Saturday, December 03, 2016

Postal Life Insurance (PLI) - Death Claim Procedures

Documents required for processing Death Claim:

1.    Original Premium Receipt Book
2.    Original Policy Document
3.    Death Certificate
4.    LI-9 (b) (Claim application)
5.    Medical certificate if the cause of death is other than Accident / Suicide/ Murder. 
6.    FIR & Postmortem Report in case of Suicide/Accident/Murder. 
7.    Claimant statement

Procedure to be followed while processing Death Claim cases

On receipt of claim application, the eligibility has to be checked along with the remission period. The Remission period is given below: 

Death occurred (from date of acceptance of the policy)
Remission period
Within six months 
Grace period (30 days)
6 – 12 months
30 days + Grace period
12 – 24 months
60 days + Grace period
24 – 36 months
90 days + Grace period
More than 36 months
11 + 1 defaults
Policy lapsed but having more than 36 credits.
Eligible for auto paid up value. 

1.    If the death occurred within the remission period then the case is eligible. 

2.    If the nominee of the policy is minor then the guardian has to claim the amount. 

3.    If the nominee is also deceased then legal heirs has to claim the amount by submitting the legal heirship certificate (in which the claim value (Sum assured + Bonus) does not exceed Rs. 100000/-).  For the policies exceeding claim value Rs. 100000/- Succession certificate has to be obtained from the legal heirs for settlement of claim. 

4.    Eligible claim cases should be forwarded to Sub Divisional Head concerned for conducting detailed enquiry. (Points to be covered in detailed enquiry report is enclosed)

5.    The CPC Manager after satisfying himself as the case is genuine may issue Death claim sanction. (Limits for settlement of Death Claim as stated in Amendments)

Detailed enquiry report should contain the following points:

Ø  Check whether exact cause of death, place of death has been mentioned. If the cause of death is any prolonged disease like Kidney failure, Liver failure, HIV +ve then discreet enquiry has to be conducted to ascertain whether the late insurant had the disease before taking policy.

Ø  In case of sudden death, the death certificate and report of the doctor who had last attended the insurant must be submitted by the claimant or legal heir. Reasons for not taking the insurant to the doctor in case of death due to some disease should be enquired in detail and the result should be recorded. 

Ø  Enquiry should be made with the neighbours, relatives, bigwigs regarding the cause of death, general health condition of the late insurant and health condition at the time of taking policy.

Ø  Particulars of other policies held by the insurant and the outcome of their settlement. 
Ø  Enquiry should be made with nearest GH/PHC whether the late insurant had taken treatment for any serious illness for the past three years.

Ø  Enquiry should be made with local police station to ascertain that the late insurant had not committed suicide or been murdered. 

Ø  Whether any bad life was insured and there is any suppression of fact at the time of taking policy. 

Ø  Specific recommendation of Sub Divisional Head. 

Ø  In case of Murder it should be enquired and eliminate that whether “The Claimant/Legal Heirs were involved in the murder”.

Ø  If death occurred at other jurisdiction then the genuineness of the death should be got verified from the Division concerned. 

Death claim Form : 

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