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Life in the Fast Lane – Personal Experiences of a Claim Settlement Officer

Claim settlement officers are the heroes who help you in times of need. They walk that extra mile and let you reap the benefits of what you or your breadwinner had invested for. As a claim settlement officer, I get to meet many people and hear many stories that are heart touching. Our first job is to empathise with the situation and offer solutions through the quick settlement process. It is a conventional affair for us; however, there have been three claim settlement cases that I can never forget.

Case 1 – When the Future Needs Saving

Mr Khanna bought a term life insurance not too many years before. He was a non-smoker and non-alcoholic. He believed in saving and paying more for future so that his family is financially sound and secure. I got a call from my company that I need to take care of a claim. Mr Khanna had died twenty days before I got this call. I got to know that he had a baby who had to still go to school and his wife was pregnant with another child. There was no one to help the family that needed financial as well as emotional support.

On investigating, we got to know that he died in a bike accident. His untimely death had devastated his wife. However, he had made emergency plans for his family. His wife thought she would get a meagre amount out of the claim, but she had no clue that he had enrolled for accidental death protection in the same plan. She not only got the basic life cover but also got over and above that. Being of help to the small family, I was pleased.

Case 2 – Saved by the Nick of Time

This instance is one of the most disturbing phases of my life. It feels good to help a family when they have lost the insured, in other words, the bread earner of the family.. I wanted to ensure that the claim is processed as soon as possible. The claimant, in this case, is a mother of a son who recently committed suicide. She was a single mother. The mother was as old as 70, and the son did not care a bit before taking the step.

The reason unknown for the cause of his suicide, the mother, was speechless. She was in debt, and many people started approaching her as they got to know that her son passed away. She vaguely remembered her son mentioning about insurance. She decided to look for the documents and called. In suicidal cases, claimants do not get any benefit for one year, but this had happened after 2 years after the policy was taken. After 30 days, when I told her about the news of getting the claim amount, she blessed me. No other feeling could compensate that.

Case 3 – Defrauding the Fraud

“Where there is money, there is corruption,” says John Simons in his book ‘Prison and Beyond’. Life insurance is no alien to such corruption. We handle many such cases where an error or fraud is visible. However, there are those typical cases where experience and diligence of the settlement officer is tested. I also experienced one such case.
The case was simply of the missing claimant, who was replaced by a person from the fraudulent party. The real policy holder did not even know about the claim being filed until his premium due date arrived and he turned up to pay the premium.

The fraudsters have acquired access to his cell phone and policy details. They contacted the claim office with fake medical certificate issued by a doctor in another city (first instance of fishy deal). They were trying to cover their story under all kinds of legal documents, like FIR, medical certificates and bills, etc.

Fortunately, I ended up discussing with my manager about it, and he immediately got involved. First thing he pointed out is how well prepared these guys were. Finally, we decided to send someone to the residential address of the policyholder and got the correct picture.

The small mistake the family had made was not blocking their cell number after the phone got stolen, and not even trying to find after a while. They had simply bought a new number and were using the same. We educated them about the incident and how to take care in future.

Any fraudulent insurance claim not only affects the insurance company, it affects the existing and new policy holders as well. While the existing policyholders may face stricter scrutiny and longer claim processing time, the new customers may end up paying higher premiums for the same policies.