Claim for life insurance policy against lic
AMIT KUMAR SHARMA
(Querist) 01 August 2013
This query is : Resolved
One of my friend Mr. Jaypal purchased a Life Insurance Policy from LIC in his father’s name. Age of his father was 42 year at the time of Policy. His father has been expired after one month of first premium paid. Jaypal has submitted claim application with all documents desired by LIC on 27.04.2013.
He has been shuttling in the Branch Office but no one is ready to give answer to him regarding his claim.
Can any one advise, what he should do to get his claim easily. If LIC deny to give claim what he should take action to get the claim from LIC and when.
Thanks & regards,
Deepak Nair
(Expert) 03 August 2013
If the claim is denied, and if you feel that the claim is valid, then you can take the following steps:
1. Send a legal notice through a lawyer demanding the claim settlement within a specific time period.
2. If they fail to settle the claim you can approach the Insurance Ombudsman of your jurisdiction.
3. Another option is that, you can file a consumer complaint in the Consumer Disputes Redressal Forum of your locality.
Kumar Doab
(Expert) 04 August 2013
It is an early claim.
If the LIC wants to investigate it has to issue information to you, and complete it in 6 months…………….
The persons responsible may come calling near and dear ones to assess the reason for sudden and early death………………………..
You may submit a written representation narrating all previous representations mentioning dates and names, addressed to Manager in CRM section under proper acknowledgment and obtain seal signature and diary number on your copy and demand a reply by redg. post only……………. You may even add that if LIC wants you are willing to supply postage prepaid self addressed envelope for sending the redg. post to you.
Your issue may get resolved.
You may go thru:
---------Insurance Regulatory and Development Authority (Protection of Policyholders’ Interests) Regulations, 2002.
6. Matters to be stated in life insurance policy
(d) the benefits payable and the contingencies upon which these are payable and the other terms and conditions of the insurance contract;
(j) contingencies excluded from the scope of the cover, both in respect of the main policy and the riders;
8. Claims procedure in respect of a life insurance policy
(2) A life insurance company, upon receiving a claim, shall process the claim without delay………………… within a period of 15 days of the receipt of the claim.
(3) A claim under a life policy shall be paid or be disputed giving all the relevant reasons……………………………..
10. Policyholders’ Servicing
(h) guidance on the procedure for registering a claim and early settlement thereof.
11. General
(4) Any breaches of the obligations cast on an insurer or insurance agent or insurance intermediary in terms of these regulations may enable the Authority to initiate action against each or all of them, jointly or severally, under the Act and/or the Insurance Regulatory and Development Authority Act, 1999.
--------- INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY : GUIDELINES FOR GRIEVANCE REDRESSAL BY INSURANCE COMPANIES
----------Handbook on Life Insurance
You can call Toll Free 155255 to lodge grievance
however
Do your home works before you initiate your action.
AMIT KUMAR SHARMA
(Querist) 06 August 2013
Kumar Doab Ji,
Thanks to give your best opinion.
As you said that "A claim under a life policy shall be paid or be disputed giving all the relevant reasons." But the Company has not yet inform like that after more than three months.
In that case what should he do to resolve the matter soon.
thanks,
Kumar Doab
(Expert) 06 August 2013
(3) A claim under a life policy shall be paid or be disputed giving all the relevant reasons, within 30 days from the date of receipt of all relevant papers and clarifications required. However, where the circumstances of a claim warrant an investigation in the opinion of the insurance company, it shall initiate and complete such investigation at the earliest. Where in the opinion of the insurance company the circumstances of a claim warrant an investigation, it shall initiate and complete such investigation at the earliest, in any case not later than 6 months from the time of lodging the claim.
Submit a written representation narrating all previous representations mentioning dates and names, addressed to BM, Manager in CRM section, under proper acknowledgment,
These officials can update you on the status.
If required peruse RTI route.
AMIT KUMAR SHARMA
(Querist) 08 August 2013
Can we send representation with all documents through Registered Post to Branch Manager of concern branch since no one is ready to receive this letter in branch.
If BM not reply to us within stipulated time in our letter, we will call on Toll Free 155255 to lodge grievance.
Is it right action, please advise.
amit
Kumar Doab
(Expert) 08 August 2013
If it is the o/o Divisional Manager then it should have a secretariat where all communications are received by affixing seal and by issuing a diary number and forwarded to the concerned personnel to whom it is addressed.
Manager-CRM usually does not refuse to receive any representation.
As an aggrieved if you feel that you are being wronged, you may keep evidence, witness and record transactions (audio/visual) and include it in your representation that on dated………………Mr/Ms……………designation……………..dept……………..
address declined to receive your representation in writing when you visited in person.
Mark a copy to Chairman.
If the dealing hand in secretariat declines to receive the letter include his name in complaint.
LIC has well defined grievance redressal
http://www.licindia.in/grievances.htm
Citizens Charter:
http://www.licindia.in/pages/Citizens_Charter-English.pdf
RTI set up:
http://www.licindia.in/RTI_ACT_Popup.htm
If everyone declines to receive you can send by registered post and issue legal notice.
It is suggested after reading your posts that you are not bale to handle the arrogant officials in the insurance company and you will be benefited if your approach your lawyer.
V R SHROFF
(Expert) 08 August 2013
It may take some time to confirm the claim, as death was within a month.
Also contact LIC Agent who insured him .
