Life insurance claim & ex-gratia payment
Bharati Agarwal
(Querist) 16 March 2015
This query is : Resolved
My Husband had a Life Insurance Policy with Metlife Insurance Co for Rs.30.00 Lac, Full Premium Paid, Myself Nominee.My Husband Died in a Road Accident,Lodged Claim with proper documents.The Agent confirmed processing of full claim and insisted on new single premium policy for the totoal claim amount, which I refused.Thereafter the Insurance Company rejected the total claim on the ground that My Husband had concealed the fact of(while applying the policy with Metlife) a policy proposal having been rejected by ICICI Life Insurance prior to applying to metlife.Metlife issued the policy after complying all the required formalities including exhaustive medical check up.
On my making several request to Metlife for review of its decisio about claim rejection, the metlife informed that they can consider paying a lumpsum of Rs.15.00 lac to me as"Ex-gratia"(but not the claim amount)provided I comply with the documentations which included indemnity, no further claim certificate, NOC etc etc which the agent made/suggested to comply and accept with assurance of balance payment from metlife with more efforts.
I accepted and executed the documents which metlife insisted and received Rs.15.00 as ex-gratia in full and final payment.
Now it is about more than one year neither the agent nor the metlife is listening to me on the ground that nothing is payable to me.
What to do??
Kumar Doab
(Expert) 16 March 2015
Has this Rs.15 Lacs also been paid to you or not?
Do you evidence of any allurements of agent e.g. Single premium Policy?
Do you copies of all documents that were signed by you?
Do you have copy of Metlife Policy and proposal form with you?
Kumar Doab
(Expert) 16 March 2015
In which year the policy was bought?
In which the death has occurred?
Rajendra K Goyal
(Expert) 17 March 2015
You should have lodged complaint before the consumer forum when the claim was rejected.
Bharati Agarwal
(Querist) 17 March 2015
Dear Sri Kumar Doab and Rajendra K Goel,
We were verbally allured by the agent for single premium policy. Yes we have all the papers signed by us. The policy was taken in 2009 and total three premium instalments were paid till 2011, Death Occured in 2012.Part Claim in form of ex-gratia received in April-2013, therafter I was after the agent and recently he has denounced the balance claim.
I wish to know that an insurance co is legally entitled to pay ex-gratia in lieu of claim, next is there any remedy available to me for the balance amount?
Please help.
Kumar Doab
(Expert) 17 March 2015
From IRDA website you may download:
Regulation of Protection of Policy holder's Interest
Decisions in cases involving M/s Metlife and others.
The agent is not empowered to approve or refute any claim.
His/her only job is to help to file the claim.
You have posted that policy was issued after full medicals thus has been underwritten after proper due diligence by Underwriters of the company.
Death is not by disease but by accident.
Your lawyer specializing in Consumer Matters can handle the contentions of the company on 'Suppression of Material Facts' and that policy can not be called in question after 2Y.................and so called Indemnity Bond and Ex-Gracia............
The matter has deftly been exploited by company in connivance with so called agent.
In future do not hurry and don't err and prefer to consult your lawyer specializing in the field of law when you are stuck well in advance. You could have narrated the offers made by agent (alongwith company's employees) on Single Premium on record and recorded .You can do so now also.
All said and done the lawyer that has examined each input and document can advise you the best.
