^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 (6.25 % for p.a. FY'19) for every day of delay beyond one working day.
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Claims Settlement Ratio
Claims Settlement Ratio
Before talking about the Claim Settlement Ratio, it is pertinent that we first understand the insurance company's perspective of having a streamlined and robust claim settlement process in place.
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
As a rule of thumb, therefore, you must consider the claims process and the claim settlement ratio of a life insurance company before purchasing insurance from them.
Why Is Claims Settlement Ratio Important?
The claim settlement ratio, also known as CSR, is a metric that reveals the percentage of life insurance claims an insurer has settled (paid out) during a financial year.
In other words, the settlement ratio is defined as the percentage of the total number of insurance claims paid out by an insurance company compared to the total number of received claims.
For example, if the claim settlement ratio of an insurer is 95 percent, it implies that:
1. The insurance company has successfully paid out 95 insurance claims out of every 100 claims received
2. The remaining 5 percent of the claims received are said to be rejected by the insurer
3. The overall risk management ability of the insurer is high, i.e. the insurance company has implemented the essential processes to identify faulty claim applications
The higher the claim settlement ratio is, the more confidence policyholders will have on the insurer. A high CSR is reflective of the insurance company's commitment to policyholders. For the FY 2019-20, our claim settlement ratio was 99.22% *.
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:
1. Claim Registration & Document Submission
2. Claim Evaluation
3. Claim Decision & Settlement
For the FY 2019-20, Max Life Insurance had a claim settlement ratio of 99.22% *.
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:
1. Claim Registration & Document Submission
2. Claim Evaluation
3. 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.
Furthermore, we assign a dedicated Claims Relationship Officer (or CRO), to guide your beneficiaries/ claimants at different steps of the claims process.
How Is the Claims Settlement Ratio Calculated?
The Claim Settlement Ratio (also known as the Claims Paid Ratio or CSR) is calculated as shown below -
Claim Paid Ratio = (Total Claims Paid / Total Claims Received) |
The Claim Settlement Ratio provides information on the number of claims that were paid successfully by the insurance company among the total claims received during a year. In other words, thus, if Max Life Insurance had a CSR of 99.22% * in the FY 2019-20.
The Claim Settlement Ratio (also known as the Claims Paid Ratio or CSR) is calculated as shown below -
Claim Paid Ratio = (Total Claims Paid / Total Claims Received) |
The Claim Settlement Ratio provides information on the number of claims that were paid successfully by the insurance company among the total claims received during a year. In other words, thus, if Max Life Insurance had a CSR of 99.22% * in the FY 2019-20.
What is a Good Claim Settlement Ratio?
What is a Good Claim Settlement Ratio?
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.
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 are the mandatory documents required for claims settlement?
#Mandatory Documents: 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 (incase of accidental death)
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
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/CSR03
Media Center
Media Center
Claims Service Leader
Life Insurance Category
CMO Asia Awards, 2019
Excellence in Claims
Service
CMO Asia Awards
2019
Company With Highest
Claim Settlement
The Economic Times
BFSI Awards - 2018
Swift and Prompt
Insurer Award
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
Frequently Asked Questions
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
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