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What to do if your term insurance claim is being delayed/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?)

Delay or rejection of a term insurance claim can create a lot of financial trouble for a family who are already grieving the loss of a loved one (the life assured, in this case). Whether you are life assured or a nominee, it’s good to know what you can do if your term plan claim is being delayed or denied. 

 

If you have filed a death claim on a term insurance plan but your claim is being delayed or denied, follow these steps to tackle the problem:
 

A. Firstly, know the rules and regulations well. Every insurer is mandated by IRDAI to have a system for policyholder services specifying the:

  • Service turnaround time

  • Claim review committee

  • Grievance redressal mechanism
     

 

Here’s an important piece of information that you must have - After you have filed a claim, the insurer should accept/reject it within 2 weeks if there’s no further investigation required or 120 days in case of any investigation.

 

 

 

B. Depending on your exact problem, you can do one of the following:

 

 

  • In case of a claim delay: Write to the grievance redressal officer of the branch servicing your policy 

  • In case of a claim rejection: Approach the Claim Review Committee of the life insurance company

  • Share all your claim details with them, either physically or electronically. Don't forget to get an acknowledgement from them for receiving your details.

 

Pro tip: You can also complain if you have received a response from your insurer and are unhappy with it.
 

C. If you are unhappy with the matter resolution, approach an Insurance Ombudsman. They can entertain a complaint up to ₹ 50 lakhs.

 

D. If your problem is still not solved, escalate the issue to IRDAI. Your complaint should be resolved in two weeks.

 

E. As a last resort, you can go to the consumer forum.

 

Keep your fingers crossed and hope to get your claim payout soon. And in the meantime, brush up on the reasons for term insurance claim rejection by your life insurance company so that you understand how you can ensure your nominee doesn’t face the hassle of a claim rejection in the future.

Your term insurance claim can be denied for various reasons such as: 

 

  • You lie or give 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 fail to pay your premiums 

  • You die due to unlawful activities such as drunk driving or drug abuse

  • Your death has been caused by an event that is mentioned in the policy exclusions 

 

Remember, your claim can also get rejected if your nominee does not follow the claim process properly. For example, it can get rejected if 

 

  • They make a mistake in the claim form such as a spelling error or information omission

  • They submit fraudulent documents

 

Find out in detail about the factors that can result in your term insurance claim getting rejected. 

Here is how you can do your best to reduce the chances of claim denial: 

 

  • Be 100% honest and share all the information truthfully that your insurer asks from you during the term insurance application process 

  • Don’t forget to pay your premiums on time to avoid a term policy lapse

  • In case there are any changes to your personal information (such as an error in the name) or nominee information, get those changes reflected in your insurance policy at the earliest

  • Read your policy’s terms and conditions thoroughly, get any errors rectified without delay and understand the policy exclusions

An insurance ombudsman is someone that helps resolve grievances when a customer and an insurance company are involved. It is like an alternate grievance redressal platform that addresses the complaints of policyholders.

 

If your family member files a death claim on your term policy and the insurance company denies it, they can approach an insurance ombudsman who can entertain a complaint of up to ₹ 50 lakhs. 

Yes, there’s no need to worry. They will get help. 

 

Even if you have bought the policy online, you can always tell your nominees to connect with your insurer online (e.g. via email) or offline such as by visiting the nearest branch and ask them for help in the claim process. The insurer may provide guidance and assistance in such cases. In fact, it is advisable that they do it to avoid making any mistake that can result in claim rejection. 

 

Check with your insurer and confirm if this provision is available with them. 

Nope, they don’t. The entire claim process can also be done online. 

 

If your nominee wants to do the claim process online, they need to: 

 

  • Inform the insurer about the death of the policyholder by registering online or over a call (dedicated claims customer care number). Some insurers may also have a dedicated claim servicing team for NRIs. 

  • Fill out the claim form online from the insurer’s website 

  • Upload scanned copies of relevant documents for claim processing such as -  

  • Death Certificate

  • Policyholder’s ID proof 

  • Nominee’s ID proof 

  • All policy-related documents

  • Hospital records and discharge form (if applicable) 

  • Postmortem report (if applicable)

 

The actual list will vary from insurer to insurer. 

 

The insurer may get in touch for some further requirements, all of which can be addressed online. 

 

However, it is best to double-check with your insurer once as depending on your case, your nominee may need to be present physically to settle a claim. 

Unfortunately, an insurance ombudsman won’t take up claims which are over ₹ 50 lakhs in value. In this case, your nominees can approach 

  • The grievance committee of your insurer 

  • IRDAI

  • Consumer court 

No, it does not. It doesn’t matter whether you have bought your term insurance policy online or offline - the claim process remains the same in both the cases. So don’t worry and buy a term plan online or offline depending on what is more convenient to you. 
 

Find out in detail if the term insurance claim process will be more difficult if you have bought your term policy online. 

It’s a good practice that they document whatever claim-based communications they have been sending and receiving from the insurer. God forbid, if the claim gets denied, your nominees can use the documented conversation as proof if they are approaching any grievance platform or the consumer court to get the matter resolved.

Here’s what your nominee needs to know about filing a death claim: 

 

  • Inform the insurer about the death of the policyholder as soon as possible. They can even take the help of an agent in case the policy was bought through one. Also, even a relative can do the claim intimation. 

 

  • Fill the claim form very carefully so as to avoid mistakes. Any mistake can result in claim rejection. 

 

  • Submit the relevant documents requested by your insurer 

 

  • Death Certificate

  • ID proof 

  • Policy documents

  • Hospital records and discharge form (if applicable) 

  • Postmortem report (if applicable)

The number of documents can be more than the above list, that’s why contact your insurer for the complete list. 

 

If the claim filing process is followed properly, typically the insurer will accept/reject the claim in: 

  • 2 weeks (without any investigation requirement)

  • 120 days otherwise

 

Find out more about filing a term policy death claim.

Yes, there are. Your job doesn’t just end after you bought a term plan. Here are some steps that you can take to ensure a hassle-free claim experience: 
 

  • Carefully check your policy documents for any errors and get them corrected without any delay

  • Understand your policy’s terms & conditions as well as exclusions 

  • Pay premiums on time. Activate auto pay from your bank account if necessary (so that you don’t miss out on paying premiums)

  • Store your policy documents carefully in physical as well as digital formats and inform your nominees on how to access these copies

  • Sync your DigiLocker and E-Insurance account. Tell your nominees about these as well.

  • Educate your nominees about making a claim and what to do if a claim is being denied/delayed

  • Make and register a Will. In the Will, clearly mention who receives the policy payout.

  • On a regular basis, review and make changes (if required) to your policy features and nominee details

Find out more about some best practices that you can adopt after buying a term policy. 

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