badge

Sunday, 20 December 2015

Amendments to Section 45: Things You Need to Know About Your Insurance Policy

Recently, the Section 45 of Insurance Act, 1938 was amended to make the rules more transparent and simplify the claim settlement process. The amendment is aimed at reducing the litigation and clarifying contentious points so that the interest of the Insurers as well as Insured is safeguarded.
In my previous post, I have discussed about the amendments made to the provisions under Section 45.


In this post we would look at the applicability of the provisions under Section 45 and facts which one needs to know about their policy.

Highlights of the Amendments to Provisions U/S 45 of the Act: One Should Know 
  • Insurer allowed only 3 years window to question a policy on grounds of suppression/misrepresentation of material facts, not amounting to fraud. This means no policy can be questioned on or after completion of 3 years even if some facts were incorrectly shared by the insured. The onus lies on the Insurer to verify the claims and facts shared by the Insured.
  • Policy does not necessarily be questioned only in case of claims but may also be questioned even when there is no claim, within the stipulated 3 years. Clearly, this means that the Insurer may question the Insured at any point of time within the 3 years, failing which Insurer can no longer question the policy on basis of incorrect facts shared by the policy holder.
          In case of Unit Linked Insurance Plans (ULIP); if
  • A Policy is called in question within 3 years of issuance on ground of misinterpretation or suppression of a material fact not amounting to fraud:- Premiums collected under the policy up to the date of repudiation are to be refunded. Fund value has no relevance. Or,
  • A Policy is called in question within 3 years of from the date of last revival for the facts shared at the time of revival:- Fund Value as on preceding to the date of last revival plus the entire premium collected for revival and thereafter would be refunded.
  • In case of Money Back Plans, where one or more Survival Benefits are paid and claim arises within 3 years of revival, and it is found that there was suppression of facts at the time of issuance of Policy, then the policy cannot be questioned. However, if the suppression of facts takes place at the time of revival of policy and is called for question within 3 years, then the premium along with admissible benefits (after deducting Survival benefits paid) is to be refunded to the Insured. As the facts were suppressed at the time of issuance and not at the time of revival, hence the policy cannot be questioned on the basis of facts shared previously.
  • Reinstatement of Surrendered Policies may be treated at par with the revival of the policy.
  • In case the Date of Issuance Policy and Date of Commencement of Risk is different, the 3 years period will be calculated on basis of latter of the two. The premiums collected from the date of issuance till the date of repudiation will have to be refunded.
  • In case of Policy is revived merely by collection of premium in arrears along with interest/penalty without obtaining any medical or health certificate, then the 3 years stipulation from date of revival is not applicable. Thus Date of Issuance or Commencement of Risk would hold good.

1 comment:

  1. Although lengths of incarceration for insurance fraud convictions are not typically as serious as sentences for violent crimes, being convicted of insurance fraud utterly destroys one's reputation, especially in the business community.qui tam attorney

    ReplyDelete