Query regarding death claim of lic policy(life insurance).
sweety
(Querist) 23 August 2013
This query is : Resolved
SIR/MADAM,
We were residents of Srisailam Dam West. My dad made a policy in LIC on March 2010 for an amount of Rs.375000 at Atmakur LIC office and unfortunately died on 10-07-2011 due to heart stroke at home. And he had not undergone any medical treatment. We applied for the claim and submitted whatever documents they asked. They had done ENQUIRY for 2 times after 1 year from the death of my father. And since 6 months , the status they are saying is that the policy is in committee.
Hence , I request you to please suggest me regarding the claim and did I have any rights over getting information on status of claim from them.
ajay sethi
(Expert) 23 August 2013
since your father died barely 15 months after taking policy LIC must be making enquires before making payment . if your father did not have any pre existing illness and there is no suppression of facts LIC will pay .
send reminders . if LIC still dosent pay then move consumer forum for necessary reliefs
Rajendra K Goyal
(Expert) 23 August 2013
Agree with the expert ajay sethi ji.
You can get the status of your claim through RTI.
You may write to LIC requesting early settlement of the claim.
Kumar Doab
(Expert) 23 August 2013
Learned experts have given valuable advice. Kindly follow it.
LIC has to dispute the claim it should within 30 days from the time of lodging of the claim.
If LIC has to conduct investigation it should initiate at the earliest and complete at earliest and not later than 6 months from the time of lodging of the claim.
Meet Manager-CRM along with a written representation ( with cc to Chairman) narrating all previous representations mentioning dates and names, and submit under proper acknowledgment.
Send acknowledged copy to Chairman along with covering letter and demand payment of the claim.
Demand all replies by redg. post only.
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, 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.
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.
Advocate Sastry
(Expert) 23 August 2013
No more to add... Well advised by Mr. Kumar Doab..
sweety
(Querist) 24 August 2013
thank u all for Ur valuable suggestions...
is there any use if i go through OMBUDSMAN directly...
