Do you know a life insurance company cannot reject your claim for non-disclosure in the proposal form after three years? Yes, you read it right. As per Section 45 of The Insurance Laws (Amendment) Act 2015, no insurance company can reject the claim after three years* of the life insurance policy being in force or three years from the date of policy reinstatement.
Read the blog to know in detail.
What Section 45 of The Insurance Act Says?
Post Section 45 of The Insurance Laws (Amendment) Act 2015, insurance companies cannot question a life insurance policy after three years. The insurer has no right to reject a life insurance claim on the grounds of misrepresentation or suppression of material facts or even if the insured commits suicide after three years. A claim can be refused only if the life insured is involved in criminal activity or commits fraud while submitting claim documents.
Can an Insurer Repudiate a Life Insurance Policy Within 3 years?
An insurer can repudiate a life insurance policy within three years on the grounds of misrepresentation or suppression of material facts.
All the premiums collected until the date of the repudiation may be refunded to the life insurance policyholder or can be forfeited if proven that the insurance policy was taken for a fraudulent motive.
However, if the insurance company detects fraud within three years, then the claim can be rejected and the premium will be forfeited.
*Note: Three years shall be calculated from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later.
Impact of Section 45
Insurance companies have three years to investigate a life insurance policy. Once the period of three years lapses, no claim can be rejected on the grounds of misrepresentation of facts. This amendment should make insurers more alert and sell policies diligently.
The policyholders must ensure that they have revealed all material facts to the insurance company. They must carefully read all the terms and conditions before signing the proposal form. This will help the policyholders to prevent claim rejection.
If the insurance company rejects your genuine claim within 3 years or even after 3 years, then you can reapply. If you are unable to fight for your genuine claim and need help, then contact Insurance Samadhan.*
Insurance Samadhan has helped resolve 14,500+ complaints of policyholders. These complaints include insurance mis-selling, claim rejection, delay in claim settlement, etc.
Contact us to get samadhan for your insurance issues, we’ll be happy to help you.
*Insurance Samadhan is a private organisation and has no association with IRDA or any Government body.
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I AM 89YRS. AND WANT TO KNOW THE RULES APPLIED ON PED IF SI IS ENHANCED WITH THE SAME INSURER WHERE YOU HAVE BEN RENEWING POLICIES ABOUT 25. YRS.
IF YOU COULD CALL ME AT – 9868546346 OR IF MOBILE NO IS PROVIDED – I WILL CALL IN THE TIME SLOT PROVIDED BY YOU, SIR.
Thank you sir for your query.
Please note that as the Sum insured is increased, the effect for the same on PED will be after the waiting period is over.
For example
X purchased a policy with Sum Insured of Rs 5 lacs in 2010 with PED of knee pain and HTN.
Let us assume the waiting period is 4 years in that policy.
So, if X enhances Sum Insured to 10 Lacs in 2013, and gets a knee replacement in 2016, the eligible sum insured for knee replacement will Rs 5 lacs only and only after completion of waiting period from enhancement, the higher Sum insured will be available for PED.
Hope this clarifies your concern.
You can still reach out to us at this number 9513631312 for more queries like this.
I am an insurance agent and I have a complaint against company how i register complaints in irdai?
You can reach out to the grievance redressal cell of IRDAI – https://irdai.gov.in/grievance-redressal-mechanism1
My term policy is more than 3 years old, recently I’m diagnosed with cancer and my critical illness rider claim got rejected stating suppression of material facts, please advise can I get my claim amount
Hi,
Thank you so much for reaching out about this— We are sorry to hear that you’re having trouble.
You can reach out to us by clicking the link below:point_down:
https://bit.ly/3WDsxMu
Just fill the form and our executive will call you shortly.
Thank you
I pay adityabirla life insurance par year 100000.rs .. 2 year. ..total amount 208765.rs can I clam …
Hi Atit,
Thank you for contacting Insurance Samadhan. We will surely help you out with this, please provide us with your contact number soon you will get a call from our executive.
Thank you