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Why Your Accidental Insurance Claim May Get Rejected?

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Every person has a higher probability of death through accident rather than natural death. In our daily life, we are exposed to many risks which can take our life. Such incidents are uncertain and could happen with anyone. Here, Accidental Insurance come to the rescue.

But first, we need to understand accident from insurance perspective:

Accident is an event which is sudden, unintended and causes bodily injury.

Accidental death means death which has been caused by an accident and proximate cause of death can be specified as visible unintended accident. Accidental death must have happened within 90 days of the accident. Though this period would depend on terms and conditions of your insurance policy.

Accidental death is covered in Life Insurance and additional cover can be bought through accidental rider by paying extra premium.

Insurance Samadhan

Rakesh had a life insurance of Rs 50 lakh and he has also bought an accidental death rider of Rs 50 lakh. Rakesh died in a road accident and his family got a claim of Rs 100 lakh on account of basic sum assured of Rs 50 lakh plus rider sum assured of Rs 50 lakh.

Accidental death cover can also be bought through General Insurance companies and should be an integral part of each individual insurance portfolio.

However, it needs to be established that the death has happened due to an accident and there has not been any carelessness.

why your accidental insurance claim may get rejected

Under what circumstances are insurance claims rejected?

There are many circumstances where an accidental death does not qualify for claim, such circumstances are given below :

  1. If a life insured has been found under a consumption of alcohol or drugs. There are many road accident cases where police records and post mortem confirms the use of alcohol or drugs.
  2. If a life insured had an accident due to violation of law of land like cases of over speeding or crossing a busy road or going to a prohibitive area.
  3. If a life insured had participated in a criminal activity.
  4. If a life insured has participated in an adventurous sport.
  5. If a life insured has died during a riot or terrorist activity and he has gone there with the intention. However, claim will be paid in a riot or terrorist activity when life insured was there at home and was killed.
  6. If a life insured has consumed a prohibitive substance knowing its implications very well.

To avoid such complications, the nominee needs a hand holding so that the right documents are submitted to the insurance company. 

List of documents required for accidental insurance claim

List of documents are stated below:

  1. Death Certificate
  2. Police FIR confirming that death happened due to an accident and case has been closed.
  3. If the accident is doubtful then the insurance company demands a Final Closure Report.
  4. Post mortem report
  5. Panchnama
  6. Any news item and photograph specially in road accident cases 
  7. Hospital report, if death has happened after some time. Here the hospital report needs to suggest that the proximate cause of death was an accident. For example, a heart patient had a road accident and had a heart attack . Now the question is, whether the claim is payable. In such a case, the claim will be paid because of the heart attack as a result of sudden shock.

click here – To know if accidental death is covered under life insurance policy.

Also Read:  How to Deal with Health Insurance Claim Rejection?

Accidental death claim is a tedious and rigorous work which needs support of an expert and Insurance Samadhan specializes in this.

Click here to register your complaint with Insurance Samadhan

You can also

Visit our website: insurancesamadhan.com

Call us on +91 9513631312

WhatsApp: 9910998252

Mail us at: corporate@insurancesamadhan.com

 

Insurance Samadhan

Srishti Agrawal

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