Common use of Claim Processing Clause in Contracts

Claim Processing. i) The bank will forward (Upload on portal) scan copy of document through e-mail and the company will start processing of claim on the basis of scanned documents. ii) On Death Claim intimation the following documents to be submitted. The claim will be settled within a TAT (turn around time) of 15 working days in case of all the below requirements are received. a) Claim Form completely filled, signed by nominee and attested by Master Policy Holder (MPH) with correct Master Policy Number and Member Id. Incomplete forms if received will not be considered. Further processing will be done after receipt of all complete requirements. b) Death Certificate issued by Birth and Death Registrar under 12/17 format duly attested by MPH. c) Copy of Self Declaration of good health should be mandatorily attached along with claim documents for all claims where sum assured is above 0.75 Lakh. d) Proof of Age of Life Assured, preferably AADHAR CARD. e) Cause of Death Certificate f) Bank Pass Book (in respective RSCB/DCCB) and KYC of nominee duly attested by MPH, In case if nominee’s bank account details is of different bank (other than RSCB/DCCB), the claim will be credited to the said bank account based on the proof given along with claim form. This has to be attached with the claim forms or else the document will be treated as insufficient. If the above requirements are compiled without any mismatch in any vital detail like nominees name/life assureds Name Etc, in the claim form and in our records then death claim will be settled as per Agreement. g) All the deficiencies/objections in the claim should be communicated to the concerned bank altogether in a single communication only by the insurance company This Agreement is final binding on both parties and no other clauses will be imposed by the Insurance Company in the name of conditions of their product. If any claim is rejected on the basis of terms and conditions of the approved product of the Insurance Company, which is not mentioned, or not as per the Agreement, it will be treated, as breach of Agreement and the insurance company will be solely responsible for all the damages. iii) If the claim is not settled by the Insurance Company within the prescribed period, then, the company shall pay interest, as per IRDA guidelines. For gross delay in majority of claims bank may consider imposing penalty and can even blacklist the company. The bank may pay interest amount along with claim amount to the claimant from performance guarantee money of the company, if claim is not settled within 90 days of upload of all required document on portal by the bank.

Claim Processing. i) The bank will forward (Upload on portal) scan copy of document through e-mail and the company will start processing of claim on the basis of scanned documents. The bank will forward hard copies of documents soon after sending e-mail to the INSURANCE COMPANY. ii) On Death Claim intimation the following documents to be submitted. The claim will be settled within a TAT (turn TAT(turn around time) of 15 ------ working days in case of all the below requirements are received. a) Claim Form completely filled, signed by nominee and attested by Master Policy Holder (MPH) with correct Master Policy Number and Member Id. Incomplete forms if received will not be considered. Further processing will be done after receipt of all complete requirements. b) Death Certificate issued by Birth and Death Registrar under 12/17 format duly attested by MPH. c) Copy of Self Declaration of good health should be mandatorily attached along with claim documents for all claims where sum assured is above 0.75 1 Lakh. d) Proof of Age of Life Assured, preferably AADHAR CARD. e) Cause of Death Certificate f) Bank Pass Book (in respective RSCB/DCCBDCCB ) and KYC of nominee duly attested by MPH, In case if nominee’s 's bank account details is of different bank (other than RSCB/DCCB), the claim will be credited to the said bank account based on the proof given along with claim form. This has to be attached with the claim forms or else the document will be treated as insufficient. If the above requirements are compiled complied without any mismatch in any vital detail like nominees name/life assureds Name Etc, in the claim form and in our records then death claim will be settled as per AgreementMOU. g) All the deficiencies/objections in the claim should be communicated to the concerned bank altogether in a single communication only by the insurance company This Agreement MoU is final binding on both parties and no other clauses will be imposed by the Insurance Company in the name of conditions of their product. If any claim is rejected on the basis of terms and conditions of the approved product of the Insurance Company, which is not mentioned, or not as per the AgreementMoU, it will be treated, as breach of Agreement MoU and the insurance company will be solely responsible for all the damages. iii) If the claim is not settled by the Insurance Company within the prescribed period, then, the company shall pay interest, as per IRDA guidelines. For gross delay in majority of claims bank may consider imposing penalty and can even blacklist the company. The bank may pay interest amount along with claim amount to the claimant from performance guarantee money of the company, if claim is not settled within 90 days of upload of all required document on portal by the bank.