The basic purpose of Life Insurance Policies is to provide Financial Security to the family. But it is a very difficult time for every family when a family member leaves this world forever. In such a difficult time, family members should control their emotions and pay attention to Financial Issues as soon as possible without any delay. Especially when a Life Insurance Policy has been purchased on the life of the deceased member.
Life Insurance Policies become a financial savior for the future of the family in such difficult times. Life Insurance Corporation of India (LIC) strives to provide financial assistance to the families of its Policyholders through the Death Claim Process.
Completing LIC Form No. 3784 is an important step in the LIC Death Claim Process. It is important to fill this form correctly so that the claim process can be completed quickly and the Death Claim can be paid easily. In today's article of Jeevan Bima Bazaar, we will get all the information about LIC Death Claim Form No. 3784 in great detail.
What is Death Claim Form No. 3784
LIC Death Claim Form No. 3784 is an important document for the Death Claim Process. This form is used to certify the claim after the death of the policyholder. This form is filled by the doctor or medical attendant who last treated the policyholder or declared him dead. This is why LIC Death Claim Form No. 3784 is also called "Medical Attendant Certificate".
Importance of Death Claim Form No. 3784
LIC's Death Claim Form No. 3784 is an important document and plays a vital role in understanding the actual cause of death. Through this form, the corporation gets help in understanding the cause of death of the deceased policyholder, the duration of the illness, habits like addiction etc. and many other important things.
With the help of the information given in this form, LIC tries to understand:
- Whether the policy was purchased within the period of illness or not.
- Whether the revival of the policy has taken place within the period of illness.
- Whether any fraud is being committed for the purpose of obtaining the claim of the life insurance policy.
- Whether the deceased policyholder was a victim of drug addiction and the cause of death was his habit.
- etc.
Who will Fill the LIC Form No. 3784
LIC Form No. 3784 should be filled by the doctor or medical attendant who was treating the policyholder just before his death or the doctor who declared the policyholder dead.
In many cases, the policyholder may have been ill for some time or for a long time and he consulted a doctor for the treatment of his illness. If the deceased policyholder was in this condition, then this form should be filled by the doctor who had treated him the last time.
In many cases, it may also happen that the policyholder dies suddenly and when the family members contact the doctor, the doctor declares him dead. In such a case, this form should be filled by the doctor or medical attendant who has declared the policyholder dead.
PDF file of LIC Death Claim Form 3784
When the Nominee or Claimant submits the information of death to the Home Branch of LIC after the death of the policyholder, then with this submission, the corporation registers the Death Claim and gives the necessary form through the Indian Postal Department or other official means. This form of LIC is also with all other forms. But keeping in mind your convenience, we are sharing with you the official PDF file of LIC Death Claim Form No. 3784. You can download it by clicking on the button given below and use it.
Get Branch Office Details
While filling this form of LIC, you have to enter the name and branch code of the home branch or service branch of LIC. Home branch is called that branch office of LIC from where the Life Insurance Policy was issued. But in some cases it may happen that the policyholder has got his Life Insurance Policy transferred to another branch office during his lifetime. In such a situation, the new branch office where the policy reaches after transfer is called the Service Branch.
The Name, Address and Code Number of the LIC Branch Office is recorded on the original Policy Bond and Premium Receipt of the Life Insurance Policy. But despite this, keeping your convenience in mind, a link button is being shared with you below. You can get complete information about any branch office of LIC by clicking on this link.
How to Fill LIC Form Number 3784
Here you have to understand that the form number of this form is 3784 and the claim form is written B. Let us now understand in detail how to fill this LIC form.
As soon as you open this form, first there is the head section of the form. In the head section, the Branch Office is written first and right after this, in the blank space, you have to write the name of the branch and the code number of the branch.
Now after the above, the Policy Number and the Name of the Deceased Policyholder have to be written in the head section of the form itself. For this, our suggestion would be to write the Name and Policy Number recorded in the Policy Bond.
Now after this, different questions are asked in the form. So here we are sharing with you each question and their possible answers and suggestions one by one.
Question 1: What was the full name, address and occupation of the deceased?
Answer: Since this form is filled by a doctor, LIC wants to know from the doctor what was the full name, address and occupation of the deceased according to him. The purpose of this question is to ascertain whether the person for whom the death claim has been submitted and the person who died are the same person or not.
The doctor should check the hospital documents and cross-check the details of the deceased before answering this question. In many cases, there may be a difference in the name etc. due to negligence or some mistakes. My only suggestion for such cases is that it is best to enter the name etc. as per the documents of the deceased policyholder, provided there is no possibility of fraud in any way.
Question 2(a): His apparent age at the time of death, as could be judged
Answer: Since this question can be answered on the basis of estimation, yet we would suggest that this answer is also best written on the basis of the date of birth recorded in the policy bond.
Question 2(b): Was he related to you and if yes, how?
Answer: If the doctor or medical attendant who is filling this form is a friend, relative or family member of the Deceased Policyholder, then the relation has to be mentioned here, otherwise the answer to this question can be written as "No".
I think through this question LIC wants to understand how much the information given in the form can be trusted. Often some people may give wrong or incomplete information for the benefit of close ones.
Question 2(c): Description of any marks or physical peculiarities noticed by you for purposes of
Answer: In the answer to this question you have to write information about the physical features and birth marks of the Deceased Policyholder.
Question 3(a): Time of death
Answer: The doctor should give the exact time of death of the deceased policyholder keeping in mind the hospital documents. It would be better to write the answer for this time keeping in mind the post mortem report (if any).
Question 3(b): Date of death
Answer: It would be appropriate to answer this question also on the basis of hospital documents. If post mortem has been done then it would be appropriate to investigate it.
Question 3(c): Place of Death (Give exact address)
Answer: The answer to this question may be different in different death cases. In such a case, if the policyholder died in the hospital then the doctor should submit the details of his hospital. But if the policyholder had died before reaching the hospital then in such a situation he should write in the answer to this question that the death had occurred before reaching the hospital.
Question 04(a). What was the exact cause of death? (Besides defining the disease or other cause of death in such terms as you consider appropriate kindly add the distinctive technical name)
Answer: Here the doctor has to state the actual cause of death mentioning medical reasons. If the policyholder died due to any disease then the doctor should give the name of the disease and technical details. But if the policyholder died due to accidental reasons then the doctor should mention all the causes accurately. The doctor should take care that the details given by him are in accordance with the official medical documentation.
Example: Generally death due to heart related problems is known as heart attack but in the answer to this question the cause of death will be "heart failure" and its technical name will be "acute myocardial infarction".
Question 04(b). Was it ascertained by examination after death or inferred from symptoms and appearance during life?
Answer: The answer may vary from death claim to death. In some cases post mortem may be done after death, while in many cases when the policyholder died due to some common disease or other common causes then post mortem is not required. So if the cause of death is revealed by the post mortem report then state it clearly. But if the cause of death is revealed by the symptoms of the disease then state it.
Question 04(c). How long had he been suffering from This disease before his death?
Answer: Through this question, LIC wants to know in detail about the disease and the duration of the disease of the deceased policyholder. To write the answer to this question, we would advise you to check the medical documents once. If you have the exact data available, then the date of first diagnosis of the disease and the date of last treatment should be noted. If the treatment of the disease was going on for a long period and the exact data is not available, then note the approximate period (for example: heart disease was treated 6 months ago).
Question 04(d). What were the symptoms of the illness?
Answer: While answering this question, the doctor should mention all the symptoms that the deceased policyholder had during the illness and it is better to use medical terminology in its explanation.
Example: Severe chest pain, difficulty in breathing, excessive fatigue and sweating, irregularity in blood pressure
Question 04(e). When were they first observed by the deceased?
Answer: Since in most of the cases the doctor does not know the patient personally, in such cases the doctor meets a patient only during his treatment. Hence we would suggest you to note the recorded date of commencement of treatment (which is available in the records) here. If the date is not clear, then an approximate time can also be written.
But in such cases, when the doctor knows the deceased policyholder personally or was the family doctor of the deceased policyholder, then you should specify precisely when you knew the deceased policyholder.
Question 04(f). What was the date on which you were first consulted during the illness?
Answer: The doctor should clearly write the date when the treatment of the deceased policyholder was started.
Question 04(g). Did you attend him during the whole of its course? If not, state during what period.
Answer: If you treated the deceased policyholder from the time symptoms of the disease started till the last breath, then you should answer this question as "Yes". But if not, then you should state for how long you treated him.
Question 05(a). Were his habits sober and temperate?
Answer: Through this question, LIC actually wants to know from the doctor whether the deceased policyholder was a narcotic or had some habits that were harmful to his health or caused his death.
So before writing the answer to this question, our advice to you would be that you should write the answer to this question in an unbiased manner. The answer to this question will determine whether the death is claimable or not. If according to your knowledge, the deceased policyholder was a narcotic or had some such habit that caused his death, then the answer to this question should be "no". Otherwise, the answer to this question should be "yes".
Question 05(b). Have you any reason to suppose or to suspect that disease was in his case caused or aggravated by intemperate habits?
Answer: If you are answering "NO" to Q. 05(a) above, you should furnish the relevant details. But if you are answering "YES" to Q. 05(a) above, you should write "NO" in answer to this question.
Question 06. What other diseases or illness (i) preceded (ii) or co-existed with that which immediately caused his death?
Answer: Here LIC wants to know what health problems the deceased policyholder had before death or what diseases he was suffering from. So if you, as a doctor, have treated the patient, then provide details of it.
It is also possible that in some cases the policyholder may have died before reaching the hospital. In such a case, if you do not have specific information in this regard, then you should write in the answer to this question - "No information in this regard"
Question 06. Give history of such disease or illness stating:
- Date when first observed?
- By whom treated?
- By whom history reported to you?
Answer: Question number 6 is in two parts. In this second part, LIC wants to know that if the deceased policyholder had any health related problem or disease, then when did that problem or disease come to your notice. After this you have to tell what was the name of the treating doctor, so here you have to write your name. After this you have to tell who informed about the disease, so if the patient (deceased policyholder) himself told the problem then write his name otherwise write the name of the person from whom you got the information about the disease.
Question 07(a). Was the deceased treated during his last illness by any other medical practitioner/s or in any Hospital before you were consulted? If so, please state their names and Addresses
Answer: In many cases it has been seen that the patient is being treated in a hospital. But when he does not get better or his health condition worsens, then that hospital refers the patient to another hospital. Later that patient dies there.
There can be different possibilities in different cases. But I want to focus your attention on the main topic. Now you can be any doctor in the above possibility. So if the patient was transferred from your hospital to some other hospital, then you have to write the full name and address of that next hospital.
But if the patient was transferred to you, then you have to write the full name and address of the previous hospital. If this is not the case, then "no" can be written in the answer to this question.
Question 07(b). Did any other Medical Practitioner/s attend on him in consultation with yourself. If so, please state their names and addresses
Answer: In some cases it is possible that during the treatment of the patient, you as a doctor may have consulted another doctor or other doctors may have been associated with you in the medical process. If this is the case then the names and addresses of the other doctors concerned will have to be written. If this is not the case then the answer to this question can be written as "No".
Question 08(a). Were you deceased’s usual Medical Attendant?
Answer: Through this question LIC wants to know from you (doctor) whether you were treating the Deceased Policyholder for a long time. If yes, then you should answer this question in "Yes" and if not, then you should answer this question in "No".
Question 08(b). If so, for how long?
Answer: If you have answered "Yes" to Question No. 08(a), you must mention for how long you were treating the Deceased Policyholder. You should check the patient's documents while writing this answer.
But if you have answered "No" to Question No. 08(a), you should write "Not Applicable" in answer to this question.
Question 08(c). If not, please state name and address of his usual Medical Attendant
Answer: If the answer to Question 08(a) is "No", then you have to tell which doctor was treating the Deceased Policyholder earlier. In such a case, it is possible that you know about him and it is also possible that you do not know about it.
If you know about the regular doctor of the Deceased Policyholder, then write his full name and address. But if you do not know about him, then you can give this information by asking the nominee of the policy or you can also write that "I do not know about the regular doctor of the Deceased Policyholder."
If you write the information by asking the nominee, then write the information in the form as follows - "Name and address of the regular doctor as per nominee ___"
Question 09. When and for what ailments did you treat the deceased during the three years preceding his last illness?
Answer: There can be two possibilities here in different cases. The first possibility can be that you have never treated the deceased policyholder before and he has never contacted you before. If this is the case, then it would be appropriate for you to write "I have never treated anyone before" in the answer to this question.
But if you have treated the deceased policyholder in the last three years, then it becomes necessary for you to give information about this. In such a situation, you should mention the name of the disease, date of treatment and method of treatment in the answer to this question.
Example: Insulin and related medicines were given on 20 January 2022 to treat diabetes, antihypertensive medicines were given to control high blood pressure on 15 March 2023.
Question 10. Was any Inquest or formal Inquiry held regarding the death or was a Post Mortem Examination of the body made? If so by whom, and what was the result or finding?
Answer: If a formal examination or postmortem of the deceased policyholder has been done, then write in detail by which institution or person and what was the result. If there was no postmortem, then answer this question as "NO".
Question 11. Have you any other information to give or remarks to make in connection with this claim concerning deceased's ailments, habits, mode of living etc.?
Answer: There can be two possibilities here. The first possibility is that you knew the deceased policyholder very well and the second possibility is that you did not know him. Hence the answer for these two possibilities will be different.
If you knew the deceased policyholder well then your answer can be something like this: "The deceased policyholder lived a modest and simple lifestyle, he did not consume any kind of intoxicants. He was generally in good health but suffered from problems like diabetes and hypertension and to the best of my knowledge he was getting regular treatment for the same from Dr. X of so and so hospital."
If you did not know the deceased policyholder well then your answer can be something like this: "We have very limited information about the lifestyle of the deceased. To the best of my knowledge he probably used to smoke cigarettes. However, there is no evidence of any specific intoxicant habit during the last illness."
Please Note: I have written all the answers to the above questions at my own discretion and this is for the purpose of understanding the form as a trainer. While this form should be written by a doctor using medical terms.
We also want to make it clear here that this form is very important and completely affects the death claim. So it is very important to be fair and give accurate information while filling this form. This information should be taken as an understanding only. We will not be responsible in any way and for any consequences. So use your discretion while filling or getting the form filled.
Precautions to take while filling Form 3784
The following precautions must be taken while filling LIC Death Claim Form No. 3784.
- This form must be filled by the doctor or medical attendant who last treated the policyholder before death or declared him dead.
- All the questions asked in the form must be answered with complete fairness, accuracy and clarity.
- While filling the form, one should use a good pen with blue or black ink and the form should not be filled with different pens.
- While answering all the questions in the form, one must check the relevant documents. While writing all the information, it is advisable to take the help of important documents like Patient Documents, Post-Mortem Report, Death Certificate issued by the hospital.
- After filling the form, it is necessary to give signature, seal and other relevant information at the appropriate place.
Sample File of Death Claim Form No. 3784
Through this article, our effort has been to give you complete information about filling the form. But if you are an LIC agent, then you may get confused due to many reasons in the Death Claim Process. Therefore, we have prepared a sample file of this form with dummy data.
You can download this sample file of LIC Death Claim Form No. 3784 by clicking on the link button below and use it to get help in filling the official form.
Start Your Business by Becoming A Life Insurance Agent
We understand very well that when the head of the family dies, the family has to face many financial problems. Because, the problem of employment is a big challenge. In such a situation, a Life Insurance Agency can be a better option for you to start employment.
If you want to start a Life Insurance Agency Business, then you have to contact the officer of the Life Insurance Company who has the right to appoint an agent. Therefore, keeping your convenience in mind, we are sharing a Link Button with you. With the help of this, you can start the process of taking a Life Insurance Agency by contacting the officer of your own area.
Information about Filling LIC Form 3784 in video
However, in this article, we have given complete information about filling LIC Death Claim Form No. 3784 in detail and have also shared a sample PDF file. I am confident that my effort will prove beneficial for you.
Since this form plays a very important role in the Death Claim Process. A small mistake can complicate your claim and can also get it rejected. Therefore, to understand the form better, we have prepared a video. I suggest you watch this entire video carefully once before filling the form.
Conclusion
LIC Death Claim Form No. 3784 is a very important form and plays an important role in the decision of the Death Claim. Through this article, we have tried to provide all the information related to Form No. 3784. An attempt has been made to explain in detail the way to answer each question, the responsibility of the doctor or medical attendant and the importance of this form in the Claim Process.
I hope our effort will prove helpful to you. But still it is possible that you may have some questions in your mind. If yes, please write your questions in the comment box of the above video or in the comment box of this article.
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