3. Who can intimate a claim? The policyholder or the nominee (as mentioned in the Policy Contract) can intimate a claim.

Transcription

1 Ktak Life Insurance :: Custmers Claims Infrmatin Library :: FAQs A: Individual Claim: 1. What is a claim? A claim is a rightful demand, fr payment in accrdance with an insurance plicy claim, by way f a frmal request t an insurance cmpany asking fr a payment based n the terms f the insurance plicy by a rightful nminee t the claim. 2. Hw t intimate a claim? T intimate a claim, all the requisite dcuments as mentined under the Claims Guidelines sectin shuld be sent t Claims Department: Claims Department Ktak Mahindra Old Mutual Life Insurance Cmpany Limited Ktak Infiniti, Building n. 21, 7th Flr - Zne 2, Infinity Park, Off Western Express Highway, General A K Vaidya Marg, Malad (E), Mumbai The claim intimatin frm can be btained under ur FORMS sectin, Life Advisr r nearest KLI branch. In view f administrative cnvenience the dcuments can als be submitted at nearest KLI branch. 3. Wh can intimate a claim? The plicyhlder r the nminee (as mentined in the Plicy Cntract) can intimate a claim. If nminee is minr, appintee, as mentined in the Plicy Cntract, can intimate a claim n behalf f the minr nminee. In case f unfrtunate event f the cntractual parties, claim can be intimated by the legal heir with prf f legal title.

2 4. Incase f multiple nminees in plicies, what are the dcuments t be submitted? Multiple Nminees Single Plicy: Incase f mre than ne nminee in a plicy, all the nminees will have t fill in separate Claim Intimatin Frm alng with all requisite dcuments. Multiple cpies f dcuments pertaining t affected persn need nt be submitted. Multiple Nminees Multiple Plicies: Incase f multiple nminees in multiple plicies f the affected persn, all the nminees will have t fill in separate Claim Intimatin Frm alng with all requisite dcuments. Multiple cpies f dcuments pertaining t affected persn need nt be submitted. 5. Can a claim be ldged in branch ther than ne frm where plicy was purchased? A claim can be ldged in any branch f KLI, irrespective f the branch frm where plicy was purchased. 6. What wuld be the prcedure in case f demise f prpser (if different frm life insured) where waiver f premium rider is nt pted in plicy? Plicy where waiver f premium rider is nt pted and prpser (if different frm life insured) dies; plicy needs t be cntinued by paying future premiums. In such claims; with respect t the plicy terms and cnditins; the request fr plicy wner change with requisite dcuments can be submitted at ur nearest branch. 7. What wuld be the prcedure in case f demise f nminee? In case f demise f nminee; the request fr nminatin change with requisite dcuments can be submitted at ur nearest branch. 8. Whse KYC dcuments are t be submitted under the fllwing instances? Under Death Claim: Nminee is Minr Incase where nminee is minr, the appintee as per the Plicy Cntract intimates the claim and KYC dcuments f appintee are t be submitted with claim intimatin. Absence f Nminatin KYC dcuments f the legal heir are t be submitted with claim intimatin.

3 Death f Nminee / Appintee - KYC dcuments f the legal heir / legal guardian are t be submitted with claim intimatin. Under Rider Claim: Latest KYC dcuments f the life insured are t be submitted with the claim intimatin. 9. If the riginal Plicy Cntract was lst and request fr issuance f duplicate was nt made, will the claim be prcessed withut Plicy Cntract? Plicy Cntract is a mandatry dcument fr claim prcessing. In case where riginal Plicy Cntract is nt available, claimant has t prvide ntarized affidavit- cum- indemnity n the stamp paper. Frmat f affidavit-cum-indemnity fr claim can be availed under FORMS sectin, any nearest KLI branch r frm Claims department at HO. 10. What will be the amunt f benefit that wuld be payable n death f Life Insured? Death benefit vary as per the plan pted by the plicyhlder. The detail f benefit payable n the death f Life Insured is readily available in the plicy cntract issued by KLI under sectin Benefits payable - Death Benefit entails the benefit payable. 11. Can claim benefit amunt be received in any ther currency ther than Indian Currency? Death benefit amunt will be paid nly in Indian Rupees. 12. Can claim amunt received as death benefit be repatriated utside India? Fr all plicies including thse under Nn- Residence Indian Insurance Scheme, claim amunt cannt be repatriated ut f India. 13. If after applying fr the plicy, life insured gets t knw abut health cnditins which were nt mentined in the prpsal frm will the claim be settled? It's a duty f life insured t infrm the cmpany abut health changes happening after prpsal signing and befre issuance f plicy. If life insured fails in his duties in infrming the life insurance cmpany, death claim wuld be prcessed after cnsidering all the facts w.r.t. health cnditins f the life insured.

4 14. If death is due t terrrist attack / war / natural calamities will the claim be settled? Death due t terrrist attack / war / natural calamities is cvered under life insurance plicies (unless specifically exclude in plicy cntract) and claim is settled if all the dcumentatin are in rder and all the cnditins are fulfilled. In such scenaris we have fast track claim prcessing t prvide quick aid fr the sudden lss. 15. What is average time taken t settle the claim intimated t us? Claims are nrmally settled within 7 t 15 days frm the date f receipt f all the requisite dcuments. In few cases, claim might be internally verified by us. Hwever, even in these cases, claims will be settled within a maximum perid f 6 mnths frm the date f intimatin f claim t KLI Claims Department. 16. Wh is eligible t receive claim benefit in absence f nminatin / unfrtunate demise f nminee? In absence f nminatin / unfrtunate demise f nminee, the legal heir is entitled t receive the claim benefits n submitting prf f legal title i.e. successin certificate, guardianship certificate alng with ther requisite claim dcuments. 17. If beneficiary is nt satisfied with the service prvided by KLI at claims stage r with the amunt f benefit paid t whm he can refer the case? KLI has internal mbudsman (Grievance Redressal Cmmittee). Beneficiary can write t KLI claims department and Claims department wuld put the matter befre internal mbudsman fr reslutin. The decisin taken by internal mbudsman wuld be cmmunicated t the beneficiary. Beneficiary can als get in tuch with Life Insurance Ombudsman (list f Ombudsman is available with KLI and can be prvided n request).

5 B: Claims under unusual events: Missing Persn Any persn, whse whereabuts are unknwn whatever, be the circumstances r causes f disappearance wuld fall under this categry. Such persn/s shall be cnsidered as "MISSING" until lcated and their well-being r therwise being duly established. In the nrmal prcess f life insurance claim settlement, filing an insurance claim withut a death certificate can create prblems. In this cnnectin, we shall fllw prvisins f Sec. 108 f the Indian Evidence Act and a Supreme Curt ruling, which are as under: Prvisins f Sectin 108 f The Indian Evidence Act, 1872: Burden f prving that persn is alive wh has nt been heard f fr seven years: Prvided that when the questin is whether a man is alive r dead, and it is prved that he has nt been heard f fr seven years by thse wh wuld naturally have heard f him if he had been alive, the burden f prving that he is alive is shifted t the persn wh affirms it. The Supreme Curt Ruling is based n the prvisins f Sectin-108 and states that "The presumptin as t death in the absence f any evidence wuld arise nly n lapse f seven (7) years". In ther wrds, it wuld mean that a missing persn is nt presumed dead until he r she has been missing fr seven years. Thus the presumptin f death f the Life Insured shall be taken int accunt nly n cmpletin f 7 years frm the date f the persn having gne missing. Mrever, this has t be by way f an rder frm a cmpetent authrity / curt. The date f rder f such authrity / curt shall be cnsidered as the date f death. C: Unfreseen Circumstances / Natural Calamities: The cmpany shall lk at cases f natural disasters r ne-ff majr incidences like Tsunami, Mumbai Flds, and 9-11 attacks etc., n an exceptin basis. We shall make basic checks / enquiries t ensure that there are n mal-practices, invalid claims are nt being incrrectly hnured by the Cmpany r benefits are nt unfairly / wrngly paid t third persns nt fairly eligible fr the claims against the interests f the Plicyhlders at large. Based n these sanity checks, the cmpany shall waive certain dcumentatin t ensure a smth claims prcess fr the benefit f the Plicyhlders at large.

6 Based n a Death Certificate issued by the Municipal Authrities r equivalent r based n a typical statistics/ gazette issued by the State / Central Gvt., claims can be prcessed n the presumptin that the Life Insured has expired, irrespective f ther dcumentatin. An indemnity may be cllected frm the nminee in each case. In all cases, we wuld need cmplete dcumentary evidence f the relatinship f the nminee / legal heir. Grup Claim 1. What is a claim? A claim is a rightful demand, fr payment in accrdance with an insurance plicy claim, by way f a frmal request t an insurance cmpany asking fr a payment based n the terms f the insurance plicy by a rightful nminee t the claim. 2. Hw t intimate a claim? T intimate a claim, all the requisite dcuments as mentined under the Claims Guidelines sectin shuld be sent t Claims Department: Claims Department Ktak Mahindra Old Mutual Life Insurance Cmpany Limited Ktak Infiniti, Building n. 21, 7th Flr - Zne 2, Infinity Park, Off Western Express Highway, General A K Vaidya Marg, Malad (E), Mumbai The claim intimatin frm can be btained under ur FORMS sectin, Custmer Relatinship Manager r nearest KLI branch. In view f administrative cnvenience the dcuments can als be submitted at nearest KLI branch. 3. Wh can intimate a claim? The Plicyhlder r the Nminee (as mentined in the Plicy Cntract) can intimate a claim. 4. What wuld be the prcedure in case f demise f nminee? In case f demise f nminee; the request fr nminatin change with requisite dcuments can be submitted t the plicyhlder.

7 5. Whse KYC dcuments are t be submitted under the fllwing instances? Under Death Claim: Latest KYC dcuments f the nminee are t be submitted with the claim intimatin Death f Nminee - KYC dcuments f the legal heir / legal guardian are t be submitted with claim intimatin. Under Rider Claim: Latest KYC dcuments f the Life Insured are t be submitted with the claim intimatin. (Refer t the dcumentatin part under claims guidelines) 6. If riginal Certificate f Insurance is lst, will the claim be prcessed withut Certificate f Insurance? Certificate f Insurance is a mandatry dcument fr claim prcessing. In case where riginal Certificate f Insurance is nt available, claimant has t prvide ntarised affidavit- cum- indemnity n the stamp paper. Frmat f affidavit-cum-indemnity fr claim can be availed under FORMS sectin r frm Claims Department at HO. 7. What will be the amunt f benefit that wuld be payable n death f life insured? Death benefit vary as per the plan pted by the plicyhlder. The detail f benefit payable n the death f life insured is readily available in the Plicy Cntract issued by KLI under sectin Benefits payable - "Death Benefit" entails the benefit payable. 8. Can claim benefit amunt be received in any ther currency ther than Indian currency? Death benefit amunt will be paid nly in Indian Rupees. 9. Can claim amunt received as death benefit be repatriated utside India? Fr all plicies including thse under Nn- Residence Indian Insurance Scheme, claim amunt cannt be repatriated ut f India.

8 10. If death is due t terrrist attack / war / natural calamities will the claim be settled? Death due t terrrist attack / war / natural calamities is cvered under life insurance plicies (unless specifically exclude in Plicy Cntract) and claim is settled if all the dcumentatin are in rder and all the cnditins are fulfilled. In such scenaris we have fast track claim prcessing t prvide quick aid fr the sudden lss. 11. What is average time taken t settle the claim intimated t us? Claims are nrmally settled within 7 t 10 days frm the date f receipt f all the requisite dcuments. In few cases, claim might be internally verified by us. Hwever, even in these cases, claims will be settled within a maximum perid f 6 mnths frm the date f intimatin f claim t KLI Claims Department. 12. If beneficiary is nt satisfied with the service prvided by KLI at claims stage r with the amunt f benefit paid t whm he can refer the case? KLI has internal mbudsman (Grievance Redressal Cmmittee). Beneficiary can write t KLI Claims Department and Claims Department wuld put the matter befre the internal mbudsman fr reslutin. The decisin taken by the internal mbudsman wuld be cmmunicated t the beneficiary. Beneficiary can als get in tuch with Life Insurance Ombudsman (list f Ombudsman is available with KLI and can be prvided n request). Claims under unusual events: Missing Persn Any persn, whse whereabuts are unknwn whatever, be the circumstances r causes f disappearance wuld fall under this categry. Such persn/s shall be cnsidered as "MISSING" until lcated and their well-being r therwise being duly established. In the nrmal prcess f life insurance claim settlement, filing an insurance claim withut a death certificate can create prblems. In this cnnectin, we shall fllw prvisins f Sec. 108 f the Indian Evidence.

9 Act and a Supreme Curt ruling, which are as under: Prvisins f Sectin 108 f The Indian Evidence Act, 1872: Burden f prving that persn is alive wh has nt been heard f fr seven years: Prvided that when the questin is whether a man is alive r dead, and it is prved that he has nt been heard f fr seven years by thse wh wuld naturally have heard f him if he had been alive, the burden f prving that he is alive is shifted t the persn wh affirms it. The Supreme Curt Ruling is based n the prvisins f Sectin 108 and states that "The presumptin as t death in the absence f any evidence wuld arise nly n lapse f seven (7) years". In ther wrds, it wuld mean that a missing persn is nt presumed dead until he r she has been missing fr seven years. Thus the presumptin f death f the life insured shall be taken int accunt nly n cmpletin f seven years frm the date f the persn having gne missing. Mrever, this has t be by way f an rder frm a cmpetent authrity / curt. The date f rder f such authrity / curt shall be cnsidered as the date f death. Unfreseen Circumstances / Natural Calamities: The cmpany shall lk at cases f natural disasters r ne-ff majr incidences like tsunami, Mumbai flds, 9/11 attacks etc., n an exceptin basis. We shall make basic checks/enquiries t ensure that there are n mal-practices, invalid claims are nt being incrrectly hnured by the cmpany r benefits are nt unfairly/wrngly paid t third persns nt fairly eligible fr the claims against the interests f the plicyhlders at large. Based n these sanity checks, the cmpany shall waive certain dcumentatin t ensure a smth claims prcess fr the benefit f the plicyhlders at large. Based n a Death Certificate issued by the Municipal Authrities r equivalent r based n typical statistics / gazette issued by the State/Central Gvt., claims can be prcessed n the presumptin that the life insured has expired, irrespective f ther dcumentatin. An indemnity may be cllected frm the nminee in each case. In all cases, we wuld need cmplete dcumentary evidence f the relatinship f the nminee / legal heir.