Rights and Responsibilities of Insurer and Insured

Rights of Insured

• Once you fill the proposal form, you should hear from your insurer within 15 days about the decision to issue or refuse the grant of life insurance
• You can appoint one or more nominees. When you do so, the sum assured will be divided among them
• If your proposal is accepted, the policy bond should reach you within a reasonable period of time
• You can ask for altering the mode of premium paid and the term of policy
• In case of loss of the policy document, you can get a duplicate copy that confers the same rights as the original policy except 15 days Free Look period.
• You can cancel your life insurance policy within 15 days from the date of receiving the policy documents.
• You can change the nominee details once the policy is issued by intimating your insurer

Responsibilities of Insured

• Fill up the proposal form correctly
• Pay premiums on time
• Don’t hide any information, however immaterial it may seem
• Don’t disclose your policy number and other confidential information to imposters identifying themselves as IRDAI officials. IRDAI never makes such calls.
• Inform your life insurance company immediately if you lose your policy documents

Rights and Responsibilities of Insurer

Duty to Defend

Depending on the nature of your agreement, your insurer may have a duty to indemnify or defend you under certain circumstances. The duty to defend provides you with legal representation if you’re sued. The duty to indemnify pays for any legal judgments against you. Both are dictated by the terms of your policy.

Insurance Contract

Your insurer must honor any responsibilities outlined in your policy. It’s free to provide you with rights above and beyond those provided by law, so your agreement may have extra responsibilities. Additionally, if a provision in your policy is found to be ambiguous it’s interpreted by a court as being in your favor if there’s a dispute.

Claim adjustment

An insurer must treat its insured’s interests with the same consideration it gives its own interests. This means that a claims adjuster must give the policy holder the benefit of the doubt. The claims adjuster should be looking for reasons to find coverage, not for reasons to deny coverage. The claims adjuster should be looking for reasons to pay the claim, not reasons to deny it. Unfortunately, sometimes insurance companies lose sight of this fundamental rule.

General Duties

An insurance company has a legal duty to fully investigate your claim, not just the parts that support their position. It must also provide you with all necessary information so you can protect your claim under the policy. Additionally, the company must respond to your communications and promptly pay your claim if it’s found valid.

Fair Deal

An insurance company’s duty of good faith and fair dealing means it must always act in the client’s best interest. This responsibility, implied in all insurance agreements, prevents the company from acting in bad faith in transactions involving your claim. If it breaches this responsibility you are entitled to sue for damages.

Payment

If payment is owed, an insurer must promptly pay the claim. In Wisconsin, an insurer must pay a claim that is owed within 30 days, or the insurer may be subject to paying the policy holder 12 percent interest per year. Even though this is the law, there is no good reason for an insurance company to hold payment for 30 days if it owes benefits under a policy.