This document discusses insurance claims processes. There are two main types of claims: maturity claims, which are paid out when an insurance policy reaches maturity, and death claims, which are paid out if the policyholder passes away. For maturity claims, the policyholder submits the original policy documents and signs discharge forms to receive payment. For death claims, the claimant submits proof of death documents like a death certificate. The insurance company is required to settle claims within 30 days if all documents are provided, or within 6 months if further verification is needed, otherwise interest is payable to the claimant.

1. Prepared by:- Priyanka sarraf and puja gupta
BBA-IV SEM, ISBM, SGVU

2.  Claim is a right of insured to receive the amount secured under
the policy of insurance contract promised by Insurer
 Insurance Claim is the request of the insured policy
holder/beneficiary from the insurer/insurance issuing company
for financial reimbursement whenever he/she suffers a loss of the
insured property/life/health/etc.
 Insurer- settle the claim after satisfying himself that all the
conditions and requirements for settlement of claim have been
compiled with

3. The claims occur under two
circumstances:
Maturity Claim: This type of claim needs settlement once
the policy completes the term selected. The policies like the
endowment plans, money back plans or child plans fall under this
category.
Death Claim: This occurs in case of death of the policyholder
during the term of the policy. The death could either be due to
illness or accidental. The term plan is the biggest example.

4. Maturity claims
A maturity claim is paid out mostly on endowment education
insurance policies whose duration has been expired. For example
in an insurance policy with duration of 15 years, the maturity value
will be paid on the 15th anniversary after affecting the policy.
Payment of maturity claim is a straightforward affair where the
customer returns the original policy document and signs a
discharge forms. A claim cheque is usually released in a period of
about two weeks once all required conditions are fulfilled.

5. Process of settlement of maturity claims
 Payable as per the terms of contract- at the end of the term
 Insurers inform the policyholder well in advance about the maturity date
 Insurers send the form of discharge which is duly signed, and returned with-
a) Original Policy document
b) proof of age- to prove the identity
c) Document of assignment- if executed on a separate stamped paper
 Gross amount includes basic sum assured, bonus etc.
 Deductions include loan amount, unpaid premium etc.
 Circumstances like settling the claim on the basis of indemnity bond require
more caution (in case original policy is not found)

6. Death claims
The death claim amount is payable in case of
policies where premium are paid up-to-date or the
death occurs within the days of grace.

7. Process of settlement of death claims
 Intimation of death by a proper person and proof of death
A. Premature/early claim: insured dies within 3 years of taking out of policy
a) statement from the last medical attendant giving details of last illness and treatment
b) Statement from the hospital
c) Statement from the employer
B. Other claim : insured dies after 3 years of taking out of policy
a) Policy number and Name of life assured
b) Date and Cause of death
c) Claimants relationship
d) Death certificate
e) Deeds of assignment

8. C. In case of unnatural death: accident, suicide,
or unknown cause etc.
a. Police inquest report
b. Panchnama
c. Post mortem report
d. Chemical examination report
D. Under the Indian Evidence Act, a person is presumed to be dead if he is
disappeared for 7 years
 Upon the death of the life insured the amount is payable to the nominee
given in the proposal form

9. As per IRDA (Insurance regulatory and development authority),
 Insurance company is required to settle a claim within 30 days of receipt of all requirements
 If the claim warrants further verification, the company should complete its procedures within
6 months from receipt of written intimation of the claim
 If the company settles the claim beyond 6 months period, then interest is payable by the
company on the claim amount
 The interest is payable only where the claimant has submitted all the requirements. Further,
rate and period of interest are decided as per IRDA guidelines