All about COVID-19 hospitalisation and death claims: How to file death claim, documents required, EDLI scheme

If a family member has been hospitalised due to COVID-19, the entire family goes into panic mode. If a family member has died from COVID-19, the entire family is devastated. During this difficult time, we will guide you on how to handle insurance claims.

What you need to know about COVID-19 hospitalisation and death claims

The COVID-19 pandemic continues to spread across the globe, including India. Millions of people had to be hospitalised, and many of them died. The two most common questions people ask are whether their health insurance policy will cover hospitalisation expenses and whether life insurance companies will pay death claims to nominees. 

In this article, we will answer these questions and others.

How have insurance companies handled COVID-19 claims so far?

Before we answer questions about COVID-19 related insurance claims, let us see how insurance companies have handled such claims so far. TL Alamelu, IRDAI member, spoke about this during the 13th Global Insurance E-summit organised by ASSOCHAM. 

Following are some of the insurance claims statistics that she presented:

Health insurance claims data Number of Claims
Total number of COVID-19 health insurance claims reported 19,11,384
Number of health insurance claims settled by insurance companies 15,39,434
Percentage of health insurance claims settled 80%
Total amount of hospitalisation claims paid Rs 15,000 crore
Total amount of hospitalisation claims paid 4%

 

Life insurance claims data Number of Claims
Total number of COVID-19 life insurance claims reported 55,276
Number of death claims settled by life insurance companies 48,484
Percentage of life insurance claims settled 88%
Total amount of death claims paid Rs 3593 crore
Life insurance claims repudiated 0.66%

(Source: Times of India)

Note: The above data is as of 22nd June 2021

Looking at the data on COVID-19 related health and life insurance claims, the insurance companies seem to have done a decent job. But, they still need to do a lot as they have settled only 80% of health insurance claims and 88% of life insurance claims.

Now, let us answer some common insurance queries related to COVID-19.

1) Is COVID-19 hospitalisation and death covered under health and life insurance plans?

Yes, health insurance policies provide cover for hospitalisation expenses, and life insurance policies provide cover for death due to COVID-19. The extent of the health cover may differ among health insurance policies. Some don’t cover consumables like PPE kits, gloves, etc. Others may not cover the cost of treatment taken at home or temporary healthcare centres. For the exact scope of coverage, read the policy document or get in touch with the insurance company.

2) Is death due to corona covered under term life insurance plans?

Yes, death due to COVID-19 is covered under term life insurance plans. In fact, death due to COVID-19 is covered under all life insurance policies.

3) Will nominees of existing policies get death benefits?

Yes, the life insurance company will pay the claim to the nominee/s on submitting all required claim documents. If you still haven’t added nomination to your life insurance policy, you can do it now also. The life insured can add/modify the nominee/s anytime during the tenure of the policy.

4) How does one file a death claim? What are the documents to be provided?

In case of a death claim, the nominee of the life insured needs to submit the following documents to the life insurance company:

  • Life insurance policy document
  • Duly filled claim form
  • Death certificate of the life insured
  • Identity and address proof of the nominee
  • Bank account details of the nominee

These are the basic set of documents required to be submitted by the nominee to the life insurance company. Some life insurance companies may ask for additional documents for processing the claim. These include medical records of the last hospitalisation (if any), a medical certificate issued by the last attending doctor, etc. For accidental death, additional documents like post mortem report, police FIR, etc., will need to be submitted.

You will have to submit the entire set of documents to the life insurance company. If you know the insurance agent of the deceased person, you can take their help for completing the claim formalities. Most insurance companies have set up dedicated teams to fast-track claim settlement related to COVID-19. 

5) How to find out if a deceased person had life insurance?

There are many cases in which a family member has died due to COVID-19, and the other members are not aware whether the deceased had an insurance policy. In such cases, you can find out if an insurance policy exists in the following ways:

  • Check the ‘important documents’ file of the deceased person to see if there are any copies of the policy document, premium receipts, notices for renewal of premium payment, tax deduction certificates mentioning policy premium receipt, etc.
  • Consult the financial advisor of the deceased person to check if they had bought any life insurance policy.
  • Check the bank account statement of the deceased person for debits related to any life insurance policy premium.
  • Contact the deceased person’s employer to check if the company had the deceased person covered under a group life insurance policy.

Once you get the life insurance policy details, you can get in touch with the life insurance company and file the claim.

6) What are the other insurance policies a family needs to check, and how can they make a claim?

Apart from the life insurance policy bought by the insured on their own, the insured may be covered under other group life insurance policies. Some of these include:

  • Group life insurance cover provided by the employer
  • Group life insurance cover provided by the Employees’ Provident Fund Organisation (EPFO) under the Employees’ Deposit Linked Insurance (EDLI) Scheme
  • Group life insurance cover provided by a bank to its account holders
  • Group life insurance cover provided by the Central Government under the Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY)
  • Any other group life insurance policies that cover the deceased person; e.g., provided by telecom service provider, credit card company, etc.

What should you do when you know about any of the above group life insurance policies covering the deceased person? You should either get in touch with the organisation that has provided the group life cover or the life insurance company that has issued the group life insurance policy and file the claim.

7) Is there any death benefit from the company where the deceased member worked as per EPFO or EDLI scheme?

The Employees’ Provident Fund Organisation (EPFO) provides various benefits to its members under various schemes such as Employee Provident Fund (EPF), Employee Pension Scheme (EPS), Employee Deposit Linked Insurance (EDLI) scheme, etc. 

Under EDLI, the employee gets a life insurance cover ranging from a minimum of Rs 2.5 lakh to a maximum of Rs 7 lakh. Check with the deceased person’s employer whether they were a member of EPFO and eligible for insurance benefits under the EDLI scheme.

8) Are there any other government benefits? If so, how can surviving family members avail of the same? 

Through Life Insurance Corporation (LIC), the Government of India offers the Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY). PMJJBY offers a life insurance cover of Rs 2 lakh to the insured. The premium is auto-debited from the linked bank account.

If you are not aware whether the deceased person has availed of PMJJBY, check their bank account statement. See if there is a debit of Rs 330 for annual premium payment. If it is there, you can file a claim with the bank by submitting the required documents.

9) How to follow up on the status of claims filed?

In the above sections, we discussed how to find out about various life insurance policies of the deceased family member and how to file a claim. Once you file the claims, you should make sure you follow up every claim until it is settled.

Many insurance companies have taken note of the hardships faced by people due to the pandemic and have relaxed the claim requirements. They have also set up dedicated claim settlement teams to expedite the claim settlements.

Are you still without life/health insurance cover?

So, did you have to pay a big hospitalisation bill for yourself or a family member as a result of COVID-19, or maybe lost a family member to the pandemic? If yes, you now understand the importance of insurance. If you have still not bought life insurance for yourself or health insurance for your entire family, get it immediately! 

The virus doesn't differentiate between rich and poor, young and old, or men and women. All are equally affected, so life insurance and health insurance are a must for everyone.

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