Claim settlement is commonly referred to as a life insurance company’s “moment of truth” by industry insiders. It is one of the most important services that an insurance company must deliver to its customers. Claim settlement, to put it simply, is the procedure by which a life insurance company pays out the sum promised and other benefits specified in the policy agreement.
Every organization utilizes a statistic called claim settlement ratio to track the percentage of claims it has settled or paid out of the total claims received within a fiscal year. For example, a claim settlement ratio of 97 percent indicates that the company settled 97 out of 100 claims received during the year. After conducting due diligence, the corporation rejected the remaining three.
The claim settlement ratio must be measured and reported to the regulator by all insurance companies. In turn, the Insurance Regulatory and Development Authority of India (IRDAI) publishes this information in its annual report on its website.
What Does the Company’s Claim Settlement Ratio Indicate?
Customers frequently use the claim settlement ratio as a gauge of an insurer’s capacity to pay out claims. Apart from a company’s dependability, this ratio, together with other data points such as persistency ratio, net promoter score, and so on, highlights the quality of a life insurer’s business. A single statistic, on the other hand, does not tell the complete story.
It’s crucial to examine each company’s claims history; consistency is just as vital as a greater claim settlement ratio. It demonstrates a pattern of the company’s comprehensive claims resolution and underwriting policies.
Why Do Life Insurance Companies Reject Claims?
Claim settlement is a topic that is frequently misunderstood. Customers have been disillusioned with insurance companies’ customer service procedures as a result of the industry’s mistrust difficulties in the past. When a claim is denied, people feel the company is fake and ill-intentioned. Life insurance providers, on the other hand, strive to resolve every legitimate claim.
Certain business intricacies, such as fraudulent claims, necessitate organizations adhering to strict procedures. Indeed, emerging technologies such as Data Analytics and Machine Learning are allowing life insurers to tighten their underwriting and risk management methods, including early fraud identification and mitigation.
You can also assist your life insurer in ensuring a smooth claims procedure as a consumer. In this context, I believe it is critical to understand why certain arguments are rejected.
1. Customer disclosures that are not completeThe fundamental goal of a life insurance policy is to get a payout in the future. As a result, it’s critical to furnish your life insurer with accurate and complete information. The information you submit throughout the underwriting process aids your firm in accurately estimating your risk profile and, as a result, determining the premium you must pay for the desired life insurance.Customers frequently withhold certain important facts (financial and medical) in order to prevent an increase in premium payable, which may result in claim denial in the future.
2. Health-related informationA life insurer can benefit from your medical records and behaviors. If there is a considerable discrepancy in your medical state, your claim may be re-examined and eventually rejected. As a result, being accurate and honest when sharing medical information to your insurance is crucial.Medical tests are viewed by the general public as a laborious activity that must be completed in order to purchase life insurance. Policies that do not necessitate medical testing are seen favorably. Medical tests, on the other hand, are an objective way of determining your health state while purchasing insurance. Your life insurer will not be able to ignore or dispute this information in the future.
3. Existing life insuranceHuman Life Value is a concept used in life insurance (HLV). HLV calculates the financial impact of a person’s death on his or her dependents. HLV varies from person to person, as one could expect. When you apply for a new policy, your existing life insurance informs your life insurer whether you are properly insured and require this new insurance policy.However, in order to safeguard customers, the legislation currently says that a life insurance cannot deny a claim for any reason after 3 years from the policy start date. If a policy is revived, this rule takes effect on the date of the revival.
How to File an Insurance Claim
The following are the many types of claims and how they are handled:
Claim of DeathIn the event of a death claim, the nominee must go through the following steps:
1. Notifying your insurer: Notifying your life insurer of your claim is the first and most critical step. The claimant must complete a detailed intimation form that includes information such as the insured’s name, policy number, cause of death, date of death, location of death, claimant’s name (you), and so on. You can obtain this form by contacting your insurance advisor, the insurer’s contact center, or the company’s website. Some insurers also provide these forms in a variety of languages to make the procedure more accessible to claimants.
2. Please submit the following documents: As a claimant, you must submit a written statement known as a claimant’s statement, as well as the insured’s death certificate, the original policy contract, and any other documents requested by the insurer.If a claim for early death occurs within three years of the policy being issued, the insurance provider may perform an additional inquiry to confirm the policy’s integrity. The company may perform the following steps as part of the procedure:
1. Obtain confirmation from the hospital where the insured was admitted for treatment.
2. In the event of an unintentional fatality, confirm the facts with the appropriate authorities.
3. If the insured dies as a result of medical complications, the insurer may request treatment records, a doctor’s certificate, a post-mortem report, and a police report, among other things.
For a rapid settlement, it is critical to provide all required documents as soon as possible. The claim will not be settled unless your insurer receives all of these papers and does due diligence.
Additional riders can be purchased with a life insurance policy to protect your dependents from particular circumstances, such as a critical illness rider, an accidental rider, a waiver of premium rider, and so on. In such circumstances, the claim procedure is usually different. Waiver of premium rider or accidental disability, for example, must be presented as a separate claim. In such cases, the insurance company will request documentation such as a copy of the police report, a disability certificate from the treating physician, a hospital report, and so on.
Claims of Maturity and Survival
Maturity payment refers to the payment made by an insurance provider at the end of the policy term or on the maturity date. The money assured, as well as any incentives or bonuses, are included in the payment amount. The insurance firm must notify the policyholder in advance in such instances. The firm sends the policyholder a policy discharge form, which must be completed and returned to the company with the original policy document, valid identification proof, a copy of the policyholder’s bank passbook, or a canceled check.
What Happens After a Claim is Filed?
Your life insurer confirms the beneficiary’s identity and guarantees the policy is active once you’ve filed your claim with the relevant proof. A claim must be settled within 30 days of receiving the essential documents, according to regulation. If a claim requires more investigation, the insurer must wait 90 days for adjudication and another 30 days for payment from the day the claim was filed.
Things to Keep in Mind to Make Sure Your Intended Beneficiaries Get the Claim Quickly
1. When you receive the policy paper, read the terms and conditions thoroughly – it’s a cliché, but information is power. It’s critical to understand your life insurance policy’s advantages, inclusions, and exclusions.
2. Prepare for the claim settlement procedure by learning about it in advance and discussing it with your loved ones.
3. When purchasing a life insurance policy, provide your life insurance company with accurate information.
4. With each major life event or stage, you should update your coverage or purchase life insurance.
5. Inform and educate your nominee on the policy and the process.