Consumer can claim relief if insurer flouts IRDA rules
Whether it is an application for bank loan or voter ID card, visa or insurance policy, responding to these queries can be tedious and exasperating.delhi Updated: Mar 10, 2012 23:57 IST
Whether it is an application for bank loan or voter ID card, visa or insurance policy, responding to these queries can be tedious and exasperating. But don't let it prompt you sign a blank form as any incorrect information mentioned in the document can land you in trouble. In case of insurance applications, it can jeopardise your claim.
In fact as far as life and health insurance policies are concerned, inaccuracies and non-disclosure of crucial information, pertaining to your health, can result in repudiation of the claim. So, fill the forms carefully and always keep a photocopy of the document that you have submitted.
The Insurance Regulatory and Development Authority (IRDA) rule on Protection of Policy Holders' Interests casts a duty on the insurer to furnish to the insured free of charge a copy of the proposal form within 30 days of the acceptance of the proposal. So, ensure that the insurer sends the copy without fail. Compare it with your copy, ensure that it has not been tampered with and keep it with your policy document.
Rajesh Gupta: In August 2009, my wife, a high-ranking professional, was diagnosed with breast cancer. She underwent a surgery and recovered. In March 2010, an agent of a private insurance company approached her for an insurance policy, under which if she paid an annual premium of Rs1.25 lakh for five years, she would receive Rs4,000 for 15 years after five years. It would also give her a life cover for Rs6 lakh. My wife told the agent about her medical history and even offered to go through the health check-ups required. The agent, however, said it was not necessary. She paid Rs1.25 lakh in 2010 and again in March 2011. In November 2011, she was diagnosed with cancer again and died next month. Now, the company is showing a proposal form filled by someone else where the questions about medical history has been ticked in the negative and refusing to pay the insurance amount. How do I get the claim amount?
Answer: It seems like the agent has deliberately concealed information about your wife's health status just to sell the policy and earn his commission. He could have got your wife's signature on a blank form and filled it to suit his purpose, but it is difficult for you to prove it. You should still lodge a complaint with the insurer and the IRDA (www.irda.gov.in) against the agent as it is a serious offence. If there are other complaints against this agent, then your case will be strengthened and the insurer has to owe the responsibility for his agent’s action.