If the insurer does not resolve your issue, you should approach Irdai’s grievance cell

Published in Mint on 31st July 2017. Written by Abhishek Bondia

I have been mis-sold a money-back plan by a private insurance company’s relationship manager. They lied about the sum assured and maturity value as well as the periodic money back. They had given a benefit illustration at the time of purchasing the plan, which was made in a spreadsheet to convince me about the returns. I have that in my possession. When I got the documents, there was a mismatch. I visited their office for cancellation but they convinced me that I will get the corrected papers. They deliberately delayed it so that the free-look period would pass. After that, they stopped receiving my calls. I complained through their grievance redressal system but they are saying they cannot do anything as my free-look period is over. The relationship manager told me over the phone that I will receive the rectified bond and told me to go for renewal. I have a recording of this call. Can I file a case of cheating and fraud through the consumer court? What are the odds that I will get my money back?

—Shashi Bhushan M N
The insurance regulator has established forums by virtue of which consumers can lodge their complaint.
First, if you had made a written request for cancellation of the policy within the free-look period, then the insurer cannot deny this right to you. Second, if they had provided any assurance to you in writing or verbal, which is supported by evidence, then your stand can still be vindicated.
Do escalate this matter with the insurer. If the insurer’s grievance cell does not resolve your issue, you should approach the Insurance Regulatory and Development Authority (Irdai) grievance cell. Here, in your complaint, you should forward the correspondence to the insurer as well. If the matter is still unresolved, you should approach the insurance ombudsman. The ombudsman considers the consumer’s point of view seriously, and you can expect a favorable outcome.

Can I have two life insurance policies from two different insurance companies? And, can claims be made and settled from both companies or from one company only? Let’s say I have life insurance from one, with a risk cover of Rs10 lakh and I want to buy a term life insurance plan with a risk cover of Rs1 crore from a different company. Then, can the beneficiaries claim from both companies? Can you refer me to any rules or government notifications in this regard?

—Rajkamal Singh
Life insurance policies are fixed benefits and not indemnity policies. Under a fixed benefit policy, the obligation of the insurer is to pay a pre-fixed amount on the happening of the insured event. The underlying loss of the insured does not determine the claim amount. So, if you have two life insurance policies, you will be able to make a claim under both. Under indemnity insurance such as Mediclaim insurance, the insurer will only reimburse the loss incurred by the insured. The principle of indemnity does not allow profit-making from an insured loss. So, if an insured has two policies, both policies contribute to the loss. To ensure this, a contribution clause’ is added to most indemnity policies. This allows insurers to share the loss in the same proportion.