1. What are the documents you need to make a valid claim of insurance ?

In case of
health insurance what are the documents the insurer verify? What are the
procedures to place a claim if your documents are lost?

Documents you need to make a valid claim of insurance

 Life insurance
To buy a life insurance policy, the following documents would be required-
Life insurance proposal form, dully filled and signed by the proposer and/or the life insured
Photograph of the proposer 
Photograph of the life insured (if different from the proposer)
Age proof of the proposer and/or the life insured 
Identity proof of the proposer and/or the life insured
Address proof of the proposer
Medical examination report of the life insured if required by the policy because of the age
and/or the sum assured chosen 
Income proof of the proposer if the sum assured and/or the premium of the policy is high
PAN card of the proposer
 Health insurance
For a health insurance plan, the following set of documents would be needed to be
submitted –
Health insurance proposal form, duly filled and signed by the proposer
Identity proof of the proposer and the insured members
Age proof of the insured members
Address proof of the proposer and insured members
Medical examination report if pre-entrance medical check-ups are specified by the
insurance company due to the age and/or the sum insured chosen 
Income proof of the proposer for very high sum insured levels
 Motor insurance
To buy a car or a bike insurance plan, the following insurance documents would be required
–
Proposal form for car or bike insurance, duly filled and signed by the vehicle owner
Invoice of the vehicle if a new insurance policy is being bought
RC book of the vehicle
Identity proof of the proposer
Address proof of the proposer

Documents the insurer verify in case of health insurance:-

Age proof – This is an important document while buying health insurance as many policies
have a fixed entry age. You can submit a copy of any of the following documents:
Voter ID Card
Pan Card
Aadhaar Card
Driving License
Passport
Birth certificate
Identity proof – This document is required for the purpose of records. In the future, your ID
proof will help your insurer identify the type of coverage offered to you. You can submit any
of the following:
Voter ID Card
Passport
Aadhaar Card
Driving License
Address Proof – Your health insurance company will need to send various communications
on your postal address. You can submit any of the following:
Ration card
Driving license
Passport
Rent agreement if applicable
PAN Card
Aadhaar Card
Utility bills like electricity bill, telephone bill, etc.
Passport-size photographs (if demanded by the insurer)
Medical reports (if demanded by the insurer)
Proposal form duly filled in and signed.

Procedures to place a claim if your documents are lost

Make the call at the toll free number of your insurer to make know about the event. For
making claims, the early you go, the better.
Also, there stands a provision for the interest of larger consumer base that companies
cannot decline the claim made on grounds of delay in intimation in case of genuine
claim.Also, there stands a provision for the interest of larger consumer base that companies
cannot decline the claim made on grounds of delay in intimation in case of genuine
claim.The documents needed while making life insurance claim include death certificate,
KYC of the nominee, bank details, policy bond, FIR in case of un-natural death or medical
papers in case of natural death together with claimant form A.
 For life insurance claim, the intimation has to be made at the earliest possible while for
critical illness situation or dreaded disease, the claim has to be made after the survival
period.

In case of loss of documents, filing of the claim is rendered easy in case of auto insurance,
as insured just by giving basic details including vehicle registration number and PAN will be
able to fetch the policy details with the help of the insurer and get his claim processed.

Also, in case there are no documents available physically to support or back the claim,
insurers in such difficult times will take good the online details stored in various digital
repositories.

2. What are the circumstances under which you can complain to

ombudsman? What are the types of complain that Ombudsman entertain
or resolve?

Circumstances under which you can complain to ombudsman

Customers facing any of these problems with their banks can first take it up with the bank's
grievance redressal process, and if not satisfied he/she can lodge a complaint with the
banking ombudsman.To enlarge the scope for customer complaints, the Reserve Bank of
India keeps revising the Banking Ombudsman Scheme from time to time. Under the Banking
Ombudsman Scheme, bank customers can raise their problems for resolution of complaints
relating to certain services rendered by banks. Appointed by the Reserve Bank of India, the
Banking Ombudsman is a senior official to redress customer complaints against deficiency in
certain banking services.
Here are the grounds under which you can raise a complaint with the banking ombudsman;
Inordinate delay in the payment, or non-payment, delay in collection of cheques, drafts, bills
etc.
Bank not accepting, small denomination notes, and/or coins without any sufficient cause,
and charging commission in respect thereof.
Non-payment or delay in payment of inward remittances or non-payment of the same can
also be raised with the banking ombudsman.
Delay in issue of drafts, pay orders or bankers’ cheques, and/or failure to issue such drafts
and cheques.
Non-adherence to prescribed working hours can also be raised with the banking
ombudsman.
Cases where the bank has failed or delayed in providing banking facilities, other than loans,
promised by the bank in writing or by a direct agent.
Non-payment of deposit, delays in non-credit of proceeds to parties’ accounts, or
nonobservance of the Reserve Bank directives, if any, applicable to rate of interest on
deposits in any account maintained with the bank, can also be raised with the banking
ombudsman.
Non-Resident Indians having accounts in India, complaints can be raised by them in relation
to their remittances from abroad, deposits and any other bank-related matter.
If the bank refuses to open deposit accounts without any valid reason for their refusal, can
also be taken up to the banking ombudsman.
The bank levying charges without adequate prior notice to the customer.
Customers can take cases up to the banking ombudsman in case of non-adherence to the
instructions of the Reserve Bank on ATM or debit card, prepaid card, and credit cards.

Types of complain that Ombudsman entertain or resolve

Types of complaints:-
You can approach the RBI Banking Ombudsman to register a complaint under the following
categories:

Non-payment or inordinate delay in the payment or collection of cheques, drafts, bills etc.
Non-acceptance, without sufficient cause, of small denomination notes tendered for any
purpose, and for charging of commission in respect thereof.
Non-acceptance, without sufficient cause, of coins tendered and for charging of commission
in respect thereof.
Non-payment or delay in payment of inward remittances.
Failure to issue or delay in issue of drafts, pay orders or bankers’ cheques.
Non-adherence to prescribed working hours.
Failure to provide or delay in providing a banking facility (other than loans and advances)
promised in writing by a bank or its direct selling agents.
Delays, non-credit of proceeds to parties’ accounts, non-payment of deposits or non-
observance of the Reserve Bank directives, if any, applicable to rate of interest on deposits
in any savings, current or other accounts maintained with a bank.
Complaints from Non-Resident Indians having accounts in India in relation to their
remittances from abroad, deposits and other bank-related matters.
Refusal to open deposit accounts without any valid reason for refusal.
Levying of charges without adequate prior notice to the customer.
Non-adherence by the bank or its subsidiaries to the instructions of Reserve Bank on
ATM/Debit Card operations or Credit Card operations.
Non-disbursement or delay in disbursement of pension (to the extent the grievance can be
attributed to the action on the part of the bank concerned, but not with regard to its
employees).
Refusal to accept or delay in accepting payment towards taxes, as required by Reserve
Bank/Government.
Refusal to issue or delay in issuing, or failure to service or delay in servicing or redemption
of Government securities.
Forced closure of deposit accounts without due notice or without sufficient reason.
Refusal to close or delay in closing the accounts.
Non-adherence to the fair practices code as adopted by the bank or non-adherence to the
provisions of the Code of Banks Commitments to Customers issued by Banking Codes and
Standards Board of India and as adopted by the bank.
Non-observance of Reserve Bank guidelines on the engagement of recovery agents by
banks.
Any other matter relating to the violation of the directives issued by the Reserve Bank in
relation to banking or other services.
A customer can also lodge a complaint on the following grounds of deficiency in service with
respect to loans and advances.
Non-observance of Reserve Bank Directives on interest rates.
Delays in sanction, disbursement or non-observance of prescribed time schedule for
disposal of loan applications.
Non-acceptance of application for loans without furnishing valid reasons to the applicant.
Non-adherence to the provisions of the fair practices code for lenders as adopted by the
bank or Code of Bank’s Commitment to Customers, as the case may be.
Non-observance of any other direction or instruction of the Reserve Bank as may be
specified by the Reserve Bank for this purpose from time to time.
The Banking Ombudsman may also deal with such other matter as may be specified by the
Reserve Bank from time to time.