Failing to disclose pre-existing illnesses or lifestyle diseases such as hypertension or diabetes, room rent submits and so on are the most common causes of disputes between policyholders and insurers. Likewise, treatment at hospitals blacklisted by insurers, too, could lead to claim rejection.
LIC told its policyholders to consult with its officials before responding to any offers
IDRAI's clampdown is said to have targeted equity-oriented ULIP policies, particularly the small-cap and mid-cap ULIPs that were launched since the beginning of 2023. Many such ULIPs were sold to capitalise on the stock market rise, without emphasising on their insurance component. The new IRDAI regulations follow the furore around life insurance companies issuing advertisements to promote new fund launches under their Ulips without upfront mention of the life insurance component embedded within.
While insurance firms make their policy terms and conditions difficult to understand, some customers try to conceal vital defects that they know would mean a higher premium or rejection of claims.
The insurance regulator’s new master circular on life insurance product regulations has largely retained the higher special surrender value provisions. This means higher premature exit payouts for policyholders, but the move is detrimental for life insurers.
Health insurance policies commonly cover costs for medical tests, consultations, and treatments incurred before hospital admission, as well as on follow-up care and medications after discharge. Typically, this coverage is for a period ranging from 30 to 90 days before and after hospitalisation.
General insurance companies will not be able reject claims merely due to insufficient documentation. IRDAI has directed insurers to only call for those documents that are directly related to claim.
If IRDAI’s new draft norm on surrender value is implemented, it will effectively mean higher payouts. in the form of a Special Surrender Value, to policyholders on premature exit from the first year itself.
The insurance regulator has asked non-life and health insurance companies to decide on cashless requests in an hour and allow release of mortal remains from hospitals immediately. It has also directed them to provide policyholders an option to either pick higher sum insured or discount on renewal premium in cases where they are eligible for no-claim or cumulative bonuses.
The policy offers support by covering a wide range of expenses, including hospitalization costs, outpatient treatment, personal and financial liabilities such as home, vehicle, and educational loans, and even legal assistance
A policyholder must aggregate the funding needs of all his goals and then arrive at how much he needs to insure for. Each individual will have different needs and thresholds, according to which his premium outgo and sum insured will vary.