To Ensure Your Life Insurance Claim Goes Smoothly, Pay Attention to the Following Factors That Can Cause Your Claim to Be Rejected

 Life insurance is like an umbrella before a rain—it provides financial peace of mind for families in the event of the insured's death. But remember, claims aren't always automatically approved. There are rules and exceptions that can lead to a claim being denied. Learn about some common reasons below:

To Ensure a Smooth Life Insurance Claim, Read This to Avoid Rejection

Life insurance provides a sense of security for you and your family against the risk of losing your source of income due to death. However, not all life insurance claims are automatically approved. Certain conditions or violations can cause a claim to be rejected by the insurance company. Here are some things you should pay attention to:

Life Insurance

1. Ensure the Information & Data You Provide is Honest and Complete

In an insurance policy or contract, honesty is the main foundation. The relationship between you and the insurance company is built on the principle of utmost good faith, which means both parties must be open and honest in providing relevant information.

The data you provide when filling out the application form (SPAJ) forms the basis for the risk assessment. If any important information is hidden or inconsistent with the facts, not only can your claim be rejected—your policy can also be reviewed or even canceled. This applies even if the claimed illness is different from a previously unreported condition (a pre-existing condition, or a medical condition that existed before the policy was issued).

Some common examples:

Hiding medical conditions or pre-existing conditions such as heart disease, diabetes, hypertension, and others

Not being honest about smoking habits, alcohol consumption, or drug use

Claiming to work in an office when in fact the profession is high-risk

Providing other inaccurate or misleading data during the assessment process

2. Understand the Waiting Period and Exclusions in the Policy

Not all life insurance benefits are immediately active when the policy begins. Some benefits, such as protection against death or certain illnesses, usually have a waiting period—generally 1 to 2 years from the policy's effective date.

If a risk occurs during the waiting period, the claim may not be paid in full or may even be rejected. Furthermore, each policy also lists a number of conditions that are specifically not covered. Examples:

Death or hospitalization for an illness during the waiting period

Suicide within the first 12 months of the policy's inception

Death resulting from a criminal act committed by the insured

Death due to extreme activities such as skydiving or other high-risk sports

Death due to overdose, illegal acts, or war

Other exclusions detailed in the policy

3. Ensure Your Policy is Always Active

One reason claims cannot be processed is because the policy is inactive (lapsed). This can happen if premiums are not paid on schedule and past the grace period. If the insured dies while the policy is inactive, the claim will be automatically rejected.

To ensure your coverage remains active, ensure you regularly pay your premiums before the due date. For greater convenience and security, activate the auto-debit feature so you always pay on time without worrying about missing payments.

4. Complete Claim Documents and Submit on Time

To ensure a smooth claim process, ensure you have read the procedures outlined in the policy, prepared all the required documents, and submitted them within the specified deadline. Claims can be delayed or rejected if the documents are incomplete or incorrect. Some common issues include:

Incomplete or invalid death certificate

Incorrectly completed claim form

Proof of identity of the insured or heir is not attached

Other required documents are not included

Claim submitted more than 90 days after diagnosis, death, or medical examination

For convenience, you can use the claim submission feature in VEGA or ask a sales representative for assistance through ORION. The guide is comprehensive, so you can be more confident that all documents are correct.

By understanding the provisions above—from providing honest information when applying, understanding the policy contents, to ensuring premiums are always active—you can ensure the claims process runs smoothly and that your family receives insurance benefits when they need them.