Non disclosures which result in claim rejections
Welcome back to the insurance mis-selling series that we started a week ago. We at Insurance Samadhan constantly speak about insurance-related problems that people deal with. We feel it is our responsibility to educate our readers so that they stay away from mis happenings because we keep getting over 500 calls per day where aggrieved customers share their stories.
The insurance industry is on the rise and it is obvious that people involved in the industry will try to sell more and more, which will surely lead to aggressive selling. In turn, many cases of insurance mis-selling will be reported. So that is why we have started this series, so the damage is minimal because we aim to make you aware of all the things that can happen.
Insurance is a subject matter of solicitation and it is the duty of intermediaries to share all facts about terms and conditions of Insurance Policy , be it life , health or general insurance. It is the responsibility of intermediaries to educate customers on true disclosures so that all promises are fulfilled. Role of intermediary is very important and good agents survive when they do ethical selling. All responsible advisors not only share all facts but also assist customers when the insured event happens and customers need hand holding.
Given below are some general scenarios which should be known to customers in terms of claims settlement:
Claim in life insurance: As per section 45 of Insurance Act, all insurance companies are supposed to investigate all claims which happen within 36 months of policy commencement. They investigate if a claim has come due to non disclosures and onus to prove it on the nominee. Such claims are called early claims and claims are denied on non disclosures of material facts listed below:
- Health
- Habits
- Income
- Previous policies
- Occupation
- Age
Hence, all policyholders should read Policy documents during freelook and share their disagreement with Insurance Company.
Claim in life Insurance: Nomination, it is important to nominate a blood relative and mention the word “Beneficiary Nominee” for undisputed claim settlement.
These scenarios happen quite frequently with many customers. Although, with a little awareness as a buyer, you can prevent these situations.
Claim in Health Insurance: Like Life Insurance, claims in Health Insurance are denied or short settled due to misinterpretations of Policy documents. Most customers do not read the terms, exclusions and blame when they face a problem. Hence it is the duty of intermediaries to educate customers on Health Insurance. Given below are few reasons due to which claim is rejected:
- Non disclosure of pre existing diseases
- Treatment in non standard hospitals
- Treatment not as per terms and conditions
- Treatment no required
- No following standard procedures
What if You Were Mis-sold
There are high chances that you will end up buying an insurance policy you did not want. In that case, every insurance company gives a 15-30 day free-look period, where you can cancel your policy. It is only for the purpose in case you buy the wrong policy or are having second thoughts. There is no denying that the insurance companies have done a great job by adding this feature.
However, if you pass that time and still feel like you were mis-sold, you can always contact Insurance Samadhan. We will be happy to assist you as we have a team of experts who will help you in getting your hard-earned money back.
Bottom Line
Remember, you have the right to say “no” if an insurance policy doesn’t feel right. Being informed and cautious can protect your money. If you ever feel you were misled, our experts are here to assist you. Your financial well-being is our priority.
We will come up with another major situation of insurance mis-selling next week. Till then, stay vigilant, stay safe!
Click here to register your complaint with Insurance Samadhan
You can also
Visit our website: insurancesamadhan.com
Call us on +91 9513631312
WhatsApp: 9910998252
Mail us at corporate@insurancesamadhan.com
