Life Insurance is taken to meet the unexpected events like untimely death of the policy holder. In the absence of the earner of the family the insurance policy helps the dependents to face the expenses like education, marriage, life style expenditures, medical costs and others. There are different types of insurance policies and they offer several benefits to the people and their family members. In the policies like term insurance one can only exercise death benefits and there are no survival benefits. In the endowment policies one can enjoy the life cover. There are ULIP schemes also where the policy holder gets the investment and life cover both and one has to have a long term approach. All the insurance plans have different terms and conditions regarding the claim and settlement process. One must have the full information about all the underlying clauses to get the claim. In most of the cases companies give the claim but it has also been observe that claims are being denied and refused due to several reasons. Let us understand in what cases these insurance service providers can deny the request for the cover and what can be the remedies.
1. In many cases the insurance companies show so much concern at the time of purchasing the insurance policies and their executives also ensure that nothing bad will occur and the customers believe them blindly. In such cases they deliberately undergo in less documentations and at the time of claims they create problems. In such a scenario one can escalate the matter to the senior people or can go to the consumer courts to get the rectifications and the claims also. Such problems can be minor and should be handled with proper negotiations.
2. Some time the insurance companies try to pay fewer amounts than what the claimant is entitled to receive. In this case the dependents must understand the underlying clauses associated with the policy bonds and do proper negotiations with the service providers. In extreme cases one can go for the arbitration, mediation or can take the help of courts to take the legal benefits of the claims.
3. In many insurance policies there are many third party insurance companies and distributors involved and the main service providers fail or do not help to take the claims. In such cases also mediation firms and consumer courts can help the victim. They can get the claims settled with all the expenses incurred in the proceedings. One can also negotiate with all the parties to share the burden. It is also considered to be the most common cases where the claim denials have been observed.
4. Nowadays people take several policies from one service provider. The entire family takes such plans and they become dependents and nominees in each other’s insurance plans. Now the insurance companies give the claims on the basis of the previous insurance policies and try to take the benefits of any former non claimed policies. Here the family can go for the judicial proceedings and proper lawsuits can be undertaken. By having proper knowledge and procedure one can handle this in a better manner
5. Many times these insurance service providers do not perform proper investigation and examination during a claim process. Even If it is a third party work they do very less investigation and decide not to pay the amount. In such cases the victim have the option to go for a third party review and then can reclaim .They can also go to the courts for the proper hearing and restoration of the claims. In such cases any legal body or the insurance regulators can be asked to play a vital role.
6. If the insurance company is doing misrepresentation of any information that may create a problem at the time of the claims and not giving the full information then the dependent of the deceased can file a lawsuit for the violation of the insurance principle of Utmost Good Faith where both the parties promise that no information that are relevant will be concealed and utmost faith will be shown and kept. In such scenario the courts and consumer forum will instruct the insurance companies to clear all the claims and settlement within the stipulated time. But the claims should be approached within the time and proper attention must be taken.
7. In many instances the insurance service providers try to misuse the medical condition of the policy holder by using it as a hurdle in clearing the claim process. In such a case the dependents has to understand the policy documents properly and must check that if the illness or any medical ailments have occurred after the policy purchase and is covered under the policy they must highlight it in the perusal of the case. Court case can be filed in such a case and proper settlements can be obtained.
8. Companies have also done a lot of other bad things like they ask for excessive paperwork so that the dependent will feel frustrated and irritated resulting into leaving the claim with no follow ups. In such a case one need to be patient and should file the case in the consumer courts and the higher authorities of the insurance company. With proper follow ups this problem can be overcome and one can receive the claims that is entitle to.
Apart from this also there are many other ways through which these insurance companies try to make the dependent deprived of getting the proper claims. If in any policy the person dies and it is difficult to decide as it is a suicide or a normal death then the expert advice is required. Companies do not hire any expert and declare it in their benefits as suicide or anything. Here also one must fight to take the proper benefits. Courts and other legal bodies are there to protect the people but one need to be aware and must put efforts to get the things right and receive the claim.