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Claim Settlement Process: A Comprehensive Guide for Independent MFDs

Updated: Jan 29

Table of Content:

  • Introduction

  • Understanding the Importance of Claim Settlement

  • The Principle of Utmost Good Faith

  • Types of Claims

  • Transparent Disclosures

  • Healthy Living and Disclosures

  • Timely Premium Payments

  • Filing the Claim Promptly

  • Understanding the Fine Print

  • Paying Attention to Notifications

  • Informing the Nominee

  • The Power of Digital Platforms

  • Conclusion

Claim Settlement Process

As an independent Mutual Fund Distributor (MFD), your role extends beyond just suggesting the best investment options for your clients. Providing guidance on critical financial matters, such as the claim settlement process, forms an integral part of your responsibility. This article serves as an in-depth guide to help you advise your clients on how to ensure their claims are settled smoothly, thereby strengthening your relationship and building trust.

Understanding the Importance of Claim Settlement

Claim settlement is a pivotal component of any insurance policy, be it health, life, property, or motor insurance. It serves as the financial safety net in the event of untoward incidents, fulfilling the primary purpose of insurance – risk management. However, the ease of claim settlement largely depends on the honesty and accuracy of the information provided by the policyholders at the time of policy purchase.

Note: The Insurance Regulatory and Development Authority of India (IRDAI) mandates insurance companies to settle claims within 30 days of receiving all necessary documents from the customers.

The Principle of Utmost Good Faith

The principle of Uberrimae Fidei, or “utmost good faith,” is a fundamental aspect of insurance contracts. It necessitates that all information provided to insurance companies is accurate and truthful. Any discrepancy or false information can lead to the insurance contract becoming void.

Types of Claims

Types of Claims


Death/Accidental/Critical Illness Claims

These claims are triggered by specific risks covered in the insurance policy.

Upon the occurrence of covered risks (e.g., death, accidents, critical illnesses), the policy pays out.

The payout provides financial assistance to manage the repercussions of unforeseen events.

Payout at the Time of Maturity

These payouts occur when the insurance policy reaches its specified end date or completion of the term.

The purpose is to fulfill specific goals for which the policy was taken.

Examples of goals include funding education, saving for retirement, or meeting long-term financial needs.

For both types of claims, it is crucial that all contact details (telephone, address, email, etc.) and bank information (account number, IFSC Code, bank confirmation, etc.) are kept updated with the insurance company.

Transparent Disclosures

At the time of policy purchase, policyholders must provide accurate and honest information along with clear documentation. The sum insured of an insurance policy is based on this information, which could be determined by the policyholder's current and future earning capacity. Any misrepresentation of facts can lead to claim rejection.

Healthy Living and Disclosures

Policyholders' medical history plays a crucial role in determining the risk level an insurance provider is willing to take for health and life insurance. Not all medical conditions are covered by insurance policies, so it's best to disclose any pre-existing conditions upfront. Though this may lead to an additional premium charge, it ensures that claims will be paid if the risk materializes.

Timely Premium Payments

Consistent premium payments ensure that the policy remains active, and the financial security it offers remains intact. Policyholders should inform their insurance provider before the policy expires if they cannot continue paying for any reason.

Filing the Claim Promptly

Policyholders should inform the insurer about a claim immediately. Some companies have a specific time frame for claim notification. Policyholders can register a claim by visiting the nearest office of the insurer, calling the insurer’s toll-free number, or referring to the insurer’s website for guidance.

Understanding the Fine Print

Reading and understanding the policy terms and conditions can prevent unpleasant surprises when the claim needs to be filed. It is imperative to understand each clause of the policy and clarify any confusion with the insurer.

Paying Attention to Notifications

Insurance companies often request alternative contact numbers and addresses at the time of policy purchase or when notifying them of a claim. They also frequently remind policyholders to update their contact information and address whenever there are any changes.

Informing the Nominee

Policyholders should keep their nominee well informed about the policy, its clauses, and its benefits. All necessary documents related to the policy should be kept safely and made accessible to the nominee.

The Power of Digital Platforms

The digitisation of claims processes allows for a faster and more efficient process. Platforms like AssetPlus serve as the perfect digital solution designed to empower, educate, and establish independent MFDs. It provides a comprehensive suite of tools and resources, enabling MFDs to provide superior service to their clients, including guidance on claim settlement.

In conclusion, by advising clients to provide accurate and honest information about their financial and medical state, an insurance policy can provide valuable security cover for their families. As an independent MFD, your guidance can make the claim settlement process smoother for your clients, enhancing their trust in your services.

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