Sample Format for Legal Notice for Insurance Claim

A Legal Notice for Insurance Claim is a formal communication issued by a policyholder to an insurance company to resolve an unsettled or disputed claim, ensuring legal compliance and prompt resolution.

Introduction to Legal Notice for Insurance Claim

A Legal Notice for Insurance Claim is a crucial legal document in India that serves to formally communicate the policyholder’s dissatisfaction with an unresolved or disputed insurance claim. It ensures clarity and compliance with insurance laws, safeguarding the interests of the policyholder and prompting the insurance company to settle the claim.

This document typically includes details such as the claim reference number, policy number, the nature of the claim, and the amount being claimed. It outlines the policyholder’s demand for settlement and sets a timeline for the insurance company to address the issue. Additionally, the notice highlights the potential legal actions that may follow if the claim is not settled within the specified time.

This template is designed to streamline the claims process by providing a structured format for legal compliance. It adheres to Indian insurance laws and can be customized to meet the specific needs of the claim, ensuring a solid legal foundation for resolving the dispute.

Sample Format for Legal Notice for Insurance Claim

Date: [Insert Date]

From:
[Name of Advocate]
Advocate
[Address of Advocate]
Contact: [Phone Number]
Email: [Email Address]

To:
The Manager
[Name of Insurance Company]
[Address of Insurance Company]

Subject: Legal Notice for Settlement of Insurance Claim Under Policy No. ____________

Under instructions and on behalf of my client, Mr./Ms. [Client's Name], son/daughter of Mr./Ms. ____________, residing at ________________________, I hereby serve you with the following legal notice.

1. Client's Background and Policy Details
My client is the holder/nominee under Insurance Policy No. ____________, issued by your company, covering the period from ____________ to ____________. This policy provides coverage for ____________________ (e.g., life, health, motor vehicle, property).

2. Incident Details
On [Insert Date], an unfortunate incident occurred, resulting in ____________________ (e.g., the death of the insured, an accident, theft, health issues, or property damage).

3. Claim Submission and Non-Compliance
Following the incident, my client promptly notified your office on [Insert Date] and submitted a claim on [Insert Date]. The claim was accompanied by all necessary documents, including:

• Copy of the policy document.
• Duly filled claim form.
• Relevant incident reports (e.g., FIR, medical records, death certificate, repair bills).
• Supporting photographs or videos (if applicable).

Despite complying with all terms of the policy and submitting the required documents, your company has not processed or settled the claim. This inaction constitutes a breach of the Insurance Regulatory and Development Authority of India (IRDAI) Protection of Policyholders’ Interests Regulations, 2017, the terms of the policy, and the Consumer Protection Act, 2019.

4. Legal Provisions and Impact
As per the law, insurance claims must be settled within a reasonable time. Your delay or denial amounts to a deficiency in service, causing undue financial and emotional distress to my client.

5. Demand for Resolution
Through this notice, I demand that you:

1. Approve and settle the insurance claim for an amount of Rs. ____________ (Rupees _________________________ only), along with interest at the rate of ___% per annum from the date of claim submission.
2. Pay compensation of Rs. ____________ (Rupees _________________________ only) for mental harassment and inconvenience caused to my client.
3. Reimburse my client’s legal expenses amounting to Rs. ____________.

6. Deadline for Response
You are required to respond to this notice within 15 days of its receipt, either by settling the claim or providing a detailed explanation for the delay/denial.

7. Consequences of Non-Compliance
Failure to comply with this notice will compel my client to initiate legal proceedings against your company. This includes filing a complaint with the Insurance Ombudsman under the Public Grievance Rules, 1998, and/or filing a case with the appropriate Consumer Dispute Redressal Commission under the Consumer Protection Act, 2019. Any costs, liabilities, and consequences arising from such actions shall solely be borne by your company.

This notice is issued without prejudice to my client’s rights and remedies available under the law.

Kindly treat this matter with urgency and respond within the stipulated timeframe.

Yours faithfully,
(Signature)
[Advocate's Name]
Advocate
Bar Council Enrollment No.: ____________