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Under what circumstances can my term Insurance claim be denied?

10 Oct 22      |       | ShareShare Share Blog Or copy link Copy Share this link via

Authored by: Anurag Ainapurapu
Reviewed by: Krupa Kenia

The Long Read


Everything you *need to know* is right above this. Scroll down, only if you'd still like to read more (honestly, why?)

Yes, sadly it can. Several factors can result in the rejection of a term insurance policy claim. 

 

It is important to know the reasons behind term insurance claim rejection so that you can help your loved ones avoid these hassles in the future.

 

Your term insurance claim can be denied if 

 

  • You lie, hide or provide inaccurate information about your 

    • Age

    • Lifestyle habits

    • Medical history (yours and your family’s)

    • Any other insurance policy you may have

    • Other personal information while buying your term insurance policy 

  • You do not pay your premiums on time

  • Your death has been caused by unlawful activities like drunk driving or drug overdose 
  • Your death has been caused by an event mentioned as an exclusion in your term policy

 

 

So, always be 100% truthful when it comes to disclosing all relevant personal information as requested by your life insurance company when applying for term insurance.

Simple, do not lie! 

 

We are serious. Do not lie while sharing whatever personal information your insurer has asked for at the time of buying your policy and thereafter. 

 

Also, if there are changes to any information that you have provided in your term policy application, ensure you get it updated on your policy at the earliest. For example, you must keep the insurer updated on any change in the personal information or living status of your nominee.


Additionally, ensure that you always pay your premiums on time to avoid a policy lapse.

Simple, know certain rules and regulations well because it will make navigating the process of making a death claim much simpler. 

 

As per IRDAI mandate, every insurer must have a system for policyholder services specifying the following:

 

  • Service turnaround time

  • Claim review committee

  • Grievance redressal mechanism

 

Here’s another important piece of information that you should be aware of:

 

After you have filed a claim, the insurer should accept/reject it in

 

  • 2 weeks if there’s no further investigation required

  • 120 days in case of any investigation

Rejection of a term insurance claim is a big problem, especially for the family of the life assured who may be in a financial crisis after their unexpected demise. 

 

But be assured that if your term insurance claim is rejected, you can take certain steps to address this issue:

 

  • Contact the Claim Review Committee of your insurer and share all your claim details

  • Submit your claim details either physically or electronically and remember to get an acknowledgement from them for receiving your details. Pro tip: You can also contact the committee if you have already gotten a response from your insurer but you’re unhappy with it.

  • Contact an Insurance Ombudsman if you are unhappy with the matter resolution. The Insurance Ombudsman can entertain a complaint up to ₹ 50 lakhs. 

  • Escalate the issue to IRDAI if the matter is still not resolved. The complaint should be resolved in two weeks.

  • And as a last resort, you can approach the consumer forum.

Yes, your claim will be rejected if your policy is inactive.
 

But don’t worry. There is a chance that you can still revive it. Here is how you can go about it: 
 

  • Most insurers offer a revival period of 2-3 years after a policy lapses. Find out the revival period of your policy from your insurer

  • Submit a policy revival application form to your insurer

  • Undergo any additional medical tests if your insurer wants you to

  • Clear the premium dues and pay the revival fees and penalty, if any (Pro-tip: Check for special spot revival schemes that offer a discount on penalty charges and revival fees)

  • Read the terms and conditions of the revived policy carefully and ensure that you follow them meticulously

  • You may have to pay higher premiums post reviving your policy. Check and confirm this with your insurer
     

Post reviving your policy, ensure you pay your premiums on time. You can even activate autopay with your bank or credit card to help you do so. 
 

Find out in detail about how to revive your term policy.

Yes. If you don’t pay your premiums on time, your policy will lapse and all the premiums that you have paid so far will go to waste along with all the policy benefits. Your nominees will not be able to claim your life cover. In short, your family will be in a financial crisis in your absence.
 

So, ensure that you pay your premiums on time. Enable autopay with your bank account/credit card to avoid missing out on timely payments.
 

Pro-tip: Pick a premium payment term (PPT) and premium payment frequency as per your convenience that will allow you to pay all your premiums comfortably without straining your pocket.
 

Take the KlarifyLife Term Guide journey to understand how to choose the best PPT and premium payment frequency as per your needs.

Good news! No, it will not.
 

Irrespective of where you have bought the term plan from, online or offline, the claim filing process is the same.
 

Even if you have bought the plan online, your nominee may be able to still connect with your insurer or an insurance agent if they want help with the claim filing process.

Check with your insurer to be doubly sure that your nominee can avail this help when making a death claim.

See, if you have truthfully disclosed your health condition and medical history (including any past experiences with cancer) at the time of term insurance application and your insurer accepts your application, then don’t worry. Even if you pass away from a cancer relapse, the death claim will not be denied. 
 

But if you have lied or hidden information about your health condition, including cancer diagnosis (past or present) when buying the term plan, your insurer may reject your claim. 
 

So, be honest and submit medical information your insurer asks for during the term plan application. 
 

If you have any doubts, check with your insurer or an insurance advisor.

No, it will not. 
 

See, if you pass away after taking the COVID vaccine, it could be because of a pre-existing comorbidity like heart disease, diabetes or kidney disease.
 

If you have honestly declared your health condition and shared all the relevant medical information that your insurer had asked for at the time of the term insurance application, you need not worry about a claim rejection. Even if you have been diagnosed with the health condition after buying your policy, your family will get your life cover. You don’t even need to inform your insurer about your diagnosis. 
 

In fact, if you contract COVID, despite having taken the vaccine and pass away from it, your nominee will still receive your claim.

If you are a nominee, you can follow the following process to make a death claim: 
 

  • Inform the insurer right away to start the process as soon as possible

  • You can also take the help of an insurance agent if the policy was purchased from one

  • You should fill out the claim form and submit with all the necessary details. You need to be careful and avoid making any mistakes at this stage. 

  • There are some additional documents you need to submit like:  
     

    • Death Certificate

    • Policy documents

    • Hospital records and discharge form (if applicable) 

    • Postmortem report (if applicable)

    • Your ID proof 
       

The list of documents will vary from insurer to insurer, and also on the basis of what add-ons the policy has. Contact your insurer for the exact requirement.


Additionally, here is some information you should know 

 

  • Beyond a nominee or an assignee, even a relative can do the claim intimation

 

After filing the claim, the insurer will accept/reject it in

  • 2 weeks (without any investigation requirement)

  • 120 days otherwise


Be sure to share this important information on how to file a death claim with your nominees if you are the life assured.

No, it will not be denied, even if you receive the diagnosis after buying a term insurance plan. But this is subject to the condition that you have accurately and truthfully declared all the information about your health condition that your insurer had requested at the time of buying the policy. 

 

If you have lied about any pre-existing underlying medical condition at the time of term insurance application, your death claim may be rejected.

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