Kindly write a written complaint to IRDA forum against who soever are calprits. And do mention all case details accordingly.
Repudiation of life insurance policies on basis of fraud subsequent
Subsequent to amendment in section 45 of Insurance Act where by repudiation can be on misoresentation or on fraud In case of repudiation on grounds of fraud where sufficient evidence of material information like major illness and treatment or surgery is not disclosed which could have definitely affected the acceptance of Risk etc But in many such repudiated cases the claimants and agents are drafting complaints to higher forums and pointin outvthe word fraudcwas not iused in the initial letter of Repudiation and then demanding payment of full death claim and then if the complaint is rejecting claiming refund of premiums inspite of clear evidence and getting in many cases Is it that if some other word is used along with details of circumstances and evidence is used in the letter of Repudiation then Repudiation is not valid Pl clarify
Asked 5 years ago in Civil Law
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5 Answers
insurer has to establish that this non-disclosure or, as the case may be, the submission of inaccurate or false information was fraudulently made and that the policy holder while making it knew of the falsity of the statement or of the suppression of facts which were material to disclose.
2) It is well settled that a contract of insurance is contract uberrima fides and there must be complete good faith on the part of the assured. The assured is thus under a solemn obligation to make full disclosure of material facts which may be relevant for the insurer to take into account while deciding whether the proposal should be accepted or not. While making a disclosure of the relevant facts, the duty of the insured to state them correctly cannot be diluted. Section 45 of the Act has made special provisions for a life insurance policy if it is called in question by the insurer after the expiry of two years from the date on which it was effected.
3) clear reasons for repudiation should be mentioned
4) you have to mention policy was predicated on grounds of misrepresentation or fraud
1. Committing fraud is enough reason to repudiate any claim anywhere which need not be specifically mentioned.
2. Repudiation of fraudulent claim is always valid if the fraud is established.
Some times an insurer may “REPUDIATE A CLAIM”, this means they are advising that your claim is not covered under the terms and conditions of your policy. You need to ask your insurer , under what part of your policy are they advising your claim is repudiated?
The claimant has the right to know the reasons for repudiation of insurance claim.
Under section 45 of the Insurance act:
The regulation as per Section 45 of the Insurance Act allows insurers for calling a policy in question on the ground of misrepresentation or suppression of a material fact not amounting to fraud only within the initial three years of the policy.
While the rules allow insurers to repudiate (or reject) death claims within the initial three years of a life insurance policy on the ground of misrepresentation or suppression of a material fact, their hands are tied for repudiation of claims, if a death happens after this period.
Life insurance contracts are based upon the legal principle of 'uberrimae fides' (utmost good faith) and hence, the potential buyer of a life insurance policy is expected to disclose all material information honestly and accurately.
Section 45(4) speaks about any incorrect statements or failure to disclose on the grounds other than fraud. Under such circumstances, by virtue of second proviso to section 45(4), refund of premiums have been advised, since it is a case of unintentional incorrect statements or non-disclosure,
Therefore the rule cannot be changed just for your desire that the wordings have to be changed so that the claimant do not get any benefit for having paid the premium amount.
Dear client,
You have to file a case in consumer court on the basis of repetition letter depends upon the court.
