Tuesday, May 17, 2011

Witholding information from insurer may result in claim rejection


 Insurance is a unique product. It is intangible and does not offer any immediate gratification. It is sold on the basis of promises made by insurers for events that may occur in the future and the policy document is a contract between the insurance company and the insured which provide for payment in case certain conditions are fulfilled.

The simplest of these conditions is completion of policy tenure. Other ‘conditions’ depend on a set of information provided by the insured and insurers generally take them on face value during the sale. But wrong information or truth withheld by consumers may make the contract void — making the consumer lose the benefits of that policy. Therefore, a great deal of the onus lies on the policyholder to ensure a hassle free on-time claim settlement. If the policyholder has been honest and true to the insurance company, he/she will get the benefits when needed. Otherwise, whatever may be the case, it’s the policyholder who loses on the benefits.
Therefore, first and foremost it is prudent to buy right and be aware of what one is buying. As a customer, one must be clear about the policy details, its features and benefits before one actually decides to buy the policy. A diligently adhered to check list minimises the risk of claim rejection.
As a customer one should never ever sign on a blank proposal form and leave the filling up to the agent. Such a practice leaves room for incorrect and incomplete information going to the insurance company. Fill the form yourself, if required with the agent’s help. Keep a photo copy of the form after having filled it. Most of the companies provide the scanned copy of proposal form as part of policy pack.
Also make sure you disclose all medical facts in the proposal form, as well as correct occupation and income. Correct date of birth along with valid age-proof is necessary for incorrect date of birth may lead to loss of full or partial claim benefits.
Insurance is the business of covering the probability of an individual getting sick or dying. In insurance lingo this probability is referred to as risk —higher the risk higher the premium. A person with high risk paying low premium by withholding critical information is like traveling with a short journey ticket, which is liable for penalty.
Nevertheless, it is also the duty of the agent to facilitate the policy holder’s family in submission of claim documents, filling up of forms. That is the time when the claimant/nominee need agent’s and insurers help the most. Life insurance above all is a contract of trust where policyholder should facilitate decision making by providing all the relevant information (medical and financial).
Always declare nominations at the proposal stage and keep the company informed at all times regarding any change in nomination as and when it happens. This helps in faster settlement of claims.
Pay premiums through account payee cheques instead of cash and insist for acknowledgment receipt from agents. If you are paying cash, preferably pay it at the life insurer’s office.
On receipt of the policy document, please read all the details and compare it with the proposal form to make sure that all the facts are in order. If not, you may get back to the insurer informing them about the differences. Regulations provide 15 days freelook period from the date of receipt of policy pack.
One should also keep in mind a few do’s and don'ts during the claims stage for speedy and smooth settlement. Submit all the required claim documents together. Details of documents required for claims settlement as well as the claims forms are available with the policy pack, with agent advisor, life insurer’s offices and on almost all life insurers’ websites.
Submit your documents as soon as possible because delay in submission may lead to delay in evaluation.
Above all, pay your premiums on time for a lapsed policy does not provide any claim benefits.

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