Are you a victim of Insurance misselling?

I received a mail from a friend of mine who attended a seminar on “The Ombudsman system in Insurance” in which the Insurance Ombudsman was the chief guest. The mail (edited a little) goes on like this ; Quote “The Ombudsman's position is a unique one: his decision is binding on the Insurance company. He cited certain examples, which I feel is very important for everyone to read and understand.

1. It seems 26% of the complaints concerning life insurance were against a certain group of companies. Surprisingly, this company has a market share of only 2%! He didn't tell us the name of the group. 

2. There is a ULIP in the market that agents sell to people around 55 years of age. The premium is Rs1 lac per year for 15 years. As per IRDA regulations, an agent has to show you a chart at the time of selling the policy - the returns look very satisfactory. If the person dies, he gets the sum assured. Now, what if he lives through the 15 years? He expects a large chunk of money from the invested portion, but the policy is structured in such a way that he gets zero! (In one Company an amount of Rs 50,000/- became Rs248/- after 5 years) It seems, as the man gets older, his mortality rate goes up exponentially and eats up  the investment!

The aged gentleman was in tears and complained to the Ombudsman. The lady representing the company insisted that the company had done no wrong as it was clearly mentioned in the policy. The Ombudsman told her to show him where it was written in the policy.He could not read it at all. Thinking that he has  bad eyesight, he asked one of his younger staff to read it and found that even the youngster could not. Then he asked the lady from the company to read it and ordered the company to refund the money when even she could not do so! 

3. In another case, a lady lodged a claim after her husband had passed away and the Insurance Company rejected the claim. She approached the ombudsman and a meeting was arranged. The company representative produced a certificate from a hospital stating that the deceased had HIV and had undergone treatment for it. The ombudsman told the lady that under such circumstances, the claim was not payable.After a few days, the lady came back to the Ombudsman with a letter from the hospital stating that no such patient was ever treated at the hospital, that there was no doctor in the hospital with the same name as the one who had signed that certificate. Further, she produced a letter from the Army that during the dates mentioned in the medical certificate, the man - a serving officer in the Army, was posted at Kargil!! Clearly, the company representative had forged the certificate. The company agreed to pay the claim.

4.  A person approached his bank manager and told him that his retirement was 3 years away and he had Rs 40 lacs to invest for 3 years. The bank manager showed him some calculations and promptly invested the entire amount in an ULIP. Imagine the guy's surprise when after three years, the value was only Rs 28 lacs and he was advised  if he surrendered the policy, he would get only 14 lacs!! He approached the Ombudsman and was advised that nothing could be done unless he had evidence that the bank manager had indeed guaranteed returns. After a lot of searching, the man found a sheet of paper where the bank manager had done the 'returns' calculation. Using that as evidence of misselling, the Ombudsman ruled against the bank. The surprising part here is that the person was an Income Tax officer! When asked how he could be taken for a ride like this, his reply was classic - "I have a 30 year relationship with that particular bank - I never thought they would do this to me.

It was a very interesting session and my take away from the session was;

(a)  Do seek recourse to the Ombudsman if you feel you have been wronged. (b) ALWAYS ask whoever is selling you the policy to give you everything in writing.(C) The only life insurance policy that anyone should buy is a Term policy.”Unquote 

Last modified on Wednesday, 10 February 2016 06:49

Prakash Praharaj

Shri Prakash Praharaj has a passion for excellence. He has been awarded two gold medals for securing top positions both in Graduation and Post Graduation in Commerce. He is an MBA with specialization in Finance and marketing. He has been awarded Diploma in Treasury, Investment and Risk Management besides CAIIB from the Indian Institute of Bankers. He is a Certified Financial PlannerCM from the Financial Planning standards Board, India (FPSB), affiliated to FPSB, Denver, USA and Certified Personal Financial Adviser from NISM. He is also a SEBI registered Investment Adviser vide Reg. no. INA 000000045 dated 2nd August 2013.His book "Your Every day guide to Personal Finance and Insurance" has been published by CNBC TV 18 in August 2015.

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