Policy Servicing Process

Policy Servicing process

This section provides information related to protection of policy holders interest.

Sourcing of Business

Every insurance agent shall explain to the prospect the nature of information required in the proposal form by the insurer, and also the importance of disclosure of material information in the purchase of an insurance contract.
An insurer or its agent or other intermediary shall provide all material information in respect of a proposed cover to the prospect to enable the prospect to decide on the best cover that would be in his or her interest.
Where the prospect depends upon the advice of the insurer or his agent or an insurance intermediary, such a person must advise the prospect dispassionately.
Where, for any reason, the proposal and other connected papers are not filled by the prospect, a certificate may be incorporated at the end of proposal form from the prospect that the contents of the form and documents have been fully explained to him and that he has fully understood the significance of the proposed contract.

Proposal for Insurance

It is the duty of an insurer to furnish to the insured free of charge, within 30 days of the acceptance of a proposal, a copy of the proposal form.
Proposals shall be processed by the insurer with speed and efficiency. All decisions thereof shall be communicated by the Insurer in writing within a reasonable period not exceeding 15 days from receipt of proposals by the insurer.
Wherever the benefit of nomination is available to the proposer, in terms of the Act or the conditions of policy, the insurer shall draw the attention of the proposer to it and encourage the prospect to avail the facility.
The policy document shall be dispatched via post/courier within 30 days of the date of receipt of the proposal/date of last document or communication received.
The delivery of the policy document shall depend upon the mode of dispatch. For Policy documents dispatch through Courier the expected delivery time shall be 10 days from date of decision by the Company and for Policy documents dispatch through post the expected time of delivery shall be 20 days from date of decision by the Company.

Freelook Period

The Insured has a period of 15 days from the date of receipt of the policy document to review the Terms and Conditions of the policy and where the Insured disagrees to any of those Terms or Conditions, he has the option to return the policy stating the reasons for his objection. Incase the Insured opts for policy cancellation during the Freelook period i.e. within 15 days of receipt of his policy document, the Company shall return the premium paid subject to the following deductions:
Deduction of a proportionate risk premium for the period on cover
Insurance stamp duty on the Policy , if any
Any expenses borne by the Company on the medicals
In-case of Unit linked policy, Units will be repurchased and any fluctuations in the NAV will be on the Policyholder’s Account.

Policyholder’s Servicing

An Insurer carrying on Life Insurance Business, as the case may be, shall at all times, respond within 10 days of the receipt of any communication from its policyholders in all matters, such as:
Recording change of address
Noting a new nomination or change of nomination under a policy
Noting an assignment on the policy
Providing information on the current status of a policy indicating matters, such as, accrued bonus, surrender value and entitlement to a loan
Processing papers and disbursal of a loan on security of policy
Issuance of duplicate policy
Issuance of an endorsement under the policy; noting a change of interest or sum assured or perils insured, financial interest of a bank and other interests
Guidance on the procedure for registering a claim and early settlement thereof
Providing receipt for the premium paid towards the policy and statement of account (unit statement for ULIP). Any policy level changes like increase/decrease in sum assured/premium/rider sum assured. Etc
Annuity servicing/registration (pension policies)
Renewal premium payment and policy reinstatement related

Claims Procedure

A life insurance policy shall state the primary documents which are normally required to be submitted by a claimant in support of a claim
A life insurance Company, upon receiving a claim, is required to process the claim without delay. Incase the Company requests for any additional documents, the requirements are required to be raised all at once within a period of 15 days of the receipt of the claim
A claim under a life policy shall be paid or be disputed giving all the relevant reasons, within 30 days from the date of receipt of all relevant papers and clarifications required.However, where the circumstances of a claim warrant an investigation in the opinion of the insurer, it shall initiate the same at the earliest and complete such investigation expeditiously, in any case not later than timelines defined in Turn Around Time (TAT) section
In case the claim is ready for payment but is not paid by the Company for identification of the payee, the Company shall hold the amount for benefit of the payee and shall pay interest at the savings bank interest rate. (effective from 30 days of submission of all relevant documents)
In case of delay in settling a claim (non compliance to the defined regulatory TAT) Company shall pay interest on the claim amount at a rate which is 2% above the bank rate prevalent at the beginning of the financial year.