Claims FAQs

A claim can be intimated by providing written information to us through-

• Your Agent Advisor
• Nearest Max Life Insurance company office
• Email at claims.support@maxlifeinsurance.com or

By sending written information at:

Max Life Insurance Operations Centre-–
Claims Department,
Max Life Insurance Company
Operations center, - 2nd floor
90A, Sector 18, Udyog Vihar,
Gurgaon-122015, India

Please refer the Claim Process document for Pradhan Mantri Jeevan Jyoti Bima Yojana. Claim Forms are available at the Bank & all Max Life Insurance Offices or can be downloaded from following link: http://www.maxlifeinsurance.com/pdf/Claims/Group_Claims/english/PMJJBY-Scheme.pdf

You can get claim forms

• Download from the website Claims Section
• Visit the nearest Max Life Insurance company branch
• Talk to your Agent Advisor

You can submit the documents at:

• Nearest Max Life Insurance branch

All claims are examined and settled by the company on the basis of information present in documents submitted by you in connection with the claim. It is advisable to provide complete information to us for faster and smoother claims processing.

It is advisable to intimate the claim at the earliest after death has happened. In case of Dread Disease and Critical Illness claims, claim should be intimated only after the end of survival period (after 28/30 days of event occurrence)

As per regulations, all valid claims are to be settled within 30 days after all necessary documents /clarifications have been received. In case, the claim warrants further verification, it may take upto 120 days to settle the claim. Subsequently, when a decision is taken, it is communicated to the claimant.

You will receive the claim amount as per the option that you have chosen at the time of submitting the claim documents. We encourage electronic fund transfer in order to provide our customers fast and hassle free experience.

In such circumstances, we would require the proof of title like Registered Will or Succession certificate issued by the competent court. The succession certificate should specifically provide orders for disbursement of policy monies. If, however, the deceased has left a Registered Will, a probate of the Registered Will is required along with the copy of the Registered Will.

The documents required to file the following claims are:

• Death claim, please click here.
• Hospitalization claim, please click here.
• Group claim, please click here.

The beneficiary or the nominee / assignee/appointee (in case of a minor) is entitled to receive the policy money as stated by the life assured in the proposal form.

A claim is declined on the non-disclosure of any material information made at proposal/reinstatement stage, which affects the issuance/reinstatement of policy/rider. Also, non-fulfillment of contract terms and conditions may also lead to claim being declined.

In case of Employer Employee & Non lender borrower schemes, nominee as stated in the Provident fund nomination form or registered at the time of coverage commencement is entitled to policy benefits.

In case of Lender Borrower schemes, outstanding loan amount in favour of the master policyholder and balance claim in favour of the nominee is registered at the time of coverage commencement.

In case of Employer Employee & Non lender borrower schemes, nominee as stated in the Provident fund nomination form or registered at the time of coverage commencement is entitled to policy benefits.

In case of Lender Borrower schemes, outstanding loan amount in favour of the master policyholder and balance claim in favour of the nominee is registered at the time of coverage commencement.

• Personal Accident Benefit Rider (PAB) provides benefit in the event of accidental disability.
• Accidental Death Rider Benefit (ADB) provides benefit in the event of accidental death.
• Dreaded Disease / Critical Illness Rider Benefit provides benefit in case of occurrence of any of the conditions / surgeries covered in the contract.
• Waiver Of Premium Rider Benefit (WOP) provides benefit in the form of premium waiver in case of accidental disability of the payer / death of the payer.

* For details on rider benefit, please refer to the policy document

Exclusions include:

• In case the dreaded disease / surgery occurs within waiting period (90 to 180 days) of the policy issuance, depending upon the contract terms and condition*.
• If the condition / surgery is not covered under the policy terms and conditions*.
• Accidental injury, which occurs due to self-inflicted injury.
• In case, the life assured commits suicide within 1 year of the policy issuance.
• In case, the life assured is involved in any unlawful activity resulting in injury.
• In cases where the injury occurred is not as per the policy terms and conditions*.

* For complete details on exclusion, please refer to the policy pack

Few instances when an Accidental Rider claim can get rejected are:

• Temporary disability such as fractures
• Condition when the disability is not total eg: amputation of toe
• Policy has lapsed as on date of accident
• In case of any material non-disclosure at the time of proposal signing

Critical illness/ Dread disease:

• If policy has lapsed as on date of event
• In case of any material non - disclosure at the time of proposal signing
• If the condition/ surgery is not covered under the policy terms and conditions
• If the criteria for the illness / surgery is not fulfilled as per the policy terms and conditions

** For other comprehensive details, please refer to the policy terms and conditions.

Exclusions include:

• Medicash Plus provides fixed Hospital cash benefit and Surgical benefit.
• Healthy Family Floater and Healthy Family Floater plus provides Hospital/Surgical cash benefit and critical illness benefit on event of any dread disease.

* For details on MA/HFF benefit, please refer to the policy document

Exclusions include:

• In case the hospitalization occurs within waiting period (90) of the policy issuance, depending upon the contract terms and condition*.(refer list I)
• In case the surgery occurs with in 24 months of the policy issuance (refer list II)
• Accidental injury, which occurs due to self-inflicted injury.
• In case, the life assured commits suicide within 1 year of the policy issuance.
• In case, the life assured is involved in any unlawful activity resulting in injury.
• In cases where the injury occurred is not as per the policy terms and conditions*.
• If the condition / surgery is not covered under the policy terms and conditions*.

* For complete details on exclusion, please refer to the policy pack

Exclusions include:

• When the Hospitalization period is less than 48hrs.
• Hospital is not registered or not fulfilling the criteria as per contract.
• Policy has lapsed as on date of hospitalization
• In case of any material non-disclosure at the time of proposal signing

Exclusions include:

• Based on the number of units purchased, per day hospitalization cash benefit will be settled apart from fixed surgical benefit if any.
• Claim settlement is based on the eligibility calculation and is independent of actual expenses incurred on the hospitalization.

** For other comprehensive details, please refer to the policy terms and conditions.

• GTL in lieu of EDLI Policy – Nominee mentioned as per the Provident Fund Nomination Form
• GTL – Max Life Super Life (Employer-Employee) Policy – Policyholder / company
• GTL – Gratuity Policy – Policyholder trust
• Lender Borrower Scheme – Outstanding loan amount in favour of the Master Policyholder & balance claim amount in favour of the Nominee registered at the time of coverage commencement
• Non Lender Borrower Scheme – Nominee registered at the time of coverage commencement

*** The nomination may vary depending upon the policy terms and conditions

Such circumstances are termed as “Open Title” situation. The company would require the proof of title / succession certificate issued by the competent court. The claimwould be paid to the person specified in the said proof and our liability as an insurer will be discharged. If the company has accepted the claim but is waiting for such proof, then the company holds the money till the proof is submitted and pays the interest as directed by the IRDA from time to time.

“Actively at work” clause means on the date the coverage commences : 

i) The employee is performing his regular duties as assigned to the employee on a full time  basis;

ii) The employee is not on leave due to any illness or injury or maternity leave. 

If the member is absent on the date the coverage commences, due to any illness or injury or maternity leave the coverage shall not commence until the date of his/her joining to duties and performing in the usual way all of the regular duties of his/her job on a full time basis and submit health declaration.

‘Actively At Work’ shall mean that when the coverage date commences, the member should be performing all his / her regular duties at work in the usual way and on a full time basis. If the member is absent on the coverage commencement date, due to illness, injury or maternity, the coverage shall not commence until he resumes work and performs all the regular duties of his / her job on a full time basis. Also, he / she needs to sign a health declaration, which has to be countersigned by the employer.

Addition / deletion list should include the members who either have joined the company or have been terminated / resigned from the company. Any member who has died should not be included in the addition / deletion list. The same should have a mention in the ’no death declaration” in the addition / deletion list.