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Insurane claim form accepted or rejected

8 critical factors that decide whether the life insurance claim is accepted or rejected.

by Holistic | Filed Under: Uncategorized

Table of contents

  • What are the most common reasons for claim rejection?
  • How to avoid claim rejection?
  • What if your claim gets rejected?

How many times have you asked yourself “Will the insurance company for which I am paying premiums regularly will settle the claims or reject the claims due to any reason in case of any mishappening to me?

Will my family get the claim benefits or not?

An insurance policy/term insurance  will be the financial security for the family if the bread winner of the family passed away. The financial security will be ensured only if the term insurance claim is settled by the insurance companies in a hassle-free manner. If the term insurance claim got rejected then the financial security of the policy holder’s family will be in deep trouble.

Then why the insurance companies/term insurance is rejecting the claim?

Insurance policies/Term Insurance are issued based on the facts and information provided by the policy holder in the proposal form while taking the policy. If he/she has not provided adequate information or hiding any information in the proposal form then it leads to claim rejection.

Now let’s see the common reasons for claim rejection.

What are the most common reasons for claim rejection?

1. Incorrect information

Fill details such as age, qualification, occupation, income, lifestyle (smoking/drinking), information on previous policies and claims if any, and all other information in the form correctly. These are important factors in determining the premium. Incorrect or incomplete information can be taken as fraud and lead to rejection of the claim.

2. Non-disclosure of medical history

Disclosure of previous and existing medical conditions, surgeries, operations, etc is compulsory as it influences the premium. Most term insurance calculators ask for your lifestyle choices (like smoking) while calculating premiums. Health conditions of family members especially conditions like cancer, blood pressure, cardiovascular diseases, or any other hereditary conditions must be informed.

3. Not filling the form by yourself

Fill the form by yourself. This will help you understand the policy better and choose the best features that suit your family’s needs.

4. Not updating nominee details

It is important to keep updated about the details of the nominee (contact information, address, etc). Failure to do so causes trouble during the processing of the claim and may lead to rejection of the claim.

5. Policy lapse due to non-payment of premiums

In case you missed paying your premiums, the policy lapses after the grace period (which is a maximum period of 30 days in annual premium policies). In case your policy lapses, try to pay the prescribed fees and continue the policy since its worth your family’s security. If you don’t choose to, then all your premiums paid go waste and there is no chance of getting it back. Hence it’s better to choose a direct debit facility to ensure your policy doesn’t lapse.

6. Not disclosing existing insurance policies

You must disclose all your previous and existing life insurance policies (name of the insurer, the sum assured, and policy number) while purchasing a new life insurance plan. Rejection of claims may also happen if you fail to disclose these facts.

7. Contestability period

Companies add a contestability clause in the policy while selling a life insurance policy. It means that if death happens shortly after the policy is taken, the claim could be rejected. Once the policy is taken, the contestability period comes into effect. This period ranges from one to two years. If a death happens within that period, the company may make an investigation. Claims also get rejected in case of suicides.

8. Type of death

Insurance companies have a standard exclusion list of deaths to avoid losses. The claim gets rejected if the policyholder has been part of hazardous activities or if the person dies of a pre-existing disease. They very minutely check the reason for death. Death due to suicide, adventure sports, drug overdose, intoxication, terrorist attacks, natural calamities, or homicides is generally not covered.

9. Delay in filing the claim

Claims get rejected if there is a delay in filing. It is rare but can happen if the delay is too long. The Insurance Regulatory and Development Authority of India (IRDAI) has informed insurance companies not to reject claims due to delays. However, it is better to promptly file the claim. Insurance companies may not outrightly reject claims but may delay in paying.

10. Avoiding medical tests

Most insurance companies conduct medical tests especially in case of old age or higher risk coverage. If you don’t take these medical tests, there are high chances of your claim being rejected stating pre-existing disease. So if you take the medical tests, the pre-existing diseases will be covered.

11. Not updating the changes

A change of address, an accident, or death of the nominee should immediately be brought to the notice of the insurance company. If not, there are chances that your claim gets rejected. Now let’s see how insurance claim rejection is avoided.

How to avoid claim rejection?

If you follow the below 8 steps while taking the term insurance policy, it not only avoids the claim rejection but also assures the financial security of your family.

1. Caution: Don’t trust your insurance agent mindlessly

We are always in a hurry and want things to happen in a jiffy. We never read the proposal form completely and fill the details required in the form. We just sign the form and ask the insurance agent/advisor to fill the details required and issue the cheque. This is absolutely a wrong practice. The agent does not know completely about yourself and the medical history of your family. He may fill some incorrect information and submit the form to meet his sales targets. Also don’t think that the agent is doing a favor for you by overlooking your health problems .

Always fill the form by yourself and keep a copy of the form. Verify the details printed in the policy document with a copy of the details filled. If you found any discrepancy inform the insurance company immediately to rectify it.

Insurance also needs the same amount of time and interest like as we do other investments like real estate, mobile phones, cars etc. We never allow a showroom guy to choose a mobile phone for you like-wise don’t allow an insurance agent to fill the forms for you.

2. Why giving incorrect information in the application don’t work and what to do about it?

It is our duty to disclose all the required information to the insurance companies. If you are hiding some facts and not maintain transparency then your claim may be rejected. To avoid this always furnish the correct and true information like your age, height, weight, occupation, income, existing policy details and any other details asked in the form. Mostly we don’t reveal the details of other policies we hold. It takes some time to gather the details of the existing insurance policies. For that reason mostly we hide these details. This can be avoided and furnish the complete information about your existing insurance/term insurance policy details to avoid any claim rejection in the future.

3. Medical history: One mistake that can ruin the claim settlement

The most important part of the proposal form is the details of the medical history of the proposer and his family. Based on this information the insurer will arrive at the premium to be charged and whether the policy can be issued or not. Disclose all the relevant facts regarding the medical history of you and your family. It is also important to disclose the habits pertaining to the consumption of alcohol and tobacco. Be honest in declaring these details to avoid the claim rejection.

4. Stop avoiding Medical Tests; Start accepting Medical Tests

Based on the information provided in the proposal form underwriter will assess the risk and the policy will be issued. Sometimes for higher sum assured policies and term insurance plans you need to undergo medical tests compulsory. Don’t avoid such medical tests. This will reduce the chances of a claim being rejected on the basis of pre-existing diseases.

5. Now update the nomination and help your beneficiaries get the claims faster

We bought life insurance/term insurance mostly for tax saving purposes and not worried much of the nomination. Usually, we nominate our parents when we are unmarried and failed to update the nominee after marriage. It may happen at the time of claim both policy-holder and the nominee was not alive. Usually, nominees are not changed frequently as people change addresses. But it is important to update the nominee details if there is any change in nominee or incase the nominee had passed away earlier than the life assured. Here the claim may not get rejected but to follow certain legal formalities to get the claim.

6. Policy lapse: The biggest threat to claim settlement

You will get the claim only when the policy is in force. It is more important to pay the premiums on or before the due date. Insurance companies are providing some grace days if we fail to pay the premiums on the due date. The claim will not be paid if the policy is not renewed within the grace period and something happens on the next day after the grace period is over. This is also a reason for rejecting the term insurance claim

7. Don’t delay filing the insurance claim

The sooner you intimate the company, the easier your claim will be processed. You may not be rejected the claim but they might delay paying you the claim.

8. Thoroughly scrutinize the policy

Check thoroughly for all the exclusions in the policy, so that you are not denied the claim at the last moment due to exclusions.

If you could take the points from the above factors and avoid claim rejection, then your family will achieve their financial goals for sure even if you are not around. Isn’t it better to know all these points beforehand, so that you won’t be denied your claims later?

Now let’s see what to do if your claim gets rejected.

What if your claim gets rejected?

After you submit the documents, the insurance company gets back to you with the following:

  1. Missing detail
  2. Acceptance of the claim
  3. Rejection of the claim

If you have incomplete information, complete it at the earliest. If your claim is rejected, the company provides a reason for it and you have the right to appeal against it. If your company has rejected your claims based on unproven grounds, you need to contact the company’s representative. If you don’t get a positive response you can take the help of the IRDAI.

If you have any comments or questions, write them in the comment box below.

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Jey S
Jey S
24. September, 2021.
I have been using Holistic Investment Planners for the last three years. Mr. Srinivasavaradhan answered all my questions and doubts very patiently during the first free consultation. I was able to clearly define my short-, medium- and long-term goals once I signed up for the comprehensive plan and got their investment plan suggestion to achieve my goals. They are very polite and highly professional whenever I contact them for any queries or make investments. They never pressurize you to invest on their recommended financial products. I would have been lost money by investing directly without their help since I do not have time and knowledge about different financial products. Risk planning is also done as part of financial planning. Truly, they are holistic planners when it comes to your financial planning. They help you to define your life goals, understand your financial resources and establish a plan to invest towards reaching those goals. They do review your plan as you progress to make sure that you are on correct path to achieve those goals. Kudos to the team and keep up the good work!!! I am happy that I found holistic investment planners for my financial planning and management.
aksaswadkar
aksaswadkar
24. September, 2021.
I was about to retire and really not understanding how to invest money to have financial freedom and fulfilling my goals. Was desperately searching on internet way out and fortunately came across Holistic Investment Planners. I read number of articles on their website and realized that this is the agency which I want and engaged their services for my retirement planning. It is an excellent experience to be associated with Holistic. Right from day one our interaction was fantastic and they gave me such a wonderful plan that I had never imagined. I am fortunate enough to be in the client list of Holistic. I have recommended Holistic to my friends as well.
Lionel Faber
Lionel Faber
16. September, 2021.
I've been availing their services for the past year. They are highly knowledgeable in the field and are very patient with all doubts and queries. Personalized financial planning is provided keeping your short term, medium term and long term goals in mind. They do not pressurize you to purchase schemes of their choice. They provide their input and suggestions and leave the decision up to you which shows their honesty and high principle.
Sridhar
Sridhar
8. September, 2021.
Financial planning brings peace in life. Holistic Investment have supported in arriving financial plan based on future goals. My investments are regular since then. They are professionals in their business, will recommend others.
Nitesh Agrawal
Nitesh Agrawal
6. September, 2021.
I have been using Holistic Investment Planners from last one year. The journey has been fantastic. Being a finance person myself I always thought we can look after and plan own finances also. However, due to lack of time and deciplain the things are not always as desired. After joining with Holistic Investment for the first time Icame to know the Financial goals and quantified them. Some dreams were unrealistic based on the earnings and savings so had a reality check. Also got the information and deciplain of investing on regular and more rewarding securities. I definetly suggest to use Holistic Investment Planners. They are professionals, available and hear youor full story before presenting plans. They are flexile in the sense if there are some urgent deviations required, they help to plan the same. For all professionals/individuals I would suggest using professional help of Holistic Investment Planners for best results in long term investment and financial goals achivements. Last advise will be to start early in your life. It really pays well to start in the beginning itself else the dreams needs to adjust :)
Swetha Vasanth
Swetha Vasanth
6. September, 2021.
This is my first year service with the Holistic Team and I would say that they are very much helpful in creating a financial plan and follow ups during the year. I would definitely suggest them if anyone who is willing to proceed with their savings professionally.
Joseph Mathias
Joseph Mathias
6. September, 2021.
I came to know about Holistic Investment Planners online while searching for different investment ideas. Once I contacted them the journey was very smooth. Mr. Ramalingam explained all the aspects of Financial planning in detail and it opened my mind. I realized how important it is to have a Financial planning. Mr. Rajan suggested all the requirements as per my goals and made a Investment plan keeping in mind of my goals. I started my Investment journey with them. I wish I had done it some years back then it would have been in a different level. Review meetings were held every six month to check the implementation of the plan and check the results as per the requirements and to check if any changes required. Overall it was a good experience with Holistic Investment team and would like to continue in the years to come.
Srinvas Kannan
Srinvas Kannan
30. July, 2021.
I came across Holistic investment planners almost 5-6 years back, but I did not have the trust since I had met a few of them who did not sound promising. Then I started investing through a financial advisor of my friend. After 4 years of investing the returns were very low. I was disappointed and started looking for financial advisors when I came across Holistic investment. I had a detailed discussion about my goals and the way they would approach achieving my goal before deciding to switch my investments to them. After a thorough analysis of my then existing portfolios, they suggested new ones and we zeroed-in on 6 schemes/funds where our investment would be split. I am glad I made the decision of switching over and taking Holistic planner's advise, my returns are handsome and I only wish I could have taken their help/advise 5 years back itself. Neverthless, I would like to recommend their services for investment and financial advise if someone is serious about their investments.
Shivaram Andiappan Selvaraj
Shivaram Andiappan Selvaraj
3. July, 2021.
I got a free first time consultation. I got my doubts resolved. They also gave additional advises for investment planning which was also useful.
Nellai B
Nellai B
26. June, 2021.
I have been associated with them for the past three years. They are very professional and polite in answering all our questions. I have complete trust in their suggestions. I strongly recommend for anyone. I am looking forward to have strong and successful association with them.
Google rating score: 4.4 of 5,
based on 61 reviews

Google Reviews

Jey S
Jey S
24. September, 2021.
I have been using Holistic Investment Planners for the last three years. Mr. Srinivasavaradhan answered all my questions and doubts very patiently during the first free consultation. I was able to clearly define my short-, medium- and long-term goals once I signed up for the comprehensive plan and got their investment plan suggestion to achieve my goals. They are very polite and highly professional whenever I contact them for any queries or make investments. They never pressurize you to invest on their recommended financial products. I would have been lost money by investing directly without their help since I do not have time and knowledge about different financial products. Risk planning is also done as part of financial planning. Truly, they are holistic planners when it comes to your financial planning. They help you to define your life goals, understand your financial resources and establish a plan to invest towards reaching those goals. They do review your plan as you progress to make sure that you are on correct path to achieve those goals. Kudos to the team and keep up the good work!!! I am happy that I found holistic investment planners for my financial planning and management.
aksaswadkar
aksaswadkar
24. September, 2021.
I was about to retire and really not understanding how to invest money to have financial freedom and fulfilling my goals. Was desperately searching on internet way out and fortunately came across Holistic Investment Planners. I read number of articles on their website and realized that this is the agency which I want and engaged their services for my retirement planning. It is an excellent experience to be associated with Holistic. Right from day one our interaction was fantastic and they gave me such a wonderful plan that I had never imagined. I am fortunate enough to be in the client list of Holistic. I have recommended Holistic to my friends as well.
Lionel Faber
Lionel Faber
16. September, 2021.
I've been availing their services for the past year. They are highly knowledgeable in the field and are very patient with all doubts and queries. Personalized financial planning is provided keeping your short term, medium term and long term goals in mind. They do not pressurize you to purchase schemes of their choice. They provide their input and suggestions and leave the decision up to you which shows their honesty and high principle.
Sridhar
Sridhar
8. September, 2021.
Financial planning brings peace in life. Holistic Investment have supported in arriving financial plan based on future goals. My investments are regular since then. They are professionals in their business, will recommend others.
Nitesh Agrawal
Nitesh Agrawal
6. September, 2021.
I have been using Holistic Investment Planners from last one year. The journey has been fantastic. Being a finance person myself I always thought we can look after and plan own finances also. However, due to lack of time and deciplain the things are not always as desired. After joining with Holistic Investment for the first time Icame to know the Financial goals and quantified them. Some dreams were unrealistic based on the earnings and savings so had a reality check. Also got the information and deciplain of investing on regular and more rewarding securities. I definetly suggest to use Holistic Investment Planners. They are professionals, available and hear youor full story before presenting plans. They are flexile in the sense if there are some urgent deviations required, they help to plan the same. For all professionals/individuals I would suggest using professional help of Holistic Investment Planners for best results in long term investment and financial goals achivements. Last advise will be to start early in your life. It really pays well to start in the beginning itself else the dreams needs to adjust :)
Swetha Vasanth
Swetha Vasanth
6. September, 2021.
This is my first year service with the Holistic Team and I would say that they are very much helpful in creating a financial plan and follow ups during the year. I would definitely suggest them if anyone who is willing to proceed with their savings professionally.
Joseph Mathias
Joseph Mathias
6. September, 2021.
I came to know about Holistic Investment Planners online while searching for different investment ideas. Once I contacted them the journey was very smooth. Mr. Ramalingam explained all the aspects of Financial planning in detail and it opened my mind. I realized how important it is to have a Financial planning. Mr. Rajan suggested all the requirements as per my goals and made a Investment plan keeping in mind of my goals. I started my Investment journey with them. I wish I had done it some years back then it would have been in a different level. Review meetings were held every six month to check the implementation of the plan and check the results as per the requirements and to check if any changes required. Overall it was a good experience with Holistic Investment team and would like to continue in the years to come.
Srinvas Kannan
Srinvas Kannan
30. July, 2021.
I came across Holistic investment planners almost 5-6 years back, but I did not have the trust since I had met a few of them who did not sound promising. Then I started investing through a financial advisor of my friend. After 4 years of investing the returns were very low. I was disappointed and started looking for financial advisors when I came across Holistic investment. I had a detailed discussion about my goals and the way they would approach achieving my goal before deciding to switch my investments to them. After a thorough analysis of my then existing portfolios, they suggested new ones and we zeroed-in on 6 schemes/funds where our investment would be split. I am glad I made the decision of switching over and taking Holistic planner's advise, my returns are handsome and I only wish I could have taken their help/advise 5 years back itself. Neverthless, I would like to recommend their services for investment and financial advise if someone is serious about their investments.
Shivaram Andiappan Selvaraj
Shivaram Andiappan Selvaraj
3. July, 2021.
I got a free first time consultation. I got my doubts resolved. They also gave additional advises for investment planning which was also useful.
Nellai B
Nellai B
26. June, 2021.
I have been associated with them for the past three years. They are very professional and polite in answering all our questions. I have complete trust in their suggestions. I strongly recommend for anyone. I am looking forward to have strong and successful association with them.
Google rating score: 4.4 of 5,
based on 61 reviews

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