cpc

insurance company wrongly forecasted the benefits


Hi,

I purchased a child insurance plan from LIC of India from Direct sales executive ( employee of LIC of India) in September 2011.

I was wrongly  advised by sales executibve and his divisional manegr  that proposer parent will get accidental death benefits under this plan.The particular column in the proposal froms meant for parent is marked as YES.

The direct sales executive,divisional manager have promised me that they will disclose all the benefits of the policy by official e-mail ID before finalising the policy and with my consent only they will proceed further.They did not do it inspite of my reminedr e-mails to disclose the policy benefits.( I have the e-mail I have send and read receipt of my e-mail from LIC of India Internet server).

They have lapsed the cooling off period by  giving me some file extracts which they send it to higher office for approval,saying that higher office has approved your insurance proposal ,hence I need not worry about accident benefit.

Late I came to know that I was cheated and approached LIC Grevience rederssal officer,he has communicated to me through official letter that accident benefit to the parent is not applicable under this plan and  the direct sales executive has wrongly advised while forecasting the Insurance product.

I approached LIC again through IRDA channel,but LIC has refused to cancel the policy and refund the premium saying that 15 days coolingoff period is completed.

Later I got certified copies of my proposal from and  compared them with the photocopies of originally submitted proposal froms,I noticed that sum assured and term is tampered without my consent and excess premium collected from me towards accident benefit is used for increasing the sum assured.But still accident benefit is marked as YES in the proposal from.

NO one LIC has observed that accident benefit to the parent is not applicable under the plan I have selected and they blindly processed my Insurance plan with due negligence.

Please advise me whether I can get back my premium through consumer forum?? or I need to approach Magistrates court???

Thanks in advance

Rajesh

 
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Lawyer in Hyderabad.wats app no.9989324294

You can approach consumer forum with all evidences of documents in your area.

 
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Dy Director

If you feel cheateed can go toconsumer forum

 
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FIN

 You have posted that:

---“I approached LIC again through IRDA channel,but LIC has refused to cancel the policy and refund the premium saying that 15 days coolingoff period is completed.”

It is a standard practice, now to convince the IRDA and courts of law that customer is duty bound to compare and approach the company for cancellation, for various reasons customer may have.

However company can deduct Medical Charges if it conducted Medical Tests on its expense and adverse movement in NAV of units if it is ULIP.

The companies have been penalized in the past for mis selling and heavy penalties have been inflicted by regulator IRDA and courts of Law. The decided cases are maintained by IRDA on its website.

It has been and it is a trend to tire the customer and keep on trying as majority of the customers/citizens would not go to court of law and this in itself would be a great relief to the company. The number of litigations, implications of litigation would minimize.

And then rarely a customer would go for criminal complaint, civil suite with damages which may be more rewarding. The erring/offender employees would continue to remain in employment.

You may ask any senior guy in Insurance be it Life Non life, to touch his heart and say “Insurance can be sold without Mis Selling” The answer would be NO. 

The bulk of sales of insurance come thru Mis selling. Therefore employee who can

mis sell are Darlings-blue eyed boys, of their masters.

If any properly informed determined citizen pursues the matter to its logical conclusion, it is the agent, or at the most poor DO who shall face the music.

In your case you have some proof against Zonal Head so do a service to yourself, fellow countrymen and bring the matter to its logical conclusion.

You may succeed provided you have unbeatable evidence.

----“Later I got certified copies of my proposal from and  compared them with the photocopies of originally submitted proposal froms,I noticed that sum assured and term is tampered without my consent and excess premium collected from me towards accident benefit is used for increasing the sum assured.”

The copy of the proposal form should be supplied as a part of the policy document delivered to the customer.

Any overwriting has to be countersigned by customer and to avoid unethical practices, forgery the BM, ZM should ensure that proposal form is returned and a new form is filled up.

The company should and companies does call the customer to check the vital entries in proposal Form e.g. Name, address, KYC docs, bank a/c, Premium paid, SA, riders opted etc……..Did you receive any such call? It is also part of practices to follow AML- KYC guidelines.

The SA is increased by increasing the premium so as to increase the commission which is paid as a % of the premium collected.

----“But still accident benefit is marked as YES in the proposal from.”

“NO one LIC has observed that accident benefit to the parent is not applicable under the plan I have selected and they blindly processed my Insurance plan with due negligence.”

Since wrong features were opted which were not available, the proposal form should have been returned/issuance of policy should have been declined and premium should have been returned without any deduction.

It is commonly used malpractice that customer’s consent is asked for changes and usually agent/Managers connive and consent form/letter with forged signature is submitted to get the policy issued. Has such consent been made a part of documents submitted by you????

The AAO/AO or for that matter CRM section can help you to see the entire bunch of docs kept in Branch and you can proceed further.

Or you may apply your resources, create a noise with CRM and in your presence, make him see the docs and submit minutes of finding on the spot under acknowledgment and apply for copies on the spot.

----“I was wrongly  advised by sales executibve and his divisional manegr  that proposer parent will get accidental death benefits under this plan.”

Did they provide copy of brochure, and later benefit illustration-PQIS? The benefit illustration is to be signed by customer and submitted with proposal form!!!!!

----“The direct sales executive,divisional manager have promised me that they will disclose all the benefits of the policy by official e-mail ID before finalising the policy and with my consent only they will proceed further.’

What is this service by email?

Did you provide any email id in proposal form? Has the company sent any email to you?

“They did not do it inspite of my reminedr e-mails to disclose the policy benefits.( I have the e-mail I have send and read receipt of my e-mail from LIC of India Internet server).’

It may help you as evidence.

 

----“They have lapsed the cooling off period by  giving me some file extracts which they send it to higher office for approval,saying that higher office has approved your insurance proposal ,hence I need not worry about accident benefit.’

What are these file extracts?

What is escalated to HO?

Does it mean an application was made to HO for providing PA rider? Why HO had to be approached? You had asked for a policy with PA for parent, if it was not a feature in the policy the proposal form should have been rejected by agent/Div. Manager, underwriter etc………….. It I strange that it passed many hands and policy was issued.

If it is not part of the policy- plan, it can not be approved even by HO. Each plan is approved by IRDA and a unique TIN is issued which you can see on each policy brochure and policy.

----“Late I came to know that I was cheated and approached LIC Grevience rederssal officer,he has communicated to me through official letter that accident benefit to the parent is not applicable under this plan and  the direct sales executive has wrongly advised while forecasting the Insurance product.’

This is admission.

You may route thru CRM to Chairman and demand exemplary punishment and refund with interest within say………………days and Title your representation as NOTICE and mention that or you shall be constrained to lodge a criminal complaint as despite this admission of forgery/mis  selling LIC has misguided IRDA also: “that 15 days coolingoff period is completed.”

 

----‘NO one LIC has observed that accident benefit to the parent is not applicable under the plan I have selected and they blindly processed my Insurance plan with due negligence.”

“Later I got certified copies of my proposal from and  compared them with the photocopies of originally submitted proposal froms,I noticed that sum assured and term is tampered without my consent’

Relate the date of receipt of certified copies with guidelines in “Regulation of Protection of Policy Holder’s Interest.” And defeat the contentions of LIC on Cooling Off Period/Free Look Period……….

 

The underwriter should have declined to issue the policy.

You may call the underwriter to court/ or issue notice to him. LIC is within preview of RTI. You shall get everything.

In LIC the underwriting be it medical, Financial, or general underwriting is done in the same Branch and almost each Branch is policy issuing branch.

No policy can be issued without underwriting and even Chairman can not overrule underwriter’s opinion.

You may go thru “Regulation of Protection of Policy Holder’s Interest.”

e.g. Definitions:2:

1. (e) Prospectus…..

3. Point of Sale (1)

4. Proposal for Insurance (1), (6)

11. General (4)

 

.

----“I approached LIC again through IRDA channel”

IRDA has introduced telephonic mode. May be you approached thru this mode and this forgery; mis selling has not been recorded. Otherwise IRDA caqn not ignore it.

You may escalate in writing to Chairman-IRDA also.

----You may also log onto website of LIC and go thru the process it has advertised as it shall follow for issuing g the policy and tap the loop holes.

Valuable advice of learned experts/members is sought.

 
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FIN

 
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