Life insurance claim rejected for non-disclosure

Section 45 of the Insurance Act 1938 says no life policy can be called in question on any ground after three years from the date of the policy, counted from issue, start of risk, revival or the rider, whichever is later. After those three years a death claim cannot be refused for non-disclosure or misstatement. Proof of age can still be asked for at any time.

Within three years the insurer can repudiate for fraud, or for a misstatement or suppression of a material fact in the proposal, and must give the insured or the nominee its grounds and materials in writing. A fact is material only if it has a direct bearing on the risk, and the insurer has to show it would not have issued the policy had it known. Silence alone is not fraud unless there was a duty to speak. A fraud repudiation also fails if the statement was true to the best of the insured's knowledge, or there was no deliberate intention to suppress.

When the insurer repudiates for misstatement and not fraud, it has to refund the premiums collected within 90 days of the repudiation. A death claim is otherwise settled within 15 days of intimation, or 45 days where investigation is warranted.

To challenge it, complain to the insurer in writing. It has 14 days to resolve the complaint. If it rejects it, gives an answer you are unhappy with or stays silent for a month, the Insurance Ombudsman takes the complaint free of charge within one year, for awards up to ₹50 lakh, when the policy is personal or held by a sole proprietor or micro enterprise. The checker works out those dates for your claim.