How does a Life Insurance claim work?

28th July 2010

1. What is a Claim?
A claim is the payment made by the insurer to the insured or claimant on the occurrence of the event specified in the contract, in return for the premiums paid for the insured. Maturity, Survival Benefit, Death, Rider benefit etc are various events for Claim.
2. What parameters are considered by the company while asking the claimant to submit particular records / document?
The Company considers the Sum at risk, cause, circumstances of claim and duration of the life insurance policy while asking for certain requirements. Eg. For accidental death, specific proofs such as Post Mortem and Police Report are required whereas for death due to illness, the Company calls for records from hospital, test reports, etc
3. Who is entitled to receive the Claim benefit?
§  The nominee or appointee (in case of minor nominee) last recorded under the Policy in case of Policy on own life.
§  Legal heir(s)/Succession certificate holder(s) in case of Policies where there is no Nomination registered/Title Disputes.
§  Assignee in case the Policy was assigned.
§  Life Assured himself in case of policy on own life for living benefit claims (Eg Critical Illness rider)
4. Once all the requirements are submitted, how much time does the Company take to settle the Claim?
The Company settles the Claim within 8 working days after all the records, documents and necessary forms are submitted and documentation is completed. In case, the Claim warrants further verification, the Company keeps the Claimant informed of the same. Subsequently, when the decision is taken, it is communicated to the Claimant by a letter and SMS.
5. Whom to approach If I am not satisfied with the Claim decision?
Bajaj Allianz has settled 98.07% of the Claims intimated during the FY 2016-17. There Could be some claims rejected due to Non-disclosure of material facts to be disclosed at the time of taking the Policy or Reviving the Policy. Even in such instances the Claimant can approach our Claims review Committee, headed by retired Civil judge, a unique Customer Centric initiative made available only at Baja Allianz  to have an impartial review of the Claims represented.
6. How do I make a Maturity Claim?
You must send us the:
1.     Completed Claim form
2.     Policy of life assurance
3.     Proof of age, if not submitted earlier

7. How to Notify a Death/Rider Claim. Can be Notified across 700+ Offices Pan India or at HO, Pune with the following documents. Once the Claim is notified an acknowledgement letter and a set of Other documents will be handed over to the Nominee/Claimant.
1.     Intimation Letter by Nominee
2.     Original Death Certificate/Relevant Hospitalization Documents
3.     KYC and Direct Credit Documents
4.     Original Policy bond
8. What are IRDA guidelines pertaining to Claim processing?
As per IRDA (Insurance Regulatory Development Authority), the Insurance Company is required to settle a claim within 30 days of receipt of all requirements. However, if the claim warrants further verification, the Company should complete its procedures within 6 months from receipt of written intimation of the claim. In case of delayed payments as against the above timelines, interest is payable by the Company on the claim amount. The interest is payable only where the Claimant has submitted all the requirements. Further, rate and period of interest are decided as per the IRDA( Protection of Policyholder’s Interests) Regulations 2002.
9. How do I contact the Company in case of any Clarification/details required Post Notification.
Customers/Claimants can Contact any nearby BALIC office, or our Toll free No : 18002337272 or Claim Status made available on the BALIC website too.



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