Insurance Policy Conditions pertaining to Life Insurance , Motor Insurance , Fire Insurance and Health Insurance are noted

1. INSURANCE POLICY CONDITIONS
Made By:
Rajat Deshmukh

2. Life Insurance Conditions
 Payment of Premiums
 Non-forfeiture regulations
 Forfeiture in certain events
 Suicide
 Guaranteed Surrender Value
 Salary Saving Scheme
 Alterations
 Duplicate Policy
 Age Proof accepted by LIC
 Alternative Age Proofs which are accepted
 Nomination

3. Life Insurance Conditions
 Assignment
 Re-assignment
 Concessions for claims during the lapsed
period
 Revivals
 Policy Loans
 Claims settlement procedure
 Maturity Claims
 Death Claims
 Double Accident Benefit Claims
 Disability Benefit Claims
 Insurance Ombudsman

4. Health Insurance Conditions
Notification of Claim to TPA:
 Planned Hospitalization – 48 hours
 Emergency Hospitalization – within 24 hours of admission
 For Medical Reimbursement – within 7 days after the discharge from
hospital
Cashless Service:
 Available only at the Network Hospitals and in case of planned
hospitalization only.
Supporting Documents required for claims:
To be submitted within 15 days of Discharge
 Duly filled claim form
 All the bills, case histories, discharge summaries etc.
 A precise diagnosis report.
 Prescriptions, drug receipts and bills for consumables

5. Claims Payment:
 All the payments will be made as per insured’s requirement stated in claim
form and after verifying that the medical cost and expenses were paid by
the insured.
 In case of death claim amount will be paid to nominee prescribed by
insured in PF.
Fraud:
 In case of dishonest claim or misrepresentation policy shall be void and all
benefits under the policy will be forfeited.
Other Insurance:
 If there exists any other insurance policy then the claim to be settled from
the first policy and the exceeding amount can be claimed from the next.
Policy Cancellation or Termination:
 If Policy is terminated on the grounds of misrepresentation or fraud then
the insurer has to state the same in written notice.
 If the policy is cancelled on the grounds of insured’s notice then the
premium has to be refunded on short period scale by insurer. {INCASE
OF NIL CLAIMS}
 If the policy is terminated by insurer due to fraud or misrepresentation on
the part of insured then the premium is to be refunded by insurer on pro
rata basis by insurer.

6. Motor Insurance Conditions
 Insured must intimate Insurer about any occurrence of claim and submit
any notice issued by third party ASAP.
 Incase of theft, insured must file an FIR and provide a copy to insured.
 Insured must never accept any liability or promise about compensation
without written consent from insurer.
 Insurer may at their choice repair, replace or make cash payment in
respect of loss whereas the maximum liability shall be limited to:
a. Incase of TL or CTL: IDV less the value of salvage
b. Incase of Partial Loss: cost of replacement less value of
depreciation
 Incase of Double Insurance the companies will contribute to claim
proportionately.
 In the event of death of Insured, legal heirs shall within 3 months of death
or policy expiry date , whichever is earlier shall have the vehicle
transferred in their name and approach insurance company for change in
the name of Insured with 1. Original Policy 2. Proof of death of Original
Insured 3. Proof of Ownership

7. Fire Insurance Conditions
1. Voidable Condition
2. Policy Ceasing Condition
3. Material alteration Condition
4. Termination Condition
5. Marine Clause
6. Limit of Liability
7. Right of entry condition
8. Condition arises out of Fraud Claim
9. Reinstatement
10. Contribution
11. Subrogation
12. Average
13. Arbitration
14. Written Communication
15. Sum Insured to be maintained for the currency of Policy.

8. References:
• Life Insurance: https://www.licindia.in/Customer-Services/Policy-
Condition
• Fire Insurance: http://www.bimabazaar.com/various-conditions-
under-fire-insurance-policy

9. Thank You !!!