^The claim amount on eligible policies is upto Rs.1C r. The policy has been in force for a minimum of three years. All the necessary documents shall be submitted before 3 pm at any Max Life Insurance office from Monday to Friday. Claims does not warrant field verification. All Claims that qualify for InstaClaimTM will be paid within 1 working day from date of submission of all mandatory documents else Max Life will pay interest at Bank Rate as on beginning of financial year in which claim has been received (4.65 % for p.a. FY'20) for every day of delay beyond one working day.
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Claim Settlement Ratio
Claim settlement ratio can be understood easily by understanding how insurance companies follow certain rules and regulations before settling an insurance claim, in case a policyholder passes away during the policy tenure.
It is possible for the claims to be denied, especially when there are some red flags in the policy draft that might go against certain policy requirements. When it comes to life insurance; therefore, you need to be sure that you fill out the necessary paperwork correctly and choose an insurer that has a proven track record of settling the major portion of the claims received, on a year-on-year basis.
Claim Settlement Ratio can serve as a reliable metric to determine if a certain policy and insurer is the right choice for you or not. Claim settlement ratio is calculated by dividing the number of insurance claims settled by the number of insurance claims received by the insurance company. Ideally, you should go for an insurer with a high claim settlement percentage or CSR.
The primary purpose of a life insurance plan, especially term insurance, is to provide financial support to your family in case something happens to you. When you purchase a term plan or any other insurance product from an insurer with a high claim settlement ratio:
1. You can be assured that the entire experience of claim filing to disbursement will be simple, convenient, and transparent
2. In case of an unexpected mishap, your loved ones will have the assurance of a quick disbursal of the life insurance benefit
How is Claim Settlement Ratio Calculated?
First, you need to understand that the Claim Settlement Ratio is calculated for all the insurance products offered by the insurance company put together, and not any specific product.
Consider the following example to understand the calculation of Claims Settlement Ratio:
Let us say that a life insurance company receives 1,000 claims, within a year, out of which it settles 992 claims by paying the insurance benefit (or sum assured) while rejecting the remaining 8 claims.
The Claim Settlement Ratio for the company would be (992/1000) % or 99.2%
Claim Paid Ratio = (Total Claims Paid / Total Claims Received) |
What is a Good Claims Settlement Ratio?
Overall, higher the percentage of the settled claims, better are the chances that your life insurance policy claim will be accepted and settled by the insurance company. Another reflection of a high CSR is on the insurance company’s finances. With settlement percentages up and above the 95% mark, a prospective life insurance buyer can be sure that the insurers are secure as they are willing to pay the insurance claim amount to most of their customers.
For the FY 2019-20, the claim settlement ratio of Max Life Insurance was 99.22% *. However, it is essential that you do not rely on this value as the only factor while determining your insurer.
What is a Good Claims Settlement Ratio?
Overall, higher the percentage of the settled claims, better are the chances that your life insurance policy claim will be accepted and settled by the insurance company. Another reflection of a high CSR is on the insurance company’s finances. With settlement percentages up and above the 95% mark, a prospective life insurance buyer can be sure that the insurers are secure as they are willing to pay the insurance claim amount to most of their customers.
For the FY 2019-20, the claim settlement ratio of Max Life Insurance was 99.22% *. However, it is essential that you do not rely on this value as the only factor while determining your insurer.
You must factor other factors such as online reviews of the insurance company, the experiences of your near ones, the features, and benefits of the insurance plan, before making a choice.
Why is Claims Settlement Ratio Important?
Buying a life insurance policy is a long-term endeavor. Not only do you have to pay a significant amount of premiums over a specific payment tenure to avail the policy benefits, you also have to be sure that your insurance policy documentation is well-rounded so that it doesn’t get rejected.
Thus, you need to compare and purchase a life insurance plan from an insurer with a high claim settlement ratio. Claims Settlement Ratio is a reliable metric that can help you determine if a certain insurance company is trustworthy or not and that your family will not have to move from pillar to post in getting the insurance benefit, after your untimely demise.
How Long Does It Take To Get Claim Payout?
How swiftly your beneficiaries receive the claim benefit is impacted by how quickly they file a claim and fill out the correct forms. Assuming the information is accurate, an insurance company will pay the claim amount in as little as one to two weeks.
The ideal conditions include:
- The life insurance policy is in effect for three years or more
- The insurance policy has all premiums paid and
- The cause of death is not suspicious
Deferrals in filing a claim or getting the right documents together could stretch the payment date. In any case, the life insurance company should pay out a death claim within 120 days.
Reasons Why Our Claims Settlement Process is Unique?
At Max Life Insurance, our claim settlement process is personalized because of the following factors -
a) Speed:
Insta claim in 1 day- Claim settlements under InstaClaim™ are subject to the following conditions:
- The claim amount on eligible policies is upto Rs.1C r
- The policy has been in force for a minimum of three years
- All the mandatory# documents shall be submitted before 3 pm at any Max Life Insurance office from Monday to Friday
- Claims does not warrant field verification
Reasons Why Our Claims Settlement Process is Unique?
At Max Life Insurance, our claim settlement process is personalized because of the following factors -
a) Speed:
Insta claim in 1 day- Claim settlements under InstaClaim™ are subject to the following conditions:
- The claim amount on eligible policies is upto Rs.1C r
- The policy has been in force for a minimum of three years
- All the mandatory# documents shall be submitted before 3 pm at any Max Life Insurance office from Monday to Friday
- Claims does not warrant field verification
b) Trust:
For the FY 2019-20, Max Life Insurance had a claim settlement ratio of 99.22% * which is by far the highest number that Max Life Insurance has achieved till date beating its own records for previous years
c) Ease:
Our website's Claim Centre crisply offers all the necessary information. Your nominee can either download the claim from the website's claim section or walk into the nearest branch office.
d) Dedicated officers:
We appoint a personalized service in the form of a dedicated Claims Relationship Officer (CRO) on the next working day of claim submission. Having a CRO is especially useful in the case of the settlement of a death claim, where your nominee receives every help to avail of insurance claim benefit in time.
e) Support:
Our round-the-clock customer support services provide a speedy resolution to customer queries and grievances. Our customer support services aim to maintain one of the lowest customer incidences throughout the insurance industry.
What is the Process for Processing a Claim?
At Max Life Insurance, we understand the importance of staying protected against life's uncertainties. We believe it is our responsibility to provide the best insurance coverage possible in your hour of need.
Our team of expert claim assessors are guided by the principle of being the 'Fairest, Fastest and Friendliest' in terms of claims processing. Our life insurance claim settlement processes, thus, includes the following three simple steps:
- Claim Registration & Document Submission
- Claim Evaluation
- Claim Decision & Settlement
For the FY 2019-20, Max Life Insurance had a claim settlement ratio of 99.22% *.
Furthermore, we assign a dedicated Claims Relationship Officer (or CRO), to guide your beneficiaries/ claimants at different steps of the claims process.
Our team of expert claim assessors are guided by the principle of being the 'Fairest, Fastest and Friendliest' in terms of claims processing. Our life insurance claim settlement processes, thus, includes the following three simple steps:
- Claim Registration & Document Submission
- Claim Evaluation
- Claim Decision & Settlement
For the FY 2019-20, Max Life Insurance had a claim settlement ratio of 99.22% *.
Furthermore, we assign a dedicated Claims Relationship Officer (or CRO), to guide your beneficiaries/ claimants at different steps of the claims process.
What Are the Mandatory Documents Required for Claims Settlement?
#Mandatory Documents required for claims settlement ratio are:
1. Original policy document
2. Original/attested copy of death certificate issued by local municipal authority
3. Death claim application form (Form A)
4. NEFT mandate form attested by bank authorities along with a cancelled cheque of bank account passbook along with nominee's photo identity proof
5. Discharge/Death summary attested by hospital authorities of FIR & Post Mortem Report/viscera report (in case of accidental death)
Max Life’s InstaclaimTM Promise - 24 Hours Is All We Will Take
The grief of losing your dear one in the hands of destiny is beyond words. As your trusted life insurer, Max Life Insurance offers Instaclaim TM
Service’ to settle your claims within one day, so that you can deal with your responsibilities in the absence of your loved one.
We, at Max Life, recognize that claim is the ultimate moment of truth for our business. Therefore, we intend to make your claim settlement experience convenient and quick with the InstaClaimTM initiative.
Through the InstaClaimTM initiative, Max Life endeavors to pay eligible death claims up to Rs. 1 Crore in only 24 hours. Additionally, a dedicated claim settlement officer further facilitates a convenient, quick, and simple settlement process.
The 24 hours claim settlement is available for the following:
- Eligible policies that have completed three continuous years
- The claim does not warrant field verification
- All mandatory documents are submitted before working
- Claim amount on all eligible policies is up to Rs. 1 Crore
Furthermore, if you don't receive payment within the time frame, you'll be entitled to additional payments in the form of " interest" on the total amount of your death benefit. T&C apply
With the InstaClaimTM initiative, Max Life further aims to enhance customer experience by paying death claim within just 24 hours in eligible cases.
Moreover, in a country with the low protection quotient(as per IPQ survey), Max Life’s claim settlement ratio of 99.22 percent gives a sense of security that their families will be financially safe during an eventuality, thus, encouraging them to opt for life insurance products.
Source:
* As per annual audited financials, FY 2019-20
Stay Safe, Stay Protected
As a policyholder or buyer, you can take a cue from the claim settlement ratio. However, the IRDAI claim settlement ratio should not be the only parameter that you consider when buying a life insurance policy. Instead, you need to ask whichever insurance company you have decided to purchase life insurance, to provide all the material information about their policy undertaking and claim settlement process.
On the other hand, you must make sure that you are sincere and transparent while filling out the application form so that your family does not have any problems while submitting a claim to the insurer, in your absence.
Source:
* As per annual audited financials, FY 2019-20
ARN:- PCP/CSR10
Frequently Asked Questions About Claims Settlement Ratio
You can register a claim with the Max Life Insurance through the following touch points. To help us process your claims faster, make sure that you submit the required documents along with the claim.
- > Your Agent Advisor, bank or corporate agent, from whom you purchased the policy
- > Nearest Max Life Insurance company office. You can easily locate a branch office near you, by clicking here https://www.maxlifeinsurance.com/contact-us and browsing through the ‘Locate an Office’ section
For any other claims support, Call on toll-free number at 1800-200-5577 or email us at claims.support@maxlifeinsurance.com or write to us on
Max Life Insurance Operations Centre -
Claims Department,
Max Life Insurance Company
Operations centre - 2nd floor
90A, Sector 18, Udyog Vihar,
Gurgaon-122015, India
Documents Required: We will need certain documents to validate a genuine claim. Below are some mandatory documents required to be furnished for each category of claims:
Death Claims: These are claims pertaining to life insurance policies that offer payout on the death of the policyholder.
We request you to submit the following documents to register a death claim:
- > Original policy documents
- > Original/attested copy of death certificate issued by the local municipal authority
- > Death Claim Application form (Form A)
- > NEFT mandate form attested by bank authorities along with a cancelled cheque or bank account passbook
- > Nominee's photo identity proof such as a copy of Passport, PAN card, Voter identity card, Aadhar (UID) card, etc.
Additional documents required basis the cause of death
For a Medical or Natural death
- > Attending physician's statement (Form 'C')
- > Medical records (admission notes, discharge/death summary, test reports, etc.)
For an Accidental or Unnatural death:
- > Copy of the First Information Report (FIR) or Panchanama/Police complaint
- > Copy of Post Mortem report (PMR)/Autopsy and Viscera report
- > Copy of the Final Police Investigation report (FPIR)/Charge sheet
Click here to download the Death Claim forms
Health Claims: These are claims pertaining to policies that offer health insurance or a critical illness component
We request you to submit the following documents to register a health claim.
- > Health claim application form (Details of forms available under Claim Forms section)
- > Attending physician's statement
- > Attested copies of all medical records
- > NEFT mandate form
Click here to download the Health Claim forms
Group Claims: These are claims pertaining to life insurance policies offered by organisations/institutions to their employees or group members.
We request you to submit the following documents to register a group claim under the following categories.
Employer-Employee Policies
- > Claim form (GTL Employer-Employee, EDLI, and Gratuity) as applicable
- > Original/attested copy of death certificate issued by municipal authorities
- > EFT mandate form to be completed by nominee/policyholder along with a copy of a cancelled cheque wherein the name of the account holder is printed or a copy of bank passbook
Non-Employer Employee Policies: These policies pertain to Lender-Borrower& Non-Lender Borrower Relationships:
- > Insurance certificate
- > Original/attested copy of death certificate issued by the local municipal authority
- > Claim form (Lender-Borrower/Non-Lender Borrower) as applicable
- > NEFT mandate form attested by bank authorities along with a cancelled cheque or bank account passbook
Additional documents required basis the cause of death
For a Medical or Natural death
- > Attending physician's statement (Form 'C')
- > Medical records (admission notes, discharge/death summary, test reports, etc.)
For an Accidental or Unnatural death:
- > Copy of the First Information Report (FIR) or Panchanama/Police complaint
- > Copy of Post Mortem report (PMR)/Autopsy and Viscera report
- > Copy of the Final Police Investigation report (FPIR)/Charge sheet
Click here to download the Group claim forms
Cancer Claims: These are claims pertaining to the cancer benefit in Cancer insurance policies
We request you to submit the following documents to file a cancer claim:
- > Cancer Insurance Claim Form - Form CA
- > NEFT Form
- > Medical Records (Admission Notes, Discharge/Death Summary, Test Reports, etc.)
Click here to download the cancer claim forms
You can get claim forms
> Download from the website Claims Section
> Visit the nearest Max Life Insurance company branch
> Talk to your Agent Advisor or insurance intermediary
All claims are examined and settled by the company by 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).
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.
The documents required to file the following claims are:
> Death claim, please click here.
> Hospitalisation claim, please click here.
> Group claim, please click here.
Rider benefits offered by Max Life Insurance have the following exclusions:
- In case the dreaded disease/surgery occurs within a 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 one 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
Life insurance holds an immense value for a family that only has one earning member. Consider a scenario wherein the breadwinner loses his or her life due to a deteriorating health or an accident. While the family has to deal with the emotional trauma of losing a loved one, they will also have to suffer financial stress, as they cannot rely on anyone else for support.
To make sure that your family doesn’t have to go through a similar chain of events, you need to create a contingency plan, with life insurance at its foundation, and various other investments making up the remaining portfolio.
Having a comprehensive life insurance plan in your kitty, you can not only provide the right financial support to your loved ones in case of emergencies but also earn long-term tax-saving benefits among others for yourself. Before you purchase an insurance plan; however, you need to compare different life insurance plans from other insurers, on the basis of their claim settlement ratio or claims paid ratio. This way you will be able to select an insurance cover that suits your present liabilities and life goals perfectly.
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Claims Service Leader
Life Insurance Category
CMO Asia Awards, 2019
Excellence in Claims
Service
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Company With Highest
Claim Settlement
The Economic Times
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The Economic Times
Life Insurance - Large Category, 2018
Claims Process Simplified Just In Three Steps
Claims Process Simplified Just In Three Steps
1
Claim Registration & Document Submission
2
Claim Evaluation
3
Claim Decision & Settlement
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