How much time does the company take to decide on a claim
At Aegon Life Insurance, we endeavor to decide the Claim within 7 working days after all the records, documents and necessary forms are submitted by the Claimant and documentation is complete, subject to all other terms and conditions being met.In case, the Claim warrants further verification, the time taken to decide upon a claim would be slightly extended. Detailed timelines are as given below:
|Turn Around Time as mandated by Insurance Regulation and Development Authority of India (IRDAI)||Death Claims||Health Claims|
|Raising Claim Requirements||Within 15 days of receipt of claim||Within 15 days of receipt of claim|
|Settlement or Rejection or Repudiation of claims wherein Investigation is not required||Within 30 days from the date of receipt of last necessary document||Within 30 days from the date of receipt of last necessary document|
|Settlement or Rejection or Repudiation of claims wherein Investigation is required||Investigation should be completed not later than 90 days from the date of receipt of claim intimation and the claim shall be settled within 30 days thereafter||Investigation should be completed not later than 30 days from the date of receipt of last necessary document and the claim shall be settled within 45 days from the date of receipt of last necessary document|
How will I receive the claim amount?
We honour most of our claim payments through direct Bank transfer. Electronic Clearing Service: You need to submit the ECS instructions along with a cancelled cheque with name of claimant printed on it. The claim amount will be transferred directly to your bank account *Electronic Clearance System or ECS is the mode to transfer your money electronically from one bank account to another. Cheque Payments: A cheque is drawn in name of claimant. It is sent to you at the address mentioned in the claim form
How will a claim be treated if policy is in Lapse status
If the Policy is lapsed as on the date of death of the life assured, no death benefit is payable For death benefit with respect to other plans, please refer to the policy terms & conditions mentioned in your policy document.
When does a claim get rejected?
It is very important to read through the Proposal form and submit true factual details at the proposal stage and provide genuine documents at the time of buying a policy. In order that your claim does not get rejected, please ensure the following:
A. At the time of buying the policy:
- Ensure that you read and yourself answer all the questions correctly and accurately to the best of your knowledge
- Ensure that you have disclosed all material facts to the Company with regard to your health and be truthful about your tobacco and alcohol consumption habits. An affirmative declaration does not mean that your proposal will be rejected.
- In case of any doubt as to whether a fact is material or not, the fact should always be disclosed
- Ensure that all the documents submitted by you (E.g. age, address, income proof etc.) along with the proposal form are genuine.
B.Upon the receipt of your policy document, please perform the following checks:
- Go through the copy of your signed proposal form enclosed along with the policy document
- Review and ensure that all the questions have been answered correctly and accurately to the best of your knowledge
- Double-check details with regards to your nominee. Ensure that your nominee knows the details of your policy such as sum assured, policy term etc. Also keep your policy bond in a safe place and ensure that your nominee knows where the original policy bond is stored.
- In case you come across any discrepancy, please contact us immediately
C. At the claim Stage:
- If documents submitted at the Proposal/Claims stage are not genuine, it would also lead to claim repudiation.
- In the claims findings, if it is established that there had been a material suppression of facts pertaining to the proposal information, which would have impacted the assessment of risk, if disclosed at the proposal stage, then it may lead to repudiation of the claim.
Most of the claims get rejected due to reasons like:
- Fraud (which is a deliberate and intentional attempt to cheat by submitting false claims. for example, submitting a death claim when the insured person is still alive)
- Non-disclosure of existing disease medical condition or income and occupation details etc at the time of buying the policy
- Non-disclosure of lifestyle attributes like tobacco and alcohol consumption at the time of buying the policy
- Committing suicide within the first year or reinstatement of policy
- Non-payment of premium within grace period which means your policy is in lapse status
How do I communicate my concerns with respect to a claim decision?
We strive to pay all genuine claims and hence a simplified claim process. In case the claimant has a query or concern they can approach the Customer Care department at (Toll Free number--1800 209 9090). In the event of response being dissatisfactory for the claimant, he/she may write to our Grievance Redressal Committee. The claimant may communicate his/her concerns to this committee by sending a written communication to the address mentioned below:
Aegon Life Insurance Company Limited, Building no.- 3, Third floor, Unit no.- 1, Nesco IT Park, Western Express Highway, Goregaon (East), Mumbai -400063, Maharashtra If the claimant is still not satisfied with the redressal, the complainant may approach the Insurance Ombudsman. For more information on the Insurance Ombudsman, please refer your policy document.