Online policies: Guard against insurance fraud
In order to curb malpractices, the Insurance Regulatory and Development Authority (IRDA) has formulated specific guidelines for the industry

WHO can resist buying an insurance policy, if it comes gift-wrapped with a large, twin-door refrigerator, health insurance for the entire family and a 50 per cent discount on the second year premium? That’s how Vinay Sareen bought a life insurance policy and paid the annual premium of Rs 20,000. However, he soon realised that he had been a victim of a telemarketing fraud played to perfection by the person marketing the policy. Sareen had been told that he would first get the policy document and then, after a month, a second document giving him the promised incentives. The second document never came and worse, the insurance company refused to take any responsibility for the promises made by its agent!

Instances such as these are not rare these days and in most such cases , the victims are senior citizens. So in order to curb such malpractices and protect consumers, the Insurance Regulatory and Development Authority (IRDA) has formulated specific guidelines for the industry. Called the IRDA Guidelines on Distance Marketing of Insurance Products, the guidelines apply to every activity of solicitation and sale of insurance products through the internet, e-mail, snail mail, newspaper inserts, SMS and the telephone.

In most of these cases, since the promises made over the telephone are verbal, the agents find it convenient to say later that they never made the promise. And the insurance companies in turn claim that they are not responsible for any promises made by the agent without their concurrence. So the guidelines mandate that first of all, every insurer has to prepare a standardized script for the purpose of marketing, incorporating all key features of the product, including the benefits, features and disclosures. This has to be filed with the regulator and all solicitations and sale activities should strictly be in line with this script and cannot deviate from it.

Similarly, every conversation over telephone with the customer has to be recorded. The guidelines also provide for a voice copy to be provided to the consumer, if he/she so desires, at any time during the term of the policy or until a satisfactory settlement of claim, whichever is later. It also mandates that telemarketers undergo statutory training for the purpose. This Guideline is in addition to regulations such as IRDA (Protection of Policy Holders’ Interests) Regulations 2002, which make it mandatory for insurers and their intermediaries to be honest, transparent and make full disclosures about the policy at the time of sale. "Any breaches of the obligations cast on an insurer, or insurance agent or insurance intermediary in terms of these regulations may enable the Authority to initiate action against each or all of them, jointly or severally under the Act and /or the IRDA Act, 1999," says the Regulation.

Similarly, the code of Conduct for agents under the IRDA (Licensing of insurance Agents) Regulations stipulates that they go strictly by the rule book, play fair and not offer different rates, advantages, terms and conditions other than those offered by the insurer.

So while the regulator has to ensure strict compliance of its guidelines and regulations, consumers too would do well to exercise utmost caution while buying policies. It would be prudent not to buy a policy on the basis of promises made over the telephone. Ask the telemarketer to send you in writing all that he wants to say, including the terms and conditions, the incentives and other details. See it at leisure, study it and buy only if you are fully satisfied that it is the right policy for you. Never fall for coercive tactics used by telemarketers saying that you would lose the incentive if you did not opt for the policy immediately. The IRDA website gives comparative information on various insurance products and their premium rates-check this too.

Even after you buy the policy, always make sure that you read the terms and conditions carefully and if you think that you have been misled or sold the wrong policy, exercise your right to cancel it, but do so within the ‘free look’ period. If you come across any violations of these guidelines or have a grievance against an insurer, you can complain to the regulator online. On the right hand side of the IRDA website (irda.gov.in), you will see a link for ‘online registration of policyholder complaints’. Click on that and it will take you to "IGMS" or the Integrated Grievance Management System’, through which you can register your complaint. However, make sure that you have registered your complaint with the insurer first as it is a pee-requisite for filing your grievance with the regulator. You also have the option of going to the Insurance Ombudsman for redress of your complaint.





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