Types of Claims

Survival Benefit payments

For money-back policies the insurance company makes specific payments to the policy holder at specific times during the term of the policy. These payments are called as survival benefits.

Surrender of the Policy

The policy holder opts for a premature closure of the policy. The amount payable to the insured is called surrender value.

Rider Benefit

A payment under a rider is made by the insurance company on the occurrence of a specified event according to the rider terms and conditions.

Eg: "accidental death benefit (ADB) rider, Critical Illness rider(CI) rider. The policy contract continues even after rider payments are made.

CLAIMS

CLAIM

It is a demand that the insurer should make good the promise specified in the contract

Survival Claims

A Survival Claim occurs when policy holder survives the term, an installment  payable in case of money back, Rider Benefit or Surrender of policy.

Death Claims

A death claim is claimed by the nominee after the death of the life insured

Medical Underwriting

Medical Factors that influence an Underwriter’s Decision

There are two measures of blood pressure

• Systolic (115+2/5 of Age)
• Diastolic (75+1/5 of Age)

Sources of Occupational Hazards

Accidental Hazards arise because certain kinds of jobs expose one to the risk of accident. There is any number of jobs in this category - like circus artistes, scaffolding workers, demolition experts and film stunt artistes.

Health hazards arise when the nature of the job is such as to give rise to possibility of medical impairment.

Eg.Jobs like rickshaw pullers, in chemical factory, in underground tunnels or deep sea.

Moral hazard can arise when a job involves proximity or can cause predisposition towards criminal elements or to drugs and alcohol

Non Medical Underwriting

A Large number of life insurance proposals may typically get selected for insurance without conducting a medical examination to check the insurability of a life to be insured. such cases are termed as non medical proposals.

Conditions for Non Medical Underwriting

• Only certain categories of fema;es, like working women may be eligible.
• Upper limits on Sum insured may be imposed(SA beyond 5 lakhs need medicals)
• Age at entry ( 40 or above need medicals)
• Certain plans of insurance (term insurance)
• Maximum term of insurance (from 20 years to age of 60)
• Class of lives with proper leave record and having periodic medical examinations.

Rating factors in underewriting

 Factors like income, occupation, lifestyle and habits which contribute to moral hazard, are assessed as part of financial underwriting, while medical aspects of health are appraised as part of medical underwriting.