|
|
|
|
|
|
|
|
|
Consumers beware! By accessing the website of the governing body of the Insurance Council, consumers can get to know case laws for filing complaints, besides understanding the problems one encounters while dealing with insurance claims
Here’s some good news for consumers. You can now access the decisions of the insurance ombudsmen around the country, on the website of the governing body of the Insurance Council. To be more specific, key in the words www.gbic.co.in/synopsis.html and you will reach the website where you can see the orders of the insurance ombudsmen in respect of both life and non-life insurance products. While under life insurance, the orders have been classified under different heads such as death claim, mortality claim, survival benefits and miscellaneous, under the general insurance or non-life insurance, you can see the orders pertaining to vehicle insurance, burglary, fire, group mediclaim, mediclaim, overseas mediclaim, individual personal accident, janata personal accident and group personal accident. These orders are extremely important because you get to know the case laws in case you have to file a complaint yourself. Even otherwise, a perusal of these orders help you understand the problems that you may encounter in dealing with your insurance claims and how to overcome them.
For a long time, the judgments of the apex consumer court have been available on the website www.consumercom.nic.in. Subsequently, the orders of the consumer courts at the district and the state level were also put up on this website. Similarly, on the banking regulator’s website, www.rbi.org.in, one could see the orders of the banking ombudsmen. The orders of the insurance ombudsmen, however, remained inaccessible to the public. Now finally, the orders have been made available, and even though what is provided is a synopsis, many of the orders give the reasoning leading to the decision and this is very helpful. And unlike the banking ombudsmen’s orders, which are given by the banking regulator without giving any complaint number or the name of the complainant or the bank against which the complaint was filed, the insurance ombudsmen’s orders have all those details for referencing. Let me quote a few orders briefly to explain how useful they are. For example, there is an order of the Chandigarh ombudsman on a householder’s policy that shows how insurers try to use any excuse to avoid paying the claim amount. In this particular case, for example, the complainant, Vinod Kumar Malik, had taken a householder’s policy for his house in Shimla, which covered not only theft and burglary, but also loss of baggage during travel. During a trip to Vrindavan, someone broke open the glass of his car and stole his baggage. When he lodged a claim for Rs 24,175, United India Insurance repudiated it on the ground that the theft occurred when the car was parked outside his house in Vrindavan and not during the journey. The insurance ombudsman in this case held that temporary parking of the car during transit was part of the journey and should be treated as such. Certain goods were kept in the car, which was secured and locked and these were stolen and the claim, therefore, was payable. The insurance company was ordered to pay the admissible amount of claim up to Rs 10,000 as per the cover for baggage. In another case pertaining to group mediclaim decided by the Chennai ombudsman, the issue was whether the insurer was right in repudiating the insured’s claim for hospitalisation and treatment of cirrhosis of the liver on grounds of pre-existing disease? After perusing all the records, the ombudsman came to the conclusion that the insurer was wrong and should pay the amount. Saying that the denial of the claim in this case was not justifiable, the ombudsman here pointed out that the panel doctor’s opinion was based on mere possibilities of the pre-existence of the ailment and not on the basis of any concrete proof. Similarly, in a case of theft, where the claim was denied on the fact that there were no signs of breaking in, the Kolkata ombudsman pointed out that the insurance company sent the investigator after three months of reporting of theft. No prudent man would keep the grills of the window, broken by the thieves, unrepaired, at the cost of his security, in order to keep the proof intact for the insurance company. While a reading of cases such as these will aid consumers fighting a similar battle, orders where the ombudsmen have upheld the repudiation of the claim will also help consumers avoid mistakes in future — for example, delay in informing the insurer could well lead to repudiation. So also deliberate suppression of facts material to the insurance policy at the time of filling the form. So visit the website and become well-informed consumers.
|
||||
|
|
||||
