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  KNOWLEDGE CENTER
FAQ - Claims

i. What are IRDA guidelines pertaining to claim processing?

As per IRDA (Insurance Regulatory Development Authority), the insurance company is required to settle a claim within 30 days of receipt of all requirements. However, if the claim warrants further verification, the company should complete its procedures within 6 months from the receipt of the written intimation of the claim. If the company settles the claim beyond 1 month of receiving all request the interest is payable by the company on the claim amount. The interest is payable only where the claimant has submitted all the requirements. Further the rate and period of interest are decided as per IRDA guidelines.

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ii. How can a Claim be intimated to PNB MetLife?

• Through Financial Advisor/Sales Manager
• Through Branch Office
• Through Claims Department at the Head Office
• In case BABP channel, the claim intimation can be received by the channel partner/Bank – who in turn should communicate to PNB MetLife Branch/Claims Team at HO
• Through Regional Service Team

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iii. Information of Claim can be received in what all modes?

Claim Intimation received through any of the modes mentioned below:
• Written
• Letter
• Email
• Fax
• In event of a verbal intimation, written claim intimation should be collected from the beneficiary in order to proceed with the claim


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iv. What parameters are considered by the company while asking the claimant to submit particular records / documents?

The company considers the sum at risk, cause, circumstances of the claim and duration of the policy. For example, in an accidental death, specific proofs such as post mortem and police reports are required. For death due to illness, PNB MetLife calls for hospital records, test reports, etc.

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v. What documents are required to be submitted in case of a Claim?

1) Death Claim

• Death Certificate (In original or copy notarized)
• Original Policy Document or Indemnity Bond in case the Original Policy Bond is lost.
• Claimant’s Statement
• Family Physician Statement
• Last Attending Physician Statement
• Photo ID proof and Address Proof of the nominee as per AML Requirements (Refer Annexure for the list of accepted documents)
• In exceptional cases, the following documents would be called for:
• Cremation/ Burial Certificate
• Obituary Announcements (Copies attested by a PNB MetLife official)

2) Accidental Death Benefit Claim

• Death Certificate (In original or copy notarized) Original Policy Document or Indemnity Bond in case the Original Policy Bond is lost
• Claimant’s Statement
• Family Physician Statement (Non mandatory )
• Last Attending Physician Statement (Non Mandatory )
• Photo ID proof and Address Proof of the nominee (Refer Annexure for the list of accepted documents)
• Attested copy of FIR (If death due to accident or unnatural cause. Attestation to be done by the SHO of the concerned Police Station) or Attested copy of the Police Inquest Report (If death due to accident or unnatural cause. Attestation to be done by the SHO of the concerned Police Station) or Panchanama Attestation to be done by the SHO of the concerned Police Station)
• Attested Copy of the Post Mortem Report (If death due to accident or unnatural cause. Attestation to be done by the SHO of the concerned Police Station)
• In exceptional cases, the following documents would be called for:
• Cremation/ Burial Certificate
• Obituary Announcements(Copies attested by a PNB MetLife official)
• Viscera or Chemical Analysis report
• News Paper Cutting

3) Critical illness claim?

• Claimant Statement
• Attending Physician Statement
• Discharge summary from the hospital.
• Original/Attested copy of all treatment & diagnosis reports. Or
• Attested copies of other hospital records (Admission sheet, Discharge Summary, bead head ticket etc.) duly attested by the Issuing authority or notarized copy
• Original Policy Document
Please Note: Critical Illness Rider can be claimed only once the Survival period is completed.

4) Waiver of Premium?

• Claimant’s statement (in specified format)
• Attending Physician’s statement (in specified format)
• Original Policy Document
• Original/attested copy of all treatment & diagnosis reports.
• Attested copies of other hospital records (Admission sheet, Discharge Summary, bead head ticket etc.)
• Disability certificate issued by the Civil Surgeon / competent specialist. (06 months after the date of injury)
• Certificate of current status of health
• First Information Report (FIR) (Copy attested by the SHO of the concerned police station)

5). Met Health Care Claim?

• Hospital Cash Benefit claim form – In original
• Hospital Certificate – In Original
• Hospital Admission notes - In Original
• Hospital discharge summary - In Original
• Final Cash paid hospital bills - In Original
• Originals to be verified at branch. To be returned after verification.

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vi. Who can I write to for information on claims?

You can write to indiaservice@metlife.com

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vii. Who is entitled to receive the claim benefit?

• The nominee or appointee (in case of minor nominee) last recorded under the policy in case of policy on own life.
• The proposer in case the policy is not on own life.
• Assignee in case the policy was assigned.
• Life Assured himself in case of policy on own life for living benefit claims (Critical Illness rider, Total Permanent Disability, Health Care claims).
• Trustee under MWP policies/HUF policies.

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viii. Once all the requirements are submitted, how much time does the company take to settle the claim?

The company settles the claim within 15 working days after all the records, documents and necessary forms are submitted and documentation is completed. In case the claim warrants further verification, the company keeps the claimant informed. Subsequently, when the decision is taken, a letter is sent to the claimant. The company generally settles such claims within 3 months.

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ix. Do we need attestation on the documents while applying for a claim?

Attestation is required on certain documents. Kindly contact your closest PNB MetLife branch for more details

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x. Do insurance policies have any exclusion?

For life cover, the only exclusion applicable is suicide in the first year. Rider benefits like CI/Accident etc have various other exclusions applicable as mentioned in the terms and conditions of the policy. Please refer to your policy terms & conditions to know the exact details

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Customer helpline no. :
1800-425-6969 (Toll Free)
(Within India only)
OR 91-80-26502244
(8am – 8pm).

IVR available 24*7
with your policy details.
Fax : 080-41506969
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PNB MetLife India Insurance Company Limited formerly known as MetLife India Insurance Co.Ltd.

Registered office address:Brigade Seshamahal 5, Vani Vilas Road, Basavanagudi, Bangalore - 560004,
Karnataka. CI No.: U66010KA2001PLC028883, Phone: 080- 66006969/26438638, Fax: 080-22421970.
Website: www.pnbmetlife.com, Email: indiaservice@pnbmetlife.co.in., IRDA Regn No.: 117
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