Anand has taken a Health Insurance Policy from XYZ Insurance Company. The Policy also covers critical illness. He paid premiums continuously without any break and without any claim for 10 years. Unfortunately, he was det
CS Professional · Insurance - Law & Practice · PYQS · December 2022
Anand has taken a Health Insurance Policy from XYZ Insurance Company. The Policy also covers critical illness. He paid premiums continuously without any break and without any claim for 10 years. Unfortunately, he was detected with a disease which is not in the classification of diseases or fall under the definition of critical illness cover of that insurance company. Anand made a claim with the insurance company after his discharge from the hospital, after treatment of the unknown disease. XYZ Insurance Company denied the claim. Anand with much disappointment due to denial of the claim sued the web aggregator who had recommended and issued the insurance policy with critical illness cover to him. Can the corporate agents and web aggregators be sued by their clients for errors or negligence during the course of their professional duties? What are the guidelines and its scope imposed by IRDAI to protect the professional interests of the corporate agents, brokers and web aggregators?
Answer & Explanation:
Yes, the corporate agents and web aggregators can be sued by their clients for errors or negligence rendered during the course of their professional duties. The insurance intermediaries engaged in solicitation and distribution of insurance products, viz., Insurance Brokers, Corporate Agents, Insurance Web Aggregators, Insurance Marketing Firms are required to take Professional Indemnity Insurance Policies to get themselves indemnified from the claims lodged against them, arising out of the contingencies mentioned in the regulations governing them. There have been numerous instances where the policy taken by the intermediary do not comply with the Regulatory provisions. A professional indemnity policy is a liability insurance product that protects individuals giving professional advice and professional entities against negligence claims by their clients for errors and omissions. It covers financial loss suffered by the clients resulting from breach of professional duty. As per the guidelines on standard professional indemnity policy issued by Regulator IRDAI effective from July 1, 2021, every general insurer should endeavour to offer the standard professional indemnity policy for insurance intermediaries, including brokers, corporate agents, web aggregators and insurance marketing firms. Standard Proposal Form - The guideline specifies the proposal form that may be used by the insurers for underwriting the risk. Standard Policy Form - All Policies, fresh and renewals, issued in the specified professional indemnity will meet the regulatory requirements of various insurance intermediary regulations. Liabilities Covered - Policies issued shall cover all damages resulting from any claim for breach of duty of the insured, fraud and dishonesty of any employee which the Insured becomes legally liable to pay arising out of claims first made in writing against the Insured during the policy period including legal costs and expenses incurred with prior consent of Insurers, subject always to the limits of indemnity and other terms, conditions and exceptions of the policy. The ratio of limit of indemnity any one accident to any one year shall not exceed 1:1. Policy Period - An insurer shall issue an annual policy to the insurance intermediary. The insurer shall endeavour to issue long term policy valid for the period of certificate of registration of the insurance intermediary.
Topics: Insurance Intermediaries
Related Questions in this Topic
- Anand has taken a Health Insurance Policy from XYZ Insurance Company. The Policy also covers critical illness. He paid p...
- Distinguish between "Agent" and "Broker". What actions does the Regulator take when there is a breach in their code of c...
- Under what conditions imposed by IRDAI, can insurance products be marketed by web aggregators ? Discuss.
- Sharma Textiles Ltd., a large garment manufacturing company, has a Standard Fire Insurance Policy with a sum insured of ...
- Sharma Textiles Ltd., a large garment manufacturing company, has a Standard Fire Insurance Policy with a sum insured of ...