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. What are the limitations of the guidelines which are issued by IRDAI to protect the interests of the corporate agents, brokers and web aggregators?

Answer & Explanation:

The limitations of the guidelines issued by IRDAI to protect the interests of corporate agents, brokers and web aggregators are "Policies issued will 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 the limit of indemnity for any one accident to any one year will not exceed 1:1," according to the guidelines.

Topics: Insurance Intermediaries

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