M, 30, is an accountant earning ₹60,000 a year. He's married to S, 29, and they have two children aged four and two. S currently stays at home caring for the children. M and S have ₹1,40,000 mortgage, ₹40,000 owing on cr

CS Professional · Insurance - Law and Practice · PYQS · December 2021
M, 30, is an accountant earning ₹60,000 a year. He's married to S, 29, and they have two children aged four and two. S currently stays at home caring for the children. M and S have ₹1,40,000 mortgage, ₹40,000 owing on credit cards, and a car loan of ₹6,00,000. M's superannuation includes ₹5,00,000 of life insurance cover. M is worried that if something happened to him, his family would be in financial difficulty. After speaking to his financial adviser, M decides to take out ₹10,00,000 life insurance policy and ₹2,00,000 trauma and disability insurance. When combined with the existing life insurance he has under superannuation, if M dies unexpectedly S and the children will have sufficient amount to live on after all debts are paid. Also, if M was to suffer from one of the medical conditions specified in his trauma insurance policy or suffer a total and permanent disability, the lump sum he receives would help meet his medical treatment costs, hopefully without the need to dip into the family's savings or go further into debt. So he bought the policy. But after receiving the policy documents, he observed that conditions in policy are different as compared to conditions informed by the agent of the insurance company. So he filed a complaint with Grievance officer designated by the insurance company on 01.01.2020. The company rejected the customer grievance on 15.01.2020 (intimating him on 20.01.2020) and closed the complaint on 31.01.2020. What conditions need to be fulfilled so that grievance can be considered closed as per insurance regulations?

Answer & Explanation:

A grievance can be closed only if the following conditions are satisfied: Where the insurance company has acceded to customer's grievance, upon acceding to the request of the customer. Where the insurance company rejects the customer's grievance, upon receipt of a communication from customer accepting the company's resolution. Where the insurance company rejects the customer's grievance and the customer does not respond within 8 weeks of receipt of resolution, upon completion of the 8 weeks. In all the above instances, the Grievance Redressal Officer shall certify that the Insurance Company has discharged its contractual, statutory or regulatory obligations.

Topics: Life Insurance

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