How do life insurance claims work in Zambia?

The main kinds of life claim

Life policies pay out on different events depending on the product.

• Death claims: the life assured has died and the beneficiary claims the sum assured.
• Funeral claims: a death under a funeral policy, usually for a fixed benefit paid quickly.
• Disability claims: the life assured is permanently or temporarily disabled and the policy includes a disability benefit.
• Maturity claims: an endowment or similar policy reaches the end of its term and the policyholder claims the maturity benefit.
• Critical illness claims: where a rider covers named illnesses.

Documents insurers typically request

Requirements differ by insurer and claim type, but a death claim commonly needs the following. Check with the insurer for its own list.

• A completed claim form, signed by the claimant.
• The original or certified death certificate.
• The policy document or policy number.
• Identification of the beneficiary, such as an NRC or passport.
• Proof of relationship to the deceased where the beneficiary is not named by NRC in the policy.
• A medical report or cause-of-death report for some claims.
• A police report where death was accidental.
• Bank or Mobile Money details for payment.

Step by step: from notification to payment

The process has five stages.

• Notify: the beneficiary, family or agent tells the insurer that a claim event has happened, by phone, in a branch, through an agent, or through a portal, app or USSD service.
• Register: the insurer opens a claim record against the policy and issues a claim reference.
• Document: the claimant submits the required documents. Missing documents are the most common cause of delay.
• Assess: the insurer confirms the policy was in force and premiums were paid, that the event is covered and not excluded, that any waiting period has passed, and that the documents are genuine. Larger or unusual claims may be investigated.
• Settle: the claim is approved and paid to the beneficiary, or declined with reasons.

Why claims get delayed or declined

Most delays come from incomplete documents or from difficulty confirming who the rightful beneficiary is. Declines usually arise from a policy that had lapsed for non-payment, a death within a waiting period, an exclusion such as suicide within an initial period, or material non-disclosure at application, for example an undisclosed illness. Policyholders can reduce this risk by keeping premiums current, answering application questions fully, keeping beneficiary details up to date, and telling beneficiaries where the policy document is.

Timelines

Funeral claims are designed to be paid within days of complete documents being received, because the whole point of the product is fast cash for a funeral. Death claims on larger policies take longer, particularly where medical or police reports are needed. Insurers publish their own service standards; ask for them at claim time rather than relying on general figures.

Complaints and escalation

If a claimant disagrees with a decision, the first step is a written complaint to the insurer. The Insurance Act No. 38 of 2021 provides for policyholder protection and complaints handling, and the Pensions and Insurance Authority can be approached if the insurer does not resolve the matter. Keep copies of everything submitted and note the dates of each contact.

How Ontech LifeI ERP handles this

Ontech LifeI ERP's claims management module registers each claim against the policy, records documents uploaded from a branch, the client portal or the mobile app, routes approvals by amount, and sends SMS or WhatsApp updates to the claimant at each stage.