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What is a claim in life insurance?

What does the concept of "claim" mean in a life insurance policy? Find out next.

02 Jul 20242 min

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Loss is an event that allows activating insurance coverage.

An accident in life insurance is any event that could trigger coverage of your insurance.  

The concept can be associated with accidents, mostly, but in the case of life insurance it can also occur in the event of illness or death. 

In other words, an insurance claim in a life insurance is any accident or illness that incapacitates the beneficiary, or their death.

Dependent on the type of coverage contracted, it can be Total and Permanent Disability (TPD) where the claim leads to a degree of disability equal to or greater than 60%, or Absolute and Permanent Disability (APD) where the claim incapacitates to a degree equal to or greater than 80%.

This means that when a covered claim occurs, you should contact the insurer to be properly compensated.  

Therefore, to ensure your rights and duties as the policyholder, insured, or insurance beneficiary, inform the insurer within eight legal working days after the occurrence of the claim.

To participate, you must provide the insurance company with information such as the causes of the claim, the date and location where it occurred, and also possible evidence of the occurrence.

For a more thorough analysis of the process, the insurer has the right to request additional evidence, and as the policyholder, insured, or beneficiary, you are required to share the requested information.

Confirming the claim, the insurance company starts the process by analyzing the causes, circumstances, and consequences, then deciding whether to cover the event.

In the case of life insurance, once the claim is confirmed, the insurer must communicate the amount to be compensated under the coverage triggered. Then, paying to whom is due, the compensation.

Note that, depending on the type of insurance and coverage, there are claims where compensation can be paid in money, goods, or even services. 

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