Policy of Insurance
“Policy of insurance” includes-
- any instrument by which one person, in consideration of a premium, engages to indemnify another against loss, damage or liability arising from an unknown or contingent event;
- life-policy, and any policy insuring any person against accident or sickness, and any other personal insurance;
Important laws related to insurance in India
We will have a look at some of the laws and regulations related to insurance that you must be aware of:
- Insurance Act, 1938: These are the basic insurance laws that the insurance companies in India must comply with while conducting their business for insurance and reinsurance. This law also provides provisions related to insurance to the regulatory bodies, insurance associations, and other councils and committees.
- Insurance Regulatory and Development Authority (IRDA) Act, 1999: This law mentions the rights, duties, and the functions of the IRDA under Section 14 of the IRDA Act, 1999 that the IRDA is supposed to carry out. The law clearly states that IRDA is to regulate, promote, and ensure that the insurance business in India grows in a fair and orderly manner. This law also lays down the code of conduct that insurance intermediaries are supposed to follow.
- The Insurance Rules, 1939: This law ensures that the various appointment of committees, licensing of intermediaries and the rules related to the process is followed by the insurance companies while conducting business related to insurance.
- The Redressal of Public Grievances Rules, 1998: This law states that the insurance company will address the grievances of its customers in accordance with the rules and regulations stated under the law. The law clearly states the procedures that the insurance company must follow while addressing its customer’s grievances.
- Amendment of Insurance Act, 2015: There were certain amendments made in the Insurance Act with the aim of boosting the insurance sector in India. One of the aims behind the amendment of the act was to increase the FDI from 26% to 49%.
Hence, these are some of the laws related to life insurance that you must be aware of. Being aware of these laws helps you make better decisions when it comes to purchasing a life insurance policy. You can also visit the official website of the IRDAI in order to get acquainted with the laws related to life insurance in detail and have a better understanding of your rights as a policyholder.
Need for insurance
All assets have some economic value attached to them. There is also a possibility that these assets may get damage/destroy or become non-operational due to risks like breakdowns, fire, floods, earthquake etc. Different assets are expose to different types of risks like a car has a risk of theft or meeting an accident, a house is expose to risk of catching fire, a human is expose to risk of death/accident. Hence insurance is require for the following reasons:
- Insurance acts as an important tool in providing a sense of security to the society on a whole. In case the bread earner of a family dies, the family suffers from direct financial loss as family’s income ceases. Life insurance is one alternate arrangement that offers some respite to the family from financial distress.
- The basic need of insurance arises as risks are uncertain and unpredictable in nature. Getting insurance for an asset does not mean that the asset is protect against risks or its exposure to risk is reduce, but it actually implies that in case the asset suffers any loss in value due to such risk, the insurance company bears the loss and compensates the insured by making payment to him.
- Insurance acts as a useful instrument in promoting savings and investments, particularly within the lower income and middle income families. These savings are use as investments to fuel economic growth.
This law is the name given to practices of law surrounding insurance, including insurance policies and claims. Insurance regulation that governs the business of insurance is typically aimed at assuring the solvency of insurance companies. Thus, this type of regulation governs capitalization, reserve policies, rates and various other “back office” processes.
Make a Claim – Life
Formalities for a death claim
When a person with a life insurance policy
– called a life assure – dies, a claim intimation should be send to the insurance company as early as possible. The assignee or nominee under the policy can do this. So can any close relative or the agent who handles the policy.
The claim intimation should contain information like the date, place and cause of death. The insurance agent has the duty to help the life assured’s family/ assignee to deal with the insurance company to fulfil the formalities for a claim.
- The insurance company will respond to this intimation and will ask for the following documents:
- Filled-up claim form (provided by the insurance company)
- Certificate of death
- Policy document
- Deeds of assignments/ re-assignments if any
- Legal evidence of title, if the policy is not assign or nominate
- Form of discharge executed and witnessed
Other documents such as
medical attendant’s certificate, hospital certificate, employer’s certificate, police inquest report, post mortem report etc could be called for, as applicable.
Formalities for a maturity claim
Where a life insurance policy is maturing, the insurance company will usually send intimation to the policyholder along with a discharge voucher at least two to three months in advance of the date of maturity giving details like the maturity amount payable.
The policyholder has to sign the discharge voucher –
which is like a receipt – have his signature witnessed and send it back to the insurance company along with the original policy bond to enable it to make the payment.
If the policy has been assign in favour of any other person or entity –
like a housing loan company – the claim amount will be pay only to the assignee who will give the discharge.
Make a Claim – Health
Formalities for a health insurance claim
You can make a claim under a Health insurance policy in two ways:
- Cashless basis and
- Reimbursement basis
On a Cashless basis: For a claim on cashless basis, your treatment must be only at a network hospital of the Third Party Administrator (TPA) who is servicing your policy. You have to seek authorisation for availing the treatment on a cashless basis as per procedures laid down and in the prescribed form. Please read the policy document as soon as you receive
it to familiarise yourself with the process rather than wait for a claim to arise.
Claims on reimbursement basis: Read the clause relating to claims in your policy document as soon as you receive it to ensure that you understand the procedure and the documents required for making a claim on reimbursement basis. When a claim arises you should inform the insurance company as per procedures required. After hospitalisation, you have to ensure that you obtain and
keep ready documents such as claim form, discharge summary, prescriptions and bills that you should submit for a claim.
Make a Claim – Motor
Formalities for a motor insurance claim
A claim under a motor insurance policy could be
- For personal injury or property damage related to someone else. This person is call a third party in this context) or
- For damage to your own, insured, vehicle. This is called an own damage claim and you are eligible for this if you are holding what is known as a package or a comprehensive policy.
Third Party Claim
In a third party claim, where your vehicle is involve, it is important to ensure that the accident is report immediately to the police as well as to the insurance company.
On the other hand, if you are a victim, that is, if somebody else’s vehicle was involve, you must obtain the insurance details of that vehicle
and make an intimation to the insurer of that vehicle.
Own Damage Claim
In the event of an own damage claim, that is, where your own vehicle is damage due to an accident, you must immediately inform insurance company and police, wherever required, to enable them
to depute a surveyor to assess the loss.
Do not attempt to move the vehicle from the accident spot without the permission of police and the insurance company.
Once you receive permission for removal of the vehicle and for repairs, you can do so.
If your policy provides for cashless service, which means you do not have to pay out of your pocket for covered damages, the insurance company will pay the workshop directly.
In either of these situations, you must intimate the insurance company immediately.
If your vehicle is stolen, you must inform the police and the insurance company immediately. In addition you must keep the transport department also informed.
As soon as you receive the policy document, read about the procedures and documentation requirements for claims rather than wait for a claim to arise.
If you have to make a claim, ensure that you collect all the required documents and submit them along with the requisite claim form duly filled in, to the insurance company.
There may be certain specific documentation requirements for specific types of claims. For instance in respect of a theft claim, there is a special requirement
that you should surrender the vehicle keys to the insurance company.
Make a Claim – Property
Formalities for making a property insurance claim
There could be several types of policies that cover property and the property itself could be stationery –
like a building, or moving around – like your household goods being transport.
When you receive your policy familiarise yourself with the documents required for a claim as well as the procedures to be follow.
Whether or not a claim arises you must follow the various dos and don’ts in respect of your property for the duration of the policy. These dos and don’ts are termed warranties and conditions in your policy document.
In general, losses and damages, including those due to theft, fire and flood need be intimate to the relevant authorities such as the police, the fire brigade and so on. It is important to ensure that you intimate your insurance company
to enable it to send a surveyor for surveying and assessing the loss.
Make a Claim – Travel
Formalities for making a travel insurance claim
A travel insurance policy is generally a package policy that includes different types of covers
like hospitalisaiton, personal accident, loss/ damage to baggage, loss of passport and so on.
The procedure and documents required for a claim would vary from cover to cover. All of them would be mention in your policy document.
For ease of procedure and your convenience, insurers normally attach the claim form with the policy document. This will contain the list of documents required in case of a claim and also the contact details including phone numbers of the claims administrator either in the destination country to which you are traveling or
in another country that is designate to receive and process your claim intimation.
Since this is a package policy with various covers and procedures it is very important that you familiarise yourself with
the procedures and documentation in case of a claim.