What should you do if insurers refuse to resolve your claim?

I am 18 years old and the nominee of all my father’s insurance policies. All the insurance companies concerned, barring one, paid me the sum assured after his demise, including a term insurance of ₹1 crore. A representative of the private insurance company which refused to resolve my claim, despite submission of all necessary documents. has suggested that I buy another policy from the company for the same amount before the claim can be processed. What should I do now?

—Name withheld on request

Life insurance typically does not have any exclusions, except for suicide, which is excluded only for the first policy year. Therefore, the only reason for delay or denial of a life insurance claim can be non-disclosure at the time of policy issuance. The insurer will investigate the circumstances of the claim and check whether all medical conditions linked to death were fully disclosed at the time of the proposal. If there is no discrepancy, then insurers cannot reject the claim. If the insurer has not denied the claim yet, you should follow-up with them for any queries or clarifications they need. You should obtain a copy of the proposal form submitted at the time of policy issuance and try to keep any medical check-up reports handy. This will help you respond promptly to any queries raised by the insurer.

You should avoid dealing with the insurer representative who is asking for reinvestment, as they are likely an insurance agent or sales manager. You should ensure that you have sent all your claim documents to the insurer directly or via an insurer broker of high standing. By now, you should have a claim registration number and a formal acknowledgement of the claim documents submitted to the insurer. The simplest way to generate a claim number is to call the insurer customer service and report the claim. If the sales representative retains the document and fails to submit it to the insurer, then it can jeopardize the claim and cause unnecessary delay.

If you have any documentary evidence of the above coercion by the insurer representative, you should report it to the insurance regulator and the insurer grievance department. For an insurer, any front-line executive has limited ability to influence the outcome of a claim.

I had enrolled my senior citizen parents in a health insurance plan provided by my employer. However, the coverage proved to be inadequate when my mother underwent a cataract operation last year and I had to bear the costs. Furthermore, my father underwent an angioplasty followed by a bypass surgery, which exhausted a significant portion of the coverage, leaving me to bear a major part of the expenses. Can I claim the expenses I paid out-of-pocket for the cataract operation and hospitalization under Section 80D?

—Bhavesh

You can claim a deduction of up to ₹50,000 for the amount spent on your parents‘ cataract and angioplasty expenses under Section 80D. However, the provision also states that you must not have paid any premium to maintain a health insurance policy for your parents in order to be eligible for this deduction.

Abhishek Bondia is principal officer and managing director, SecureNow.in