Claims in Life insurance

When a loved one passes away, the nominee or beneficiary needs to file a death claim. The required documents are mostly the same for all deaths, with a few extra papers if the death was due to an accident or other unnatural causes.

1. Death Claims

Basic documents required for any death claim:

• Death Claim Form
• Original Policy Document –the life insurance policy bond/document. (If lost, the insurer will guide on alternate proofs or indemnity.)
• Official Death Certificate – issued by the local municipal authority (original or attested copy).
• Identity and Address Proof of Claimant – e.g. Aadhaar card, PAN card, passport, voter ID, driving license, etc., to verify the claimant’s identity and address.
• Claimant’s Bank Details – a cancelled cheque or a copy of passbook showing the account holder’s name and IFSC code.
• If no valid nominee is present: proof of legal title to the policyholder’s estate (e.g. succession certificate or court order). This is needed when the claim is being made by the legal heirs.

Additional documents for accidental or unnatural death claims:

If death occurred due to an accident, homicide, suicide, or other unnatural circumstances, the insurer will require extra documentation for investigation:

• First Information Report (FIR)
• Post-mortem Report
• Police Investigation/Final Report –the conclusion of the police inquiry (sometimes called the charge sheet or final report) confirming cause of death.
• Panchnama/Inquest Report –a report by police or magistrate, if applicable (often part of the investigation in accident cases).
• Driving Licenseof the deceased – if death was due to a road accident, insurers may ask for the deceased’s driving license to ensure they were authorized to drive.
• Newspaper Clippings – any news report of the accident (if available). This is optional, but if the death was reported in the media, providing a clipping can be helpful.

Total/Partial Disability Claims (Accident or Disability Riders)

Total or partial disability claims arise from riders (add-ons) that cover disabilities, often due to accidents. If the life insured has become permanently or partially disabled as defined in the policy, these riders pay out a benefit. Filing a disability claim requires medical evidence of the disability.

Documents typically required for a disability claim:

• Disability Claim Form
• Disability Certificate – a certificate from an appropriate medical authority or board confirming the nature and extent of disability.
• Doctor’s Statement and Medical Records – all relevant medical documents related to the injury or illness causing disability. This includes hospital admission and discharge summaries, treatment records, investigation reports (X-ray/MRI scans, etc.), and a statement from the attending physician.
• FIR or Police Report (if accident) – if the disability is due to an accident, provide a copy of the FIR/accident report. This helps establish the occurrence and circumstances of the accident.
• Employer’s Leave/Work Certificate (if employed) – some insurers ask for a certificate from the employer detailing leave of absence or inability to work, typically the leave records of the last 6 months. This is to corroborate the period of disability.
• Original Policy Document – the insurance policy document, for reference and verification.
• Identity and Address Proof of the claimant (if different from the life insured) or the life insured (for KYC). Standard KYC documents like Aadhaar, PAN, passport, etc., are accepted.
• Bank Details– a cancelled cheque or bank details of the beneficiary where the disability benefit should be paid. (Often the benefit is paid to the policyholder if alive and disabled, so it would be their account details.)

2. Critical Illness & Terminal Illness Claims

Critical illness riders cover serious illnesses like cancer, heart attack, stroke, etc., while a terminal illness benefit (often built into life policies) pays out if the life assured is diagnosed with a terminal condition (usually with less than 6-12 months to live). The claims process for both is similar – it focuses on medical evidence of the illness.

Documents required for a Critical Illness claim:

• Critical Illness Claim Form
• Medical Records and Reports – all documents related to the diagnosis and treatment of the illness. This includes doctor’s reports, hospital records, test results (like biopsy reports, blood tests, scans, etc.). Essentially, any evidence that confirms the diagnosis of the covered critical illness should be provided.
• Treating Physician’s Statement –This typically covers the diagnosis, date of diagnosis, and current status. Ensure your doctor’s contact information and signature with stamp are on medical reports or forms.
• Original Policy Document
• Identity & Address Proofof the claimant/policyholder – for KYC (Aadhaar, PAN, etc., similar to other claims).
• Bank Details – cancelled cheque or bank passbook copy for the payout.

Additional requirements for a Terminal Illness claim:

Terminal illness claims often use many of the same documents as critical illness claims, but with an emphasis on prognosis:

• Doctor’s Certificate stating Terminal Illness – a written statement from the treating specialist that the illness is terminal (cannot be cured) and stating the patient’s life expectancy (e.g. “life expectancy is less than 12 months”). This is crucial for terminal illness benefit claims.
• Supporting Medical Evidence – any pathology reports or scan results that led to the conclusion of terminal illness, if not already included. For example, oncology reports for late-stage cancer, or medical summaries indicating end-stage disease.

3. Maturity Claims

A maturity claim is when your policy term is completed and the policy “matures,” meaning it’s time for the insurer to pay you the maturity benefit (applicable for endowment, money-back, ULIPs, etc., not for term insurance which has no maturity value). Maturity claims are usually straightforward because the insurer initiates the process.

Documents required for a maturity claim:

• Policy Discharge Form – also called a maturity claim form. This is a form the insurance company provides around the time of maturity. The policyholder needs to fill and sign it.
• Original Policy DocumentKYC documents of the policyholder, such as PAN, Aadhaar, passport, etc., to ensure the payment is being made to the right person.
• Identity and Address Proof –
• Bank Mandate Form and Cancelled Cheque – a form for NEFT/bank transfer details, often provided by the insurer, to be filled with your bank account info. You’ll attach a cancelled cheque or bank passbook copy to confirm the account details.
• PAN Card Copy – Since maturity amounts (especially from certain policies) can be substantial, insurers often ask for a PAN card copy for tax purposes (TDS may be deducted if applicable). This is usually part of KYC, but worth noting separately if specified.

Once you submit these documents, the insurer will verify everything and process the claim, and as long as everything is in order, the payout will be made to the nominee’s bank account after approval. If anything extra is needed, the insurer will inform you within a short time of filing the claim.

Note: The information provided herein is for general informational purposes only and is intended to serve as an illustrative guide. Specific document requirements, notification time frames, and procedural details may vary significantly between different insurers and policies. This summary is not intended to be comprehensive or a substitute for the actual policy wording. For precise and up-to-date information, please refer to your insurer’s official policy documents or contact them directly.