW OF LITERATURE METHODOLOGY RESEARCH QUESTION SIGNIFICANCE OFTHE PRESENTSTUDY SCOPE OF THE PRESENT STUDY 21 21 23 24 24 24 CHAPTER.2 CASE STUDY 26 CHAPTER.3 RESEARCH METHEDOLOGY 34
  • 7.
    T.Y BANKING &INSURANCE (SEM-VI) 7 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 RESEARCH METHOD SOURCE OF DATA RESEARCH AREA METHOD USE FOR DECIDING SAMPLE PLAN SAMPLING PLAN VALIDATION OF TOOL DATA COLLECTION INSRUMENT RATING SCALE RESEARCH PERIOD DATA PROCESSING AND ANALYSISPLAN 35 35 36 36 36 36 36 37 37 37
  • 8.
    T.Y BANKING &INSURANCE (SEM-VI) 8 CHAPTER.4 DATA ANALYASIS & INTERPRITENTION 38 CHAPTER 5 SUMMERY OF FINDING & CONCLUSION 53 CHAPTER 6 SUGGESTION 58 BIBLIOGRAPHY 60 ANNEXURE 61
  • 9.
    T.Y BANKING &INSURANCE (SEM-VI) 9 Chapter-1 INTRODUCTION 1.1) Background of the study:-
  • 10.
    T.Y BANKING &INSURANCE (SEM-VI) 10 Insurance is a promise of compensationforspecific potential future losses in exchanges for a periodic payment. Insurance is designed to protectthe financial well-being of an individual, company or other entity in case of unexpected loss. Agreeing to the terms of an insurance policy creates a contract between the insured and insurer. In exchange for payments from the insured (called premium), the insurer agrees to pay the policy holder a sum of money upon the occurrence of a specific events. There are two types of insurance. They are- Life Insurance and General Insurance. General Insurance comprisesof insurance of property against fire, burglary etc. Personal Insurance such as Accidentand Health Insurance, and Liability Insurance which covers legal liabilities. Personal Insurance covers include policies forAccidents, Health etc. Products offering Personal Accidentcoverare benefitpolicies.A Health Insurance Policy can provide financial relief to a personundergoing medicaltreatment whether due to disease or any injury. Accidentand Health Insurance policies are available for individuals as well as groups.
  • 11.
    T.Y BANKING &INSURANCE (SEM-VI) 11 1.1.1) Introduction to Life Insurance:- Human life is subjectto risks of death and disability due to natural and accidental causes.When human life is lost or a personis disabled permanently or temporarily, there is a loss of income to the household. The family is put to hardship. Sometimes,survival itself is at stake for the dependants.Risks are unpredictable. Death/disability may occur when one least expects it. An individual can protecthimself or herself against such contingencies through life insurance. Though human life cannot be valued, a monetary sum could be determined which is based on loss of income in future years. Hence in life insurance, the sum assured is by way of a benefitin the case of life insurance. It is the uncertainty that is risk, which gives rise to the necessityfor some form of protectionagainst the financial loss arising from death. Insurance substitutes this uncertainty. The primary purpose of life insurance is the protectionof family. Insurance in its various forms protects against such misfortunes by having the losses of the unfortunate few paid by the contribution of the many that are exposedto the same risk. This is the essence of insurance- the sharing of losses and substitute of certainty for uncertainty. There are a variety of life insurance products to suits to the needs of various categories of
  • 12.
    T.Y BANKING &INSURANCE (SEM-VI) 12 People-children,youth, women, middle-aged persons,old people;and also rural people,etc. life insurance products could be purchased from registered life insurers notified by the IRDA. Insurers appoints insurance agents to sell their products should receive properadvice from insurance agents/insurers so that a right products could be chosento suit particular financial needs. 1.1.2) Claim in Insurance An insurance claim is the actual application for benefits provided by an insurance company. Policy holders must first file an insurance claim before any money can be disbursed to the hospital or repair shop or other contracted service. The insurance company may or may not approve the claim, based on their own assessmentof the circumstances.Individual who take out home, life, health, or automobile insurance policies must maintain regular payments called premiums to the insurers. Most of the times these premiums are used to settle another person’s insurance claim or o build up the available assets of the insurance company. When claims are filed, the insured has to observe the settled rules and procedures and the insurers has also to reciprocated in a similar manner by undertaking appropriated steps for speedydisposalof claims. It is true that claims settlements is complexin nature, but it is the driving force to plant confidence in the hearts of people, in general and beneficiaries inspecifies.Insurance claim is a right of insured under a contract of insurance.
  • 13.
    T.Y BANKING &INSURANCE (SEM-VI) 13 Insurance contract is a contract by which one party called the insurer promise to save the other party, the insured on the payments of considerationknown as the premium. The insurer promises to save the insured are nominees/assigneesof the insured on happening of event or risk insured. Disputes crop up in the payment of claim when the insurer and the insured understand the process of claims payments in a differentway. Claims settlement is an integral part of the insurance business which is a service industry and its growth is interwoven with the people,the customers and consumers of service.It is inevitable for the insurance company to protectand guard the interest of the policyholders.An insurance claim is the only way to officiallyapply for benefits under an insurance policy, but until insurance company has assessedthe situation it will remain only a claim, not a pay-out. 1.1.3) Claim Management Many insurers have recognized the need to improve the efficiencyof their claims management process.They have streamlined processes,eliminated paper-based forms and redistributed work to match the demands to skills. The objectives of their efforts are to lower costs, while also increasing overall throughput. Efficiency improvements make tasks quicker and less costly execute. However, to realize even greater improvements in the claims handling process,insurers must also focus on the effectivenessof their claims decision.
  • 14.
    T.Y BANKING &INSURANCE (SEM-VI) 14 Claims handling costs typically represents 10% to 15% of net earned premium; in contrast, claims represent40% to 65%. Insurers that expand their focus to include effective as well as efficientclaims processing will find a far longer poll of saving opportunities. Technologycan play a significant role by providing integrated channels for communication and collaboration. This would help the insurance company increase employee productivity by reducing cycle time and defectrate and also increaser employee participation and compliance. Claims Processing sometimesinvolves collating and sharing large amounts of information among multiple parties involved in a claim, from bodyshops to adjusters to investigators to lawyers and doctors to claimants and regulator. And it involves the knowledge of experienced adjusters to determine be the fair and appropriate outcome of a claim. In fact, losses and loss expenses absorb 80% of premium collected by carriers. Service representatives and claims adjusters need to access data from multiple sources when processing or assessing a claim, which delays settlements time and increases costs.Manual steps reduce transparency of the claims process and raise the risk of fraud, manipulation or simply human error. Customerretention is also a challenge- experts say that 75% of customers leave their insurer due to claims issues.
  • 15.
    T.Y BANKING &INSURANCE (SEM-VI) 15 1.1.4) Prodecure of cliam management in life insurance:- INSURER On Recepit of Claim, Verify the claim Review the Claim application Respond to Claimant Claim Investigation Claim negotiation Claim settlement Claim payment INSURED Type of Suffering Loss or The Damage Understanding and Identyfing the Cause of Action Infoming or Giving Notice of Claim or Loss to Insurer Providing Sufficient Proof of Loss to Insurer
  • 16.
    T.Y BANKING &INSURANCE (SEM-VI) 16 1.2)Placing the research problem:- The major role made by insurance programme is the indemnification of risk averse individual who mightly adverse affectedby natural probablistic phenomenan. Customerservice has great importance in the insurance company. While the coverage of insurance industry is expanding day by day. This is because customer demanding insurance in todays world. This can be achieved through speed,service quality and customersatisfaction. These elments are going to be key differentiators foreach insurance company success. 1.3)Stating the need for survey:- Insurance users pay premium, year after year, trusting their policies tp protecttheir lives or business in the event of a loss. However, there are innumerable instances where a genuine insurance users with a genuine loss and a seeminglyvalid claim, has been denined his claim amount in full or part. This happen because the insurance company is not able to estiamte the total amount of the claims. In life insurance claims the
  • 17.
    T.Y BANKING &INSURANCE (SEM-VI) 17 insurance company tries to reject the claims without knowing the causes of death or loss of the person. 1.5) Title of the study: - To Study about Claim Management in Life Insurance. 1.6) Objective of the study:-  To study claim management in Life Insurance.  To find out problem while taking insurance by people.  To find out problem arising while claim settlementof life insurance.  To find out overall satisfactionabout life insurance. 1.7) Null Hypothesis:- Some people are not aware about claim management in life insurance & not also avail the claim management in life insurance.
  • 18.
    T.Y BANKING &INSURANCE (SEM-VI) 18 1.8) Hypothesis:- Majority personare aware about claim management in life insurance facility and they also take benefitof claim management in life insurance. Majority personare aware about claim management in life insurance facility and they also take benefitof claim management in life insurance. 1.9) Definition of important terms:-  Definition of life insurance Life insurance is a contract between two parties whereby one party agree to pay to the other party, a certain amount of money is premium to make the good loss of life arising out of an uncertain event in which insured has interest.  Definition of claims A claim is a right of insured to receive the amount secured under the policy of insurance contract promised by insured.
  • 19.
    T.Y BANKING &INSURANCE (SEM-VI) 19 1.10) Assumption made for present study:-  Customerquires are solved by insurance company personnelimmediately.  All people are engaged in claim management in life insurance.  It is assume that majority of customerare aware about claim management in life insurance. 1.11) Review of Literature:- According to complaints Sunanda Kanthale, her husband Manoharrao kanthale who worked as a stores superintendent with the Amravati policy for Rs 20,000 on November28, 1992. The policy which was a non-medical one was scheduled to mature on November24, 2004,she said. Unfortunately Manoharrao passed away on October 22. 1993,10 months and 25 days from the date of purchasing the instrument. Being the nominee in the policy, she asked for her claim for an account of Rs 40,000 (under double benefit provision in accidentcases) and made an application to the Akola branch manager of LIC.The senior manager of LIC (Amravati Division) however refused to settle the claim vide his letter dated August 4, 1994.As the policy was a non-medical one, the reason given by the official
  • 20.
    T.Y BANKING &INSURANCE (SEM-VI) 20 for not settling the claim was also a bogus one, she alleged. Sunanda then wrote to the area manager of LIC, Mumbai, justifying her claim. The Mumbai office too (vide letter dated April 20, 1995)refused to settle the claim, Kanthale added. She then lodged a complaint with Akola District Consumers Grievances redressed forum.In the complaints, she applied to the forum to issuer the necessarydirectives to the LIC for paying Rs 40,000 along with 18% interest, a compensationof Rs 50,000 towards mental tension caused and Rs 1,000 towards legal expenses. Defending the stand taken by the company, the LIC refuted all the allegations made by Sunanda. Manoharrao, who held the policy, had kept the information about his health a secretwhile purchasing the instrument, the company alleged. The forum referred to columns 14 and 26 in the application for where the policy purchaser had made statements about his health. The form was duly signed by Dr. B R Jain, the forum said. The LIC officials produced proofs before the forum regarding heart disorderof the policy holder and sick leave availed by him after taking the policy. However, they could not prove that Manohar was not well on the day of purchasing the policy. The District ConsumerGrievances RedressalForum has directed Senior Divisional Manager of Life Insurance Corporation (LIC)Amravati, Area Manager, Mumbai and Branch Manager, Akola, to pay Rs 20,000 to Sunanda
  • 21.
    T.Y BANKING &INSURANCE (SEM-VI) 21 Kanthale towards insurance claim besides intereston the amount from October22, 1993,till the date of payments at a rate of 12%. The forum has also directed LIC to pay compensationof Rs 10,000 to the woman for causing mental tension to her during the 4 years, after her husband’s death, in releasing the insurance amount. If the insurance company failed to pay the compensation within two months from the date of receiptof copyof the judgment, the company will be liable to pay interest at a rate of 18% on the amount till final payments besides legal expenses of Rs250,the forum ruled. The forum also ruled that through the compensationamount, demanded by the complaints, appeared,considering the troubles she had to face in the last four years for settlementof claim, the company should pay her Rs 10,000 towards compensation. 1.12) Methodology:- The researcher approaches to 50 respondents in Dombivli area. All 50 respondents respond to the questionnaire. The final study of projectwas done through based on these 50 respondents.The analysis of data was done with help of mean percentage and excel sheet.
  • 22.
    T.Y BANKING &INSURANCE (SEM-VI) 22 1.13) Research Question:- Which service provide under claim management in life insurance? 1.14) Significance of the study:-  The researcher needs to know procedure of claim management in life insurance.  The researcher want to know which facilities is avail by customer of claim management in life insurance. 1.15) Scope of the present study:- The survey method has been followed for the study well structure questionnaire to elicit the necessarydata and get filled the details from the respondent. The study will also help to identify the customer satisfaction toward the claim management in life insurance.
  • 23.
    T.Y BANKING &INSURANCE (SEM-VI) 23 Chapter-2 CASE STUDY
  • 24.
    T.Y BANKING &INSURANCE (SEM-VI) 24 (1) Life insurance Corporation of India v/s Mrs. Sunanada kanthale According to complaints Sunanda Kanthale, her husband Manoharrao kanthale who worked as a stores superintendent with the Amravati policy for Rs 20,000 on November28, 1992. The policy which was a non-medical one was scheduled to mature on November24, 2004,she said. Unfortunately Manoharrao passed away on October 22. 1993,10 months and 25 days from the date of purchasing the instrument. Being the nominee in the policy, she asked for her claim for an account of Rs 40,000 (under double benefit provision in accidentcases) and made an application to the Akola branch manager of LIC.The senior manager of LIC (Amravati Division) however refused to settle the claim vide his letter dated August 4, 1994.As the policy was a non-medical one, the reason given by the official for not settling the claim was also a bogus one, she alleged. Sunanda then wrote to the area manager of LIC,
  • 25.
    T.Y BANKING &INSURANCE (SEM-VI) 25 Mumbai, justifying her claim. The Mumbai office too (vide letter dated April 20, 1995)refused to settle the claim, Kanthale added. She then lodged a complaint with Akola District Consumers Grievances redressed forum.In the complaints, she applied to the forum to issuer the necessarydirectives to the LIC for paying Rs 40,000 along with 18% interest, a compensationof Rs 50,000 towards mental tension caused and Rs 1,000 towards legal expenses. Defending the stand taken by the company, the LIC refuted all the allegations made by Sunanda. Manoharrao, who held the policy, had kept the information about his health a secretwhile purchasing the instrument, the company alleged. The forum referred to columns 14 and 26 in the application for where the policy purchaser had made statements about his health. The form was duly signed by Dr. B R Jain, the forum said. The LIC officials produced proofs before the forum regarding heart disorderof the policy holder and sick leave availed by him after taking the policy. However, they could not prove that Manohar was not well on the day of purchasing the policy. The District ConsumerGrievances RedressalForum has directed Senior Divisional Manager of Life Insurance Corporation (LIC)Amravati, Area Manager, Mumbai and Branch Manager, Akola, to pay Rs 20,000 to Sunanda Kanthale towards insurance claim besides intereston the amount from October22, 1993,till the date of payments
  • 26.
    T.Y BANKING &INSURANCE (SEM-VI) 26 at a rate of 12%. The forum has also directed LIC to pay compensationof Rs 10,000 to the woman for causing mental tension to her during the 4 years, after her husband’s death, in releasing the insurance amount. If the insurance company failed to pay the compensation within two months from the date of receiptof copyof the judgment, the company will be liable to pay interest at a rate of 18% on the amount till final payments besides legal expenses of Rs250,the forum ruled. The forum also ruled that through the compensationamount, demanded by the complaints, appeared,considering the troubles she had to face in the last four years for settlementof claim, the company should pay her Rs 10,000 towards compensation.
  • 27.
    T.Y BANKING &INSURANCE (SEM-VI) 27 (2) Life insurance Corporation of India v/s Neelam Metha The case arose following the refusal of LIC to pay the insurance money following the death of her husband Mahendrabhai Metha. LIC had repudiated the life policy alleging that he had hid from it that he was suffering from diabetes at the time of taking the insurance policy in December1993.On 6 November1994 he died following a heart attack. Neelam told the consumerforum that she came to know that her husband had a life policy with LIC 3 months after his death, when she started receiving ‘forms one after another to be filled through LIC agent’. She then filled up all the relevant papers. She also formally informed LIC about death of her husband and claimed the insurance money. Thereupon, LIC intimated her that the claim for her husband’s insurance policy was repudiated because the life assured had ‘deliberately’ withheld information regarding his ‘pre- existing illness which was diabetes’and which, it said, had led to his death. It also alleged that because of this
  • 28.
    T.Y BANKING &INSURANCE (SEM-VI) 28 disease he had been hospitalized before his death and that he was a insulin-dependent diabetic. Neelam represented to both the Bhavnagar and Ahmebad office of LIC and later to its zonal office in Mumbai urging them to recommend herclaim to the review committee. This request was made in September1996 till now no decisionhad been taken and the ‘matter is still under consideration’. She also denied that her husband was a diabetic or that he had been hospitalized for this. He had not been treated for any ailment during the 5 years preceding his death, she asserted.The forum comprising its president,K.D. Desai, members LeenaDesai and Malaybhai Kantharia, found that LIC has failed to prove that Mr. Metha had made false statement and misrepresentation about his health.”The burden of proving that there was a suppressionof material fact and that it was made fraudulently” lied on LIC and it had failed to prove it, the forum observed.LIC therefore was legally and morally duty-bound to pay the claim, it said. Consumerdisputes redressalforum, Ahmedabad,has directed LIC of India to pay up Rs. 50,000 plus 12% interest for 7 years, as insurance money due to after her husband’s death. The forum also ordered payment of Rs. 5000 for causing mental agony, hardship and inconvenience to Neelamben. It granted Rs. 3000 as cost.
  • 29.
    T.Y BANKING &INSURANCE (SEM-VI) 29 (3) Life insurance Corporation of India v/s Lily Rani Roy The petitioner has purchased a life insurance policy from the appellate and premiums were paid regularly. The maturity of the said policy was in 1978.Because of some personal reasons the claim was not filed. The petitioner had filed the claim after 13 years of its maturity. The LIC of India rejected the payment on a plea that claim is time barred claim and as such the claim will not be paid. The petitioner has filed a complaint with consumercouncil with a requestto direct the LIC for the payment of the maturity claim as the policyholderhad paid the entire premium till the date of the maturity and has the right to receive the claim amount. Assured held LIC guilty under ConsumerProtection Act, 1986 Section(I) (g) for deficiencyin service. But, the LIC of India pleaded that the Corporation will be maintaining the records fora period of 5 years only and the Corporation has received the claim notice from the
  • 30.
    T.Y BANKING &INSURANCE (SEM-VI) 30 petitioner in 1990 which is far beyond the time. The LIC also produced a photo copy of the maturity claim payment registershowing the payment of the complainant’s money. After examining all the facts, the State forum has declared that the petitioners cannot claim the payment of policy as it is already time barred. On the decisionof the State Commission,the petitioners filed a petition with the National Commission. The National Commission,after verifying the terms of the policy, has opined that through the payments of claim is time barred, the insurance company should have given notice to that effector should include a clause in the policy documentstating that the time barred maturity claims will not be paid. As the Corporation has filed to bring this information has filed to bring this information to the notice of the policyholderor failed to create the awareness among the policyholders,it has failed in its duties and as such it is liable to pay the claim to the petitioners. Thus, the National Commissionhas ordered the payment of time barred maturity claims.
  • 31.
    T.Y BANKING &INSURANCE (SEM-VI) 31 Chapter-3 RESEARCH METHOLODOGY
  • 32.
    T.Y BANKING &INSURANCE (SEM-VI) 32 3.1) Research Method:- Researcherdecidesto survey in thane(w) .The researcherused the survey method for presentstudy. 3.2) Source of Data:- Primary data and secondary data are collected for presentresearch study. a) Primary data- The researcher collected the primary data personally through face to face interaction and also with observation method. b) Secondarydata- The secondary data was collected throughvarious ways that is  Internet- www.investopedia.com www.wikiipedia.com  Newspaper-The economics times
  • 33.
    T.Y BANKING &INSURANCE (SEM-VI) 33 3.3) Research Area:- The researcher has made research in Thane(w). 3.4) Method Use for Deciding the Sampling Plan:- The sample constituted of 50 respondents.The sample size was 50, the elements for samples i.e. the responds selected through selective sampling method. 3.5) Sampling Plan:- The approach was made to the respondents twice times. At the 1st visit out of 50, 17 respondents responded perfectly and then 13 responded through telephone 20 responded after approaching twice time through appointment. 3.6) Validation of Tool:- The tool was send to professor,insurance official,to verify their validity & correctionwhere made after receiving their suggestionthe tool was then finalized.
  • 34.
    T.Y BANKING &INSURANCE (SEM-VI) 34 3.7) Data Collection Instruments:- The types of instruments used for data collectionwere through surveying, internet, approaching to insurance agents and to customer to know about claim management in life insurance.. 3.8) Rating Scale:- Liker scale used for quantitive analysis. 3.9) Research Period:- The research has made during the month of march 2019 3.10) Data processing& Analysis of Plan:- The data processing & analysis with the help of mean percentage method and bar diagram.
  • 35.
    T.Y BANKING &INSURANCE (SEM-VI) 35 Chapter-4 DATA ANALYSIS AND INTERPRETATION
  • 36.
    T.Y BANKING &INSURANCE (SEM-VI) 36 Q.1. From which company you have taken life insurance policy? TABLE NO PARTICULAR HDFC ICICI LIC Others 1 RESPONSE RECEIVED 03 13 24 10 2 TOTAL RESPONDENT 50 50 50 50 Interpretation:- Fromtheabovediagram, we can see that 06% people use HDFC, 26% useICICI, 48% useLIC, 20% use others. 06% 26% 48% 20% 0 10 20 30 40 50 60 70 80 90 100 HDFC ICICI LIC Others
  • 37.
    T.Y BANKING &INSURANCE (SEM-VI) 37 Q.2. Are you aware of claim settlement? TABLE NO PARTICULAR Yes No 1 REPONCE RECEIVED 50 0 2 TOTAL RESPONDENT 50 50 Interpretation:- Fromtheabovediagram, we can say that all the people are awareof claim settlement. 100% 0% 0 10 20 30 40 50 60 70 80 90 100 Yes No
  • 38.
    T.Y BANKING &INSURANCE (SEM-VI) 38 Q.3. From where did you know about claim settlement? TABLE NO PARTICULAR While takingpolicy Aftermaturity 1 RESPONSE RECEIVED 50 0 2 TOTAL RESPONDENT 50 50 Interpretation:- Fromtheabovediagram, we can say that people know claim settlement while taking the project. 100% 0% 0 10 20 30 40 50 60 70 80 90 100 While taking policy After maturity
  • 39.
    T.Y BANKING &INSURANCE (SEM-VI) 39 Q.4. Have you applied for any claim? TABLE NO PARTICULAR Yes No 1 RESPONSE RECEIVED 23 27 2 TOTAL RESPONDENT 50 50 Interpretation:- Fromtheabovediagram, we can see that 46% of people say that have claim while 54% people say isn’t. 46% 54% 0 10 20 30 40 50 60 70 80 90 100 Yes NO
  • 40.
    T.Y BANKING &INSURANCE (SEM-VI) 40 Q.5. How many times you approach in insurance office for inquiry about claim? TABLE NO PARTICULAR 1 time 2 times 3 timesor more 1 RESPONSE RECEIVED 10 20 20 2 TOTAL RESPONDENT 50 50 50 Interpretation:- Fromtheabovediagram, we can say that 10% of people go 1 time, 40% of people go 2 times, 40% of people go 3 times or more. 10% 40% 40% 0 10 20 30 40 50 60 70 80 90 100 1 time 2 times 3 times or more
  • 41.
    T.Y BANKING &INSURANCE (SEM-VI) 41 Q.6. Where has your queries solved? TABLE NO PARTICULAR By insurance companies Personally 1 RESPONSE RECEIVED 34 16 2 TOTAL RESPONDENT 50 50 Interpretation: - Fromtheabovediagram, we can say that 68% of people quires solved by insurancecompanies while 32% solvetheir quires personally. 68% 32% 0 10 20 30 40 50 60 70 80 By insurance companies Personally
  • 42.
    T.Y BANKING &INSURANCE (SEM-VI) 42 Q.7 From which company you have settle your claim? TABLE NO PARTICULAR HDFC ICICI LIC Others 1 RESPONCES RECEIVED 03 13 24 10 2 TOTAL RESPONDENT 50 50 50 50 Interpretation:- Fromtheabovediagram, we can say that 3% of people se HDFC, 26% uses ICICI, 48% uses LICand 20% uses others. 06% 26% 48% 20% 0 10 20 30 40 50 60 70 80 90 100 HDFC ICICI LIC Others
  • 43.
    T.Y BANKING &INSURANCE (SEM-VI) 43 Q.8. How is the procedure forclaim settlement? Interpretation:- Fromtheabove diagram, we can say that 36% people says thatIs easy while 64% don’t. TABLE NO PARTICULAR Easy Length 1 RESPONSE RECEIVED 18 32 2 TOTAL RESPONDENT 50 50 36% 64% 0 10 20 30 40 50 60 70 80 90 100 Easy Length
  • 44.
    T.Y BANKING &INSURANCE (SEM-VI) 44 Q.9. How much time required for settling the claim? TABLE NO PARTICULAR 15 Days 1 Month 2 Months or more 1 RESPONSE RECEIVED 15 21 21 2 TOTAL RESPONDENT 50 50 50 Interpretation:- Fromtheabovediagram, we can say that 16% of people required to settle the claim since 15 days, 42% since2 months and 42% since2 months or more. 16% 42% 42% 0 10 20 30 40 50 60 70 80 90 100 15 Days 1 Month 2 Months or more
  • 45.
    T.Y BANKING &INSURANCE (SEM-VI) 45 Q.10. Do you get any problem while settling the claim? TABLE NO PARTICULAR Yes No 1 RESPONSE RECEIVED 30 20 2 TOTAL RESPONDET 50 50 Interpretation:- Fromtheabovediagram, we can say that 60% people says yes while40% don’t. 60% 40% 0 10 20 30 40 50 60 70 80 90 100 Yes No
  • 46.
    T.Y BANKING &INSURANCE (SEM-VI) 46 Q.11. Are you satisfy with facilities provided by company? TABLE NO PARTICULAR YES NO 1 RESPONSE RECEIVED 29 21 2 TOTAL RESPONDENT 50 50 Interpretation:- Fromtheabovediagram, we can say that 58% of people are satisfy with servicewhile 42% don’t. 58% 42% 0 10 20 30 40 50 60 70 80 90 100 Yes No
  • 47.
    T.Y BANKING &INSURANCE (SEM-VI) 47 Q.12.Is your claim accepted bycompany? TABLE NO PARTICULAR YES NO 1 RESPONSERECEIVED 40 10 2 TOTAL RESPONDENT 50 50 Interpretation:- Fromtheabovediagram, we can say that 80% of claims were accepted while 20% don’t. 80% 20% 0 10 20 30 40 50 60 70 80 90 100 Yes No
  • 48.
    T.Y BANKING &INSURANCE (SEM-VI) 48 Q.13. Is your claim rejected by company? TABLE NO PARTICULAR YES NO 1 RESPONSE ERCEIVED 10 40 2 TOTAL RESPONDENT 50 50 Interpretation:- Fromtheabovediagram, we can say that 20% of claims were rejected while 80% don’t. 20% 80% 0 10 20 30 40 50 60 70 80 90 100 Yes No
  • 49.
    T.Y BANKING &INSURANCE (SEM-VI) 49 Q.14. Do you have any complain against claim settlement? TABLE NO PARTICULAR YES NO 1 RESPONSERECEIVED 33 17 2 TOTAL RESPONDENT 50 50 Interpretation:- Fromtheabovediagram, we can say that 66% of people having problem while 34% don’t. 66% 34% 0 10 20 30 40 50 60 70 80 90 100 Yes No
  • 50.
    T.Y BANKING &INSURANCE (SEM-VI) 50 Chapter-5 SUMMARY OF FINDINGS AND CONCLUSION
  • 51.
    T.Y BANKING &INSURANCE (SEM-VI) 51 Summaryof Findings:- 1. Majority of people having their life insurance policy in LIC. 2. Majority of people are aware about claim settlement. 3. Majority of people know about claim settlement while taking policy. 4. Majority of people have not applied for claim. 5. Majority of people gone 2 times, 3 times or more than that for inquiry about claim. 6. Majority of people have solved their queries by insurance companies. 7. Majority of people have settled their claim through LIC. 8. Majority of people says that procedure is length for claim settlement. 9. Majority of people required 1 or 2 month or more than that for settling the claim. 10. Majority of people gets problem while setting a claim. 11. Majority of people are satisfy facilities provided by companies.
  • 52.
    T.Y BANKING &INSURANCE (SEM-VI) 52 12. Majority of people claim are accepted by companies. 13. Majority of people claim are not rejected by the companies. 14. Majority of people have complaints regarding claim settlement.
  • 53.
    T.Y BANKING &INSURANCE (SEM-VI) 53 Conclusion:- The insurance business is major service oriented business in the world. The service offered by the industry is well recognized and utilized by the general public and commercialsectorof the world. The life insurance business has covered nearly 40% of the population of the world. Global players with strong brand in the insurance company today set p there back office operationin low costcountry, manage capital on the global basis, make use of their specialskills worldwide and use their superior managerial ability to secure leadership positions in the industry. The claim management in an integral part of insurance. It involves the strong, processing and transmission of information relating to settlementof insurance claims. The use of Information Technology also plays an important role in claim settlement.In managing the claims handling the function, insurers seekto balance the elements of customersatisfaction, administrative handling expenses, and overpayment leakages. As part of this balance act, fraudulent insurance practices are a major business risk that must be managed and overcome.Disputes between insurers and insured over the validity of claims or claims
  • 54.
    T.Y BANKING &INSURANCE (SEM-VI) 54 handling practices occasionally escalate into litigation which should be solved with due care. In the fast scenario it will not be enough if companies have the futuristic strategies.Implementationof the strategies,effectivelyadapting them to ongoing changes can spell success.The success of claim management depends on the satisfaction of the customer. The customers are attracted to an insurance company by its state of art claim service. Therefore,before designing an IT system for claim management, customer’s expectations are to be taken into account. The customers, their needs,knowledge of how the market works, and what they want, these are the things that are important for an insurance company for serving the customers in a better manner through better technology.
  • 55.
    T.Y BANKING &INSURANCE (SEM-VI) 55 Chapter-6 SUGGESTION
  • 56.
    T.Y BANKING &INSURANCE (SEM-VI) 56  Companies should provide better facilities for claim settlement.  Company’s procedure regarding claim management should be easy.  Companies should take short time while settling the claim.  Companies should not rejected the claim without knowing the reason properly.  Companies should give better knowledge regarding claim settlement.  Companies should solve the queries properly regarding claim settlement  Companies should satisfy the consumer needs.
  • 57.
    T.Y BANKING &INSURANCE (SEM-VI) 57 BIBLIOGRAPHY  WEBLIOGARPHY:- www.investopedia.com www.wikipedia.com  BIBLIOGARPHY:- The Times of India Magazines
  • 58.
    T.Y BANKING &INSURANCE (SEM-VI) 58 ANNEXURE
  • 59.
    T.Y BANKING &INSURANCE (SEM-VI) 59 Questionnaire for customer Name: ______________________________________ Education:____________________________________ Q.1. From which company you have taken life insurance?  HDFC  ICICI  LIC  Others Q.2. Are you aware about claim settlement?  Yes  No Q.3. From where did you know about claim settlement?  While taking policy  After maturity Q.4.Have you applied for any claim settlement?  Yes  No Q.5. How many times you approach in insurance office for inquiry about claim?  1 time  2 times  3 times or more
  • 60.
    T.Y BANKING &INSURANCE (SEM-VI) 60 Q.6. Where has your quires solved?  By insurance companies  Personally Q.7. From which company you have settle your claim?  HDFC  ICICI  LIC  Others Q.8. How is the procedure of claim settlement?  Easy  Length Q.9 How much time required for setting the claim?  15 Days  1 Month  2 Months or more Q.10. Do you get any problem while setting the claim?  Yes  No Q.11. Are you satisfy with facilities provided by company?  Yes  No Q.12. Is your claim accepted by company?  Yes  No
  • 61.
    T.Y BANKING &INSURANCE (SEM-VI) 61 Q.13. Is your claim rejected by company?  Yes  No Q.14. Do you have any complaint against claim settlement?  Yes  No Sign: __________