Take the case of Kolkata -based Sabita Mukherjee, who was hospitalized due to respiratory tract infection. Mukherjee said, “First, the insurer did not approve the cashless claim and later rejected the reimbursement claim that it was not necessary to be hospitalized. I had paid more than seven premiums in the policy.”
However, according to the Administration section for health insurance policies defined by India’s Insurance Regulatory and Development Authority (IRDAI), if a policyholder has paid five or more annual premiums, an insurance company cannot reject its claim, even if they have not revealed already existing disease or any other important information.
“Any policy and claim of claim will not be competent on any basis of non-completion and/or wrong bayani, except for the established fraud, after completion of the foundation period, ie, after continuous coverage of 60 months,” reads Section 13 of the Master Circular on IRDAI (insurance products).
In life insurance, if a policyholder has paid three consecutive annual premiums, an insurance company may not reject a claim on the basis of incorrect or non-discourse, or even fraud.
“No insurer will rebuild a life insurance policy on the land of fraud, if the insured/beneficiary can prove that the misunderstanding was correct for the best of his knowledge and no intentionally intended to suppress this fact or within the knowledge of the insurer about suppression or suppression of physical facts,” Insurance Law (Amendment) Act, is said to be in 2015.
Ban in health insurance
In health insurance, an insurer can claim fraud even after five years.
“Somebody should not misunderstand (the sub -institution) section. When you buy a policy, you should declare your health conditions in totality. If you hide a major disease, so that the insurance company is motivated to reject your policy proposal at first, they can reject your claim even after the end of 5 years, and right,” said the chief executive official. “(The superstition) section is only valid when an insurer has rejected your claim for non-matuable disease.”
After reaching an insurance grievance redressal company Insurance Samadhan, the Administration Claus came to assist Mukherjia. Shilpa Arora, co-founder of Insurance Samadhan, said, “We often receive cases in health insurance where the period of the sub-institution has expired, but the insurer still rejects the claim that classifies it as a fraud.” “Sabita’s claim was finally approved when we insisted on the Administrative Block and on the fact that the doctor advised to be hospitalized.”
The years specified under the Sidhangana section also apply when a policyholder ports a policy for another insurer. Iradai said, “Stopping credits received under ported and migrated policies will be counted for the purpose of calculating the period of sub -institution.”
For example, if you have paid two annual premiums for a health insurance policy and then ported it to another insurer, you will only have to pay three more annual premiums to complete the postponement duration.
However, if you increase the insurance cover in a ported policy, the duration of the regulation will begin on increased yoga. If you had a cover 10 lakhs in the original health insurance policy and 30 lakhs in ported policy, origin The remaining adjournment period of three years in 10 lakh covers will be more There will be a period of five years of adjust for 20 lakhs. Also, if you include a no-calm bonus, then say, 1 million, new 5-year adjournment will be applicable only in ported policy 10 lakhs.
There was 8 years in health insurance, but in May 2024, it was reduced by 5 years.
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Ban in life insurance
Section 45, 1938 of the Insurance Act states that no life insurance policy will be said in question on any basis after the end of three years from the date of the policy – IE, from the date of issuance of the policy from the date of issuance of the policy, the start of the risk, the date of the date, the date of revival of the policy, or the date of the rider, whatever the policy.
Mahavir Chopra, co-founder of Digital Insurance Marketplace Beshak.org, said, “The difference between the Administration section in life and health is that the claims can be rejected on the basis of fraud later, but not in the east.”
However, insurance companies still find the methods around it.
The father of Madhya Pradesh -based Kabir Zaidi bought life insurance policies from many insurers, including two policies. 25 crore from India’s Life Insurance Corporation and a private insurer.
LIC approved the claim for Zaidi’s father, but the private insurer denied the payment, saying that the policyholder did not disclose information about the LIC policy according to the Zaidi.
“My father had revealed the details of every insurance policy to the insurer, which was taken from LIC, and still rejected the claim. I approached the consumer court, but did not help. I planned to appeal again,” Zaidi said.
To ensure this, Zaidi’s father bought a policy from a private life insurer in 2014.
“The Insurance Act was amended in 2015, earlier the insurers could reject the claims even after 3 years in the case of fraud. Since he (private insurer) classified Zaidi’s case as a fraud, he said that the amendment is not valid. But it is not valid that I should emphasize that it does not claim a fraud,”
