I purchased a group accident policy from a general insurance company for my family on May 6. But after reviewing it, I realised it did not suit my requirements. I called up the customer helpline on May 9 and 10 to get the policy cancelled. They suggested that instead of cancelling it, I downgrade it to level-I solely for myself and exclude the other members. I would, thus, save Rs 99. I agreed to modify the policy, but it has not been changed as yet. I have also not received the premium refund. My repeated phone calls have failed to elicit any response.
Also, I took an accident insurance policy a year back with a Rs 30 lakh cover. The policy was renewed without my consent on May 29. What steps should I take to resolve the matter?
The first part of your query relates to an original policy not meeting your requirements and your subsequent acceptance of a different policy. Since you have approached the company in writing, according to the Insurance Regulatory Development Authority (Irda) mandate, it must respond within three days and resolve the matter within a period of 15 days. If you are not satisfied, you may approach Irda or the insurance ombudsman. Irda has issued “grievance redressal guidelines” (effective from August 1) and details of the same as well as the addresses of insurance ombudsman are available on Irda’s site.
For the renewal of the policy without your consent, you may ask the insurance company to refund the premium, which they should within 10 days, subject to the type of coverage and the policy terms . In this case also, you may approach the insurance ombudsman if you are not satisfied with the decision of the insurance company.
I have been maintaining a mediclaim policy for my family since April 6, 1999, with an insurance company. I shifted to another company on April 6, 2007. I paid the premium for the policy renewal on April 2, 2009, and also have the receipt for the same from my agent, but my bank account was debited on April 8, 2009. Typically, the insurance company sent me the policy 20-25 days later. However, I had a claim on April 14, 2009, and I intimated the company about it within seven days. Sensing the claim to be substantial, the insurance company chose not to issue the policy, and instead, offered to refund the premium already taken. I declined the offer. The insurance company tried to mount pressure through the agent and sent me the cheque that I had returned. The matter has been taken up with Irda and the banking ombudsman, but no response has been received as yet. Kindly advise.
After the insurance company has accepted the renewal cheque, it cannot deny the renewal and refund the premium without a valid reason. In fact, Irda regulations prescribe that a health insurance policy cannot be denied for renewal, even in case of a high value claim. The insurance company can deny renewal if the customer is unable to furnish valid documentation in support of the claim or in case of a fraudulent claim. You have reported the matter to the banking ombudsman, but this needs to be taken to the insurance ombudsman. You can find details about the insurance ombudsman on Irda’s website.
The writer is the MD and CEO of Tata AIG General Insurance Company. Send your queries to yourmoney@bsmail.in