ch.3- life ins, a&s ins, anuity claims pmt of proceeds Flashcards
claimant
- may be insured, or insureds estate, or beneficiary, or assignee
insurers records
- insurers pay beneifts based on most recent beneficiary designation on file or estate if n o ben.
notice of claim
- insurer usually receives notice of eth from agent, estate executor, beneficiary or emplyer
- once NOD recd, no more premiums, and insurer waits to reeive claim
- insurer not req to notify bens.
proof of claim: docs req
- beneficiary completed claim form
- -> oncde recd insurer will assess if claim payale, and pay of entitled
proof of claim: claimant needs to proove (4)
- insured person died
- insured persons age
- claimant has right to benefit
- claimant name and identity
may req more evidence
proof of claim: probate
must receive sufficient evidence of parties right to pmt
proof of claim: proof of age
- if aent properly verified age at time of app, insurer will use age on file w/o proof
proof of claim: proof of identity
- person who changed nam (i.e marriage) needs additional proof, ppl w common name (?)
- bens describe in terms: children, court app trustee, executor, guardian, etc….. have to establish qualification w additional proof
proof of claim: accidental vs natural causes (loimitations, accidental deth)
- if limitations on casue of death, insurer may investigate further
- may req more proof if policy has esclusions
- accidental death policies: only pay if death is accident–> need proof deth was accident
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disappearance + presumptions of death
- if insured missing more than 7 yrs –> court can declare dead
- if policy lapsed due to non pmt— need to proove policy was in force while alive
death of 2 or more ppl
- time and seq of deth importan t to estab lish who entitled to benefits
- jpit policy— may state who is presumed to have died 1st
payment in to court
- if insurer cant determine beneiciary or if a minor, prov+ terr ins legislation allows payment to coursts, releases insurer from liability
proceeds on deposit
- policy settlement options; insurer mayb provide options for pmt of DB
- most common: lump sum pmt to ben. or executor
time to pay claim
- insurer must pay claim w/in 30 days os proper evidence
- seg fund/IVIC: DB must be calculated
Denial of claim (3+1)
- fraud
- pmt of db against public order (i.e ben. killed insured)
- lapse– pmt default
4th: limitation period- claim not made in timely mannerr
pmt contrary to public order
beneficiary caused death of life insured
accidental death and dismemberment (AD&D)
- PH can name ben.
- if accident cause loss of i.e limbs: pmt to PH/insured
- if accident = loss of line–> pmt to ben.
accident and sickness claims (AADC)
diff benefits payable
- accidental injury/ dismemberment
- accidental death
- disability
- critical illness
A&S claims: accident death + dismemberment claims
- PH can name ben.
- if accident cause loss of i.e limbs: pmt to PH/insured
- if accident = loss of life–> pmt to ben.
A&s: disability claims
- unable to work, work F/T, continue same job
- caused by accident, illness, mental/psychological conditions (depression, anxiety)
- requires doctor to provide attending physician stmt (APS)
SEE PG 91
A&s diability claims: Critical illness (CI)
cRITICAL ILLNESS— lump sum pmt, once paid CI policy finished
if insured dies for reason not it CI policy— premiums refunded to ben.
SEG FUNDS + ANNUITIES
- When dead: ben or estate gets DB –> unless if immediate annuity if pmts started—>???
immediate or payout annuity
- can be purchased w guarantee period—> if death before guaraneed # pmts, insurer still has to make pmts (to annuity grantee)
amts accrued in annuity for retirement
- locked in
- may only be trfd to a: LIRA, another pension plan, purch immediate life ann. or deferred life ann. , LIF
seg funds/ann.: Death before retirement
- spouse becomes eligible to receive pmts
- no spouse—> paid to ben
- no Ben. —-> paid to estate
seg funds/ann: Death after retirement
- spouse may be eligible or survivors DB –> reduced amt of pension paid to pensioner
- if no spouse—> commuted lump sum of rest of pmts to ben
- if no Ben.—> to estate
