The proposal form is the buyer’s most important claim document because it records what the insurer asked and what the buyer answered.
Review the submitted proposal yourself and correct inaccuracies before relying on the issued policy.
Complete the proposal carefully.
Final proposal form.
Signing a blank form.
Health, occupation, income, travel, smoking, existing insurance and family history questions should be answered accurately according to the form.
Intermediaries may assist with data entry, but the proposer remains exposed if incorrect answers are submitted and accepted without review.
Medical underwriting can result in standard acceptance, loading, postponement, exclusion or decline. Preserve the decision and related reports.
| Area | What to establish | Operating rule |
|---|---|---|
| Questions | Every proposal answer is reviewed. | Do not sign blank forms. |
| Medical evidence | Tests and declarations align. | Keep copies. |
| Underwriting | Changes and additional terms are recorded. | Read acceptance letter. |
| Correction | Errors are notified in writing. | Obtain endorsement. |
Use written disclosures rather than verbal conversations. Attach a clarification where the form’s yes-or-no format cannot capture the history accurately.
After issue, compare the policy with the proposal and underwriting communication during the free-look period.
Record the policy number, insured person, event date, claim amount, insurer decision, disputed clause and relief sought. This converts a complaint into a reviewable case.
Do not sign a discharge, settlement or surrender document without reading the amount, effect and reservation of rights. Keep a copy of everything submitted.
Insurance disputes are contract and evidence problems. The reviewer should identify the insured event, the benefit claimed, the exact clause, the factual condition for that clause and the amount in dispute. Emotional urgency is real, but a structured file is more likely to produce a reasoned response.
The policyholder should preserve the full proposal, schedule, wording, customer information sheet, endorsements, premium history and claim correspondence. A short schedule cannot be read without the definitions and exclusions in the complete contract.
Medical, accident, travel or payment evidence should be contemporaneous. Later explanations can clarify an inconsistency, but they should not replace the hospital, police, airline, bank or insurer records created when the event occurred.
Every submission should have an index and acknowledgement. Where originals are handed over, retain readable copies and a receipt identifying what was submitted. Never alter, backdate or recreate supporting documents.
Escalation should follow the correct sequence: operational claim team, insurer grievance officer, Bima Bharosa where appropriate, and the Insurance Ombudsman or another lawful forum if eligible. Each stage should state the unresolved point and remedy requested.
For life policies, the proposal and underwriting file are as important as the claim form. Disclosure, policy status, nominee or assignee authority and cause-of-death evidence should be reviewed separately.
Guaranteed benefits, illustrated benefits, surrender values and insurance cover should never be merged into one return number. The contract may respond differently to death, maturity, lapse, paid-up status and surrender.
A policyholder should distinguish the insurer’s operational request from its final contractual position. A request for another report, original bill or clarification is not the same as a repudiation, and a partial authorisation is not necessarily the final settlement.
Prepare a money bridge from the gross bill or policy benefit to the amount received. Show excluded items, deductible, co-pay, sub-limit, depreciation, tax, prior payment and balance disputed. This prevents the complaint from becoming a debate about only one headline number.
Keep communication factual and consistent. State what happened, what the policy says, what evidence proves it and what action is requested. Avoid unsupported allegations, medical conclusions outside the treating record or changing versions of the event.
Track all dates: policy receipt, premium payment, event, intimation, document submission, insurer query, response, grievance and external escalation. Time limits can affect both insurer service standards and the policyholder’s remedies.
When the dispute is material, medically complex or legally sensitive, obtain advice from an appropriately qualified insurance, medical or legal professional. The article cannot replace review of the actual policy and evidence.
For life policies, distinguish claim investigation from routine document completion. If the insurer seeks medical or financial history, answer accurately and preserve the request and response.
Where several policies exist, prepare a policy-by-policy matrix because nominee, assignment, premium status and proposal disclosures may differ.