A period of four weeks in consumer protection court is definitely not enough to understand the intricacies of this simple yet complicated compensatory system of legality. But it is definitely a good amount of time for understandings its know- how. One such ‘know’ is the insurance claims and the ‘how’ is still in my bucket list. To be clear, this how is not the solving of these claims and appeals against them but a question hindering my thoughts on the advantages of an insurance policy.
The entire concept of insurance policy has its foundation in the vision of a brighter future and a risky present. Why do we take policies for our house, cars, investments, health and even life? Because we know that every moment of our life is temporary and the next moment things will change, sometimes minutely, sometimes drastically. To save us and our close ones from the ever lasting effects of these momentary changes we take up insurance policies but what if this security is in itself a limited assurance.
Sitting in the courtroom has made me witness more than 90% of insurance policy disputes and two-third of its appeals for either stay or reversing the order of the lower forum. Each insurer in that court either refuses the claim of the insured or demands it to be a fundamental breach and if it is not possible, then humbly requests for its further stay. Even when the lower court has given the decision, they argue to at least decrease the amount of expenses borne by the other party for litigation. If I was able to judge the scenario well, my judgment would be their sheer intention to accrue least liability. When they don’t want to give compensation, why do they issue insurance policies? To pool the amount in their bank accounts. With all these claims and appeals and further appeals the aggrieved looses bit by bit. The courts do provide compensation for the mental agony they went through but that too can never equate the time, sufferings and money spent. The policy of 5 lakh 5 years back had a higher market value than today’s 5 lakh, so no compensation can ever be enough.
The other loophole that grabbed my attention was the limitation period of the heath insurances. Even if you die a natural death or have been inspected with cancer in the limitation period of 1 year (for some of the cases the term can be of 2 years as well, as per the condition of the policy in question) then your premiums are for charity as they are not going to indemnify your loss. But what if the cancer detection was after the registration of the policy? What if a shock took a life of a person whose heart was free from any disease till date?
The other one is the non disclosure of facts. The essence of any insurance policy, be it health or fire, is the presence of good faith between the parties, that is something which differentiates all other contracts from the insurance contract and the non-compliance of which causes the fundamental breach of policy, hence fulfilling the goals of the insurance company- free from any liability. But this concept is applicable for the material facts. The facts never asked and hence never disclosed cannot be taken as misrepresentation or non-disclosure. I attended the proceedings of one such case, wherein all the terms and conditions were in place; the only argument of the insurer’s lawyer was the presence of the BPL card on the name of the insured which was not shown by her during the procedure of documentation. The truth was, no such document was required nor was asked from her at that time. But the question that shook us all, was posed by the judge “are the poor not allowed to insure their future?”. That sentence summed it all.
For the next one, I can’t even blame the insurers as this rule has been a part of the insurance system since time immemorial…. MURDER. Any life insurance policy lapses when the insured has been murdered, even if accidentally. This is the fundamental and universal truth, the presence of the word murder foregoes every opportunity of winning and getting the claim as well as strengthens the dismissal of it, of course exceptions do exist but sadly I have never encountered any. This concept in my personal opinion is not on the lines of equity, justice and good conscience. The scenario of suicide can be justified for the fact that they were responsible for the end result of their life but the one murdered due to a conspiracy, a rivalry, a psychopath or any other of the thousand and odd reasons has committed no mistake (unless he is a gangster/criminal, etc). And the family of those should not be left in vain for no fault of their own.
All these errors in the policies transform it from a life support, a hope of help in need or savings of a century to a lost court case. These errors of the policy defeat its objective of assurance and happy holders but on the cruel side make its holders feel that it was not the error in their policy that defeated them but the wrong decision of taking an erroneous policy. They all curse the day they brought it home….
I brought you home
To save my life.
I nurtured you
With my hopes and sweat.
And what you did,
When I was in pain?
You drank my blood
And ate my flesh….
It was fault of mine
Or the fault of trust?
It’s my dilemma
From the day of reality.
If you are the error of policy
Or policy of errors…
About the Author
Dimple is a law student from Symbiosis Law School, Pune, who believes that hardwork always pays off as it adds perfection. A candid straightforward person, she writes poetry and loves the art of paper quilling & combines both for her close ones. Her mantra of life is “ANYTHING IS POSSIBLE”. The greatest influence in her life is her mother who taught her the most important lesson of her life, which is there is only one way of doing things- doing it right. She is currently pursuing her internship with Alexis Centre for Public Policy and International Relations.