Common the reason why time interval insurance coverage protection claims get rejected

Concealing pre-existing diseases: When shopping for a time interval insurance coverage protection plan, prospects must current all supplies knowledge regarding their income particulars, nicely being standing and medical historic previous, and life-style actually. If candidates withhold or give false knowledge, it may probably develop right into a official set off for rejecting a declare.

Sunil Sharma, president, chief menace officer and actuary at Kotak Mahindra Life Insurance, acknowledged, “If the insured did not disclose his proper nicely being standing or any current non-public medical historic previous impacting his nicely being whereas shopping for a protection, his declare could get rejected. The life insurance coverage protection insurance coverage insurance policies are normally based on assessing the nicely being declarations or knowledge the candidates share. Moreover, if the insured did not disclose his proper occupation/curiosity, which could be hazardous in nature whereas shopping for the protection, and the info was so necessary that had he disclosed proper particulars, this may need led to the denial of safety.”

Delay in premium payment: A lapsed policy cannot fetch any benefits. Sometimes, policyholders forget to pay timely premiums. For this, insurance companies offer a grace period. This grace period can go up to 30 days. However, if the policyholder does not pay the premium, the policy is marked as a lapse. Hence, policyholders must ensure they pay the premium towards their term plan on or before the payable date. For instance, the insurance company will reject the claim if a claim is made even a day after the policy lapse.

Withholding information about existing insurance policies: When purchasing a term plan, it is necessary to disclose all the current and previous insurance policies to the insurer. Rhishabh Garg, head of Term Life Insurance, Policybazaar.com, said, “Withholding information about existing insurance policies can get your term insurance claim rejected, as this is relevant information essentially required by the policymaker for a complete risk assessment.”

Undisclosed life-style picks: Information regarding life-style habits like smoking, ingesting, and unhealthy consuming, ought to be disclosed to the insurer whereas purchasing for the time interval insurance coverage protection. Moreover, if someone is inclined to journey sports activities actions like deep-sea diving, paragliding and plenty of others., they should inform the insurer sooner than making use of for a time interval plan. This will help the insurance coverage protection agency to guage the individual’s case greater.

Absence of updated nominee particulars: Failing to switch the nominee particulars requires a listing of documentation to point out the highway of succession. This course of is cumbersome and creates hindrances in insurance coverage protection declare settlement. If the insurance coverage protection agency can’t affirm the approved heir, it may end in declare rejection. Indraneel Chatterjee, Co-founder of RenewBuy, acknowledged, “Sometimes, declare settlements may additionally get rejected throughout the absence of a nominee. If the policyholder forgets to switch the nominee’s determine, it may probably end in declare rejection. In many circumstances, the nominee would not know that he is entitled to a declare and reaches out to the insurer very late when the declare investigation turns into troublesome or unimaginable.”

Fraud: “Refers to insurance fraudsters who take out a life insurance policy for someone who is terminally ill, or in some cases impersonate persons who are already dead just so that they can avail of the life cover, said Satishwar B., MD & CEO, Aegon Life Insurance.

Grievance redressal mechanism: If you think the insurer outrightly rejects your claim without giving you any valid reason, you can approach the Grievance Redressal Officer. Most insurers have multiple modes of access for policyholders and nominees.

Firstly, nominees can approach the insurance company from where the policyholder has purchased the insurance coverage. Every insurance company has a dedicated grievance handling cell as mandated by the Insurance Regulatory and Development Authority of India (IRDAI). The Insurance company usually lists the details of its grievance cell in the policy document. The first thing that a nominee should do is visit the insurer’s website and go to the customer service or claims section, as appropriate. There, the company lists all the ways to contact them, typically including a WhatsApp number, email address, chatbot, a toll-free number to call, and sometimes the nearest branch. These services are available even if you purchase the policy through an agent.

The nominee can call on the number or write a letter or mail mentioning the issue. Suppose the nominee does not get a response within 15 days. In that case, he can contact the insurance company’s regional or central office’s grievance cell, stating that the grievance has not been acknowledged or addressed.

In case the issue gets directed to IRDAI, one can reach out to a Grievance Redressal Officer (GRO) to register a complaint at a higher level. There is also a cell for the redressal of grievances at IRDAI, where policyholders can register their complaints with the regulator under the “Bima Bharosa system” (bimabharosa.irdai.gov.in).

Even after that, the nominee can technique the ombudsperson if the nominee does not receive choices. The ombudsperson will hear the case and cross judgment, which could lastly help a nominee clear up the issue.

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