Chapter 11

  1. Pure Risk is classified under INSURABLE RISK.
  2. If a person is absconding then after 7 years he will be considered as dead and SA would be paid to the nominee.
  3. The delay in settling claim by an insurance co. as per IRDA norms has to pay 7.2% if the present Bank interest is 5.2%.
  4. Family Floater health insurance plan covers ALL THE MEMBERS OF A FAMILY.
  5. Misrepresentation falls under the term Voidable Contract.
  6. Under Indian Evidence Act, 1872 after 7 Years presumption clause would apply, if the person is not heard of living.
  7. If a person wants to take SA of Rs. 100000 then to take the benefit of Deduction of Income tax his premium should be 20000 or below 20000.
  8. If a person is not able to continue his policy then along with Surrender of policy he has got another option i.e. discounting of Policy.
  9. If a person has got a term plan of Rs. 1000000 SA and also has a Critical Illness Rider of 100000 SA and he being hospitalized for Critical illness but died after 3 days then he would be paid the claim for both CI Rider as well as Term Rider.
  10. If a policyholder is getting the amt. of SA or % of SA back before maturity of the policy then this policy would be a Money Back Policy.
  11. If a person is died in a Road Accident then CORONER’s Report, POLICE’s First Information Report and Post Mortem Report is required but ADVISOR’S CONFIDENTIAL REPORT IS not required.
  12. In case of Maturity Claims the Insurance Company itself initiates the maturity claim process.
  13. If a person thinks that he does not need the insurance for the protection of his family because he has enough money in bank and got income from rent etc. then we will say that he wants to retain the risk with him rather transferring it to the insurance Company.
  14. In Case of confirmed Accidental death the insurance Benefit is paid in the form of LUMSUM SA PLUS ACCIDENTAL SA.
  15. If all the documents relating to a claim are submitted to the insurance Company then the Company Should settles the claim within 30 Days.
  16. Under Hospital Care Rider the insurance company pays the treatment costs in the event of hospitalization of the insured. It is subject to terms and conditions of the rider.
  17. Along with IRDA’s Customer Grievance Cell, Ombudsman, A customer can approach the CONSUMER FORUM.
  18. After all the necessary documents regarding death claim are received by the company then with 30 Days the claim is required to be paid.
  19. When a policy is lost insurance company take utmost care while settling Maturity claims because the Policy may have been pledged.
  20. Detailed investigation is triggered in case of Early Death Claims.
  21. If a person is missing for 7 years then insurance Company can pay claim to the nominees by considering the missing person as dead.
  22. If a person took a Money Back Policy for 20 years and take a loan on it and died before 2 years of Maturity then he will get FULL SA + VESTED BONUS – ANY OUTSTANDING LOAN /PREMIUM & INTEREST.
  23. If with in 2 years a claim occur and it is found in investigation that insured person was suffering from cancer then that claim would not be payable and would be rejected.
  24. If a person dies when his policy was not in force if death claim occurs it would not be paid.
  25. A demand to fulfill the insurer’s obligation is known as Claim under an Insurance policy.
  26. If a person has got a number of Life Insurance policies then his family would be paid death claim for all the policies.
  27. In claim if the policyholder gets more than what is the SA of the policy then this can be because of the nature of payment of that policy.
  28. In the process of settling maturity claim the process is initiated by the company well in advance of the maturity date.
  29. If a person has taken a term plan and an accidental rider then in the event of his death by accident his nominee would get both the claims.
  30. If the policy documents are sent by the company but not received by the policyholder and Life insured died then Full amt. of SA is payable.
  31. Insurer would not pay the claim unless the event insured against happens.
  32. If a policyholder has taken a loan upon a policy then the amt. of the loan would be deducted from his claim.
  33. If client died on 89th day and claim is not payable then this might be a case of Suicide because in case of an suicide claim is not payable for 1 year.
  34. If a person dies before the expiry of the grace period then full SA – any outstanding premium would be payable to his nominees.
  35. If the policy was not in force in a term plan then in that case claim would not be payable.
  36. If there is an advertisement in a newspaper regarding any claim under a policy then that would be a case in which policy might have lost.
  37. Claim within 2 years of issuance or revival of the policy is known as Early Claim and detailed investigation is done by the company before paying them.
  38. Insurance Company makes enquiry only in death claim cases and not in Maturity Claim cases.
  39. The agent’s duties and responsibilities end when claim is settled.
  40. Because of Indisputability clause if there is a breach on the part of the policyholder then insurance Company can retain the premium of the policyholder.
  41. If the indemnity bond was signed in a policy when the claim was paid, this indicates that policy is lost.

Click here for Next Chapter