A personal accident policy and a happy family floater policy are usually sufficient for most individuals and families to head out for a holiday. Or that’s what a honeymooner thought.
The following is a case of a person holding all relevant policies but different interpretation of certain clauses by the insurer could have denied him reimbursement. Maintaining all relevant receipts, bills and records probably too came in handy for the insured.
For Hiren B Joshi, a resident of Mira Road, the holiday was also his honeymoon within a fortnight of his marriage on 28 November 2014. He selected Manali in Himachal Pradesh after consulting Heena Tours & Travels. Lakhs of people visit Manali each year for adventure sports including paragliding from India and abroad, newspaper reports say. {
https://www.thrillophilia.com/cities/manali/tags/paragliding}
The Joshis were part of a group of 100, in which they would go up in the air through a non-motorized, foot launched flying glider with an inflatable wing, which would gradually descend with the help of a parachute. In the case of Mr Joshi, the parachute did not open fully, despite attempts by the pilot. On descent he hit the rocky portion of the surrounding hills and was grievously injured, says a South Mumbai District Consumer Disputes Redressal Forum order dated 1 June 2019.
The paragliding, on 10 December 2014, was being operated by an expert and Mr Joshi had no role in operating it and was no more than what a passenger would be in an airplane.
For his injuries, Mr Joshi was admitted the same day to Lady Wellingdon Hospital at Kullu. He was moved to Fortis Hospital at Mohali the next day and was discharged on 6 January 2015. Soon after reaching Mumbai, he was hospitalized again at the Borivali Orthopaedic Clinic from 6 February 2015 to 9 February 2015 and again from 1 April 2015 to 4 April 2015.
“The complainant lodged the claim claiming compensation of Rs6 lakh under the happy floater policy and in support of it he had submitted a duly completed claim form and the original medical and investigation reports, case papers, bills, memos, which was received by the opposite party on 12 January 2015,” said the order by the South Mumbai District Consumer Disputes Redressal Forum.
Mr Joshi also filed a claim under the personal accident policy issued to him by the insurance company.
Mr Joshi sought Rs6 lakh plus Rs1.28 lakh for the settlement of his claims under the happy family floater policy and personal accident policy and compensation. He also asked the insurance company to pay him Rs60,000 towards payment of fees to a senior advocate.
He submitted every single piece of document that could be relevant for the case including brochures given by the travel operator, medical and hospitalisation bills, communications with Raksha TPA, among others.
The insurance company rejected his claims on 25 March 2015 and the order was confirmed by the ombudsman on 26 October 2015. One of the key grounds for rejection of his claims by the insurer was Clause 4.19 of the policy.
Clause 4.19 of Oriental Insurance Co states “Any treatment arising from Insured’s participation in any hazardous activity including but not limited to scuba diving, motor racing, parachuting, hang gliding, rock or mountain climbing etc. unless specifically agreed by the Insurance Company.”
However, Joshi contended that he himself did not indulge in any risky activities, he was not operating any equipment and was just like a passenger being navigated by a trained pilot.
At the Consumer Forum, the insurance company “appeared and filed a written statement through their authorised signatories and the divisional manager Jaysurya Rapaka ,stating that, the complaint is false and bad in law, reliefs prayed for are not maintainable and there is no cause for action and the complaint is time barred, hence dismissed with cost.”
“…taking part in paragliding is itself risk, knowing the same complainant has taken the risk and hence the injury cause due to taking such risk is not covered,” the insurer contended.
The insurer could not provide any material evidence to back up the contention that paragliding is a hazardous activity, and that injuries were sustained because of Joshi’s own negligence, Joshi contended.
Mr Joshi’s request to Raksha TPA for cashless facility on 12 December 2014 too had come a cropper, with Raksha replying that as per clause 4.19 the injury has been sustained during a hazardous sport. Raksha assured Joshi that he could seek a review later.
The bench finally decided that Joshi is entitled to Rs6 lakh under happy family floater policy, Rs1.28 lakh under personal accident policy, along with 3% interest from the date of filing the complaint. Mr Joshi also got Rs7,000 as compensation for mental agony and Rs3,000 for the proceedings.
Manjiv Sharma
5 months agoLET THE COURT TAKE THE CALL IN COMMON INTEREST OF ALL.
BUT JEEVAN SARAL IS A GREAT PLAN.
ITS A PURE TERM & ENDOWMENT COMBINATION.
SO, UNLIKE TERM PLAN
IT DOES RETURN OF AN AMOUNT.
WHICH IN CASE OF TERM PLAN IS LOST ( LOSS A CONSEPTION, NOT A FACT).
PL ASK WIDOWS WHO RECEIVED THE 250 TIMES CLAIM
( BIGGER THAN ANY TRADITIONAL ENDOWMENT, IN SAME PREMIUM ,TERM).
I FEEL IN COURT LIC WILL WIN. ON PRODUCT GROUND.
AS PRODUCT IS PASSES BY IRDA AFTER DUE SCRUTINITY.
NO FLAW IN PRODUCT TERM & CONDITION.
FOR EXAMPLE:
TAKE SAME PREMIUM & TERM & COMPARE IT WITH OTHER ENDOWMENT PLANS OF ALL LIC & PRIVATE INSURANCE CO.
PARAMETERS AS:
1.PREMIUM :SAME
2.TERM:SAME
3. RISK COVER= SARAL IS. BETTER
4. MATURITY= SARAL IS BETTER.
AS LA DEPENDS UPON MORTALITY & INVESTMENT RETURNS.
LONG TERM WAS BETTER.
BUT
AS ON DATE NOW:
SARAL PLAN IS CLOSED FOR NEW SALE.
THE EFFECT ON MORTALITY WILL BE ADVERSE.
AS IT WAS DESIGNED TO BE AN OPEN ENDED PRODUCT.
IN EASY TERM: WITH NEW LA ENTERENCE THE AGERAGE AGE REMAIN CONSTANT ( PROBABILITY) BUT NOW THE AVG AGE OF POLICY HOLDER WILL RISE. RESULTING INTO MORE CALIM.
EVENTUALLY: ITS BETTER TEN A TERM PLAN WHERE .NO RETURNS ON MATURITY.
ANYWAYS:
ITS IN FAVOUR OF POLICY HOLDER.
MU JUDJMENT:
THOSE WHO GOT THE CLAIM,
FLEXIBILITY IN WITHDRAWL
INTEREST OF 7% ON LAPSES .
POLICY(BROKEN PERIOD).
250 TIMES THE RISK COVER.
PARTIAL WITHDRAWL
SAME PREMIUM FOR ALL AGE.
TERM + ENDOWMENT COMBINATION
ITS WAS A GREAT MIX OF NEED & WANTS.
COURT IS THE BEST PLACE, WE ALL WILL RESPECT & ABIDE BY ITS GOOD DECISION.
NOTHING WRONG IN GOING TO COURT OF LAW. IF CASE OF ANY DOUBT.
GOOD INITIATIVE
NICE JOB.
BEST WILL PREVAIL.
Sanjay Buche
In Reply to Manjiv Sharma 5 months agoNicely explained.
Most of the people are commented without the knowledge of this product,and the besic concept of life insurance as well.
Half knowledge is dengerous.
Amit Kumar
In Reply to Sanjay Buche 5 months agoYou are absolutely right, most people are commenting without the knowledge of the product. But tell me who is responsible to share the details of the product?? Is it the customer's who should know the details on their own or that agent should tell the details in detailed manner to a customer before selling any product. The agents have only misguided the customers on behalf of LIC and LIC should accept its fault.
MDT
In Reply to Sanjay Buche 5 months agoThanks for your comment. Are you the same Sanjay Buche, who is shown as ABM at Life Insurance Corporation of India? (https://in.linkedin.com/in/sanjay-buche-52585791?trk=public_profile_samename_mini-profile_title) Have you ever thought about policyholders, especially from your own family or friend circle who would have lost money due to hyped selling by LIC?
MDT
In Reply to Manjiv Sharma 5 months agoThanks for your comment. Are you the same Manjiv Sharma, who is shown on LinkedIn (https://in.linkedin.com/in/manjiv-sharma-71a80819) as development officer of LIC? In that case, we request you to think for a second about your agents and their clients, especially those above 50 years, who have lost money in this scheme. Also a normal comment is fine with us and our other readers, instead of using all capital letters.
Amit Kumar
In Reply to Manjiv Sharma 5 months agoDear Sir,
What you said is totally true. But one thing is also true that the mentioned plan was not sold as term plan. Nobody knew its more of a term plan and less of a traditional plan. And while selling also returns were discussed instead of cover as regarding to term plans.
Regards
Sanjay Buche
5 months agoJeevan saral is a very nicely designed insurance plan.
Thanks to LIC for this inovative product.
Main concern is not understanding of this product.
Basically Insurance policies are for Insurance cover.and not for higher returns.
In term insurance policies nothing will be payable at maturity,This does not mean that Term insurance is bad for return.
Can anybody file a case for no returns in term policies.
Risk premium increases with age and death sum assured.
Higher the age higher will be the risk premium.
If any body opts for insurance at higher age ,naturally the premium amount towards risk will be higher.
Jeevan saral plan of LIC is very nicely designed innovative product and was awarded at various platform.
It is absolutely wrong to say about this plan.
Please understand the product first and then comment.
This plan gives good return as compared to other product, for lower age at entry . Returns will be less for Higher age at entry.
It is quite obvious that higher the age higher will be the probability of risk of being died.
In Many policies of Jeevan saral LIC settled the death claim.
Prashant Doshi
In Reply to Sanjay Buche 5 months agoVery shameful blind sale by a trustworthy corporation in India due to the poor knowledge of the team heads for the agents..
Prashant Doshi
In Reply to Sanjay Buche 5 months agoThis product was sold in the market without mentioning it's side effects ...Because of the poor study by the sellers and their Superior officers only interested in new business more and more
Rishabh Adukia
5 months agoExtremely sad state of affairs by LiC and ministry , nobody is taking accountability
A policy holder must be given an option to surrender and take money back along with Interest
Request others to join in this mission
Lalit Khurana
5 months agoI was holding this Jeevan saral policy from last 6 years and have just surrendered this a month back only and have not even got what all I have paid in the last 6 years....Can I also file any complaint regarding this ? Please confirm
Sucheta Dalal
In Reply to Lalit Khurana 5 months agoYou can join out complaint by filing an affidavit - write to [email protected] and we will send you a draft that you have to fill and send back. It is in your interest to do so, especially since there will be no cost to you.
Prashant Doshi
In Reply to Sucheta Dalal 5 months agoThe proposal review slip-on the policy docket don't contain the amt of Maturity SA within mentioned even in the written decision by officers and the definition of The word Maturity SA is mentioned nowhere
Prashant Doshi
In Reply to Prashant Doshi 5 months agoNo morality charges are ever mentioned using any table in the policy document
Amit Kumar
5 months agoI also own a policy of Jeevan saral and continuing since 2013. While selling the LIC agent showed a chart containing returns starting from 10 years to 35years and said the returns are good. Which worked as a catalyst for me to invest in such a policy. Now I'm reading all these about the policy. Kindly guide me what to be done as of now.
Aditya Joby
In Reply to Amit Kumar 5 months agoHi!
Thanks for your comment. I am a part of Moneylife, and hope I can resolve your issue regarding the Jeevan Saral Policy you have. Here is the link to a maturity calculator, created by an independent agency (so all your doubts are alleviated).
https://www.investobite.com/maturity-calculator/lic-jeevan-saral-plan-165.html
If you still believe that you have been cheated, please send us a mail at [email protected], with the subject:"Attn: Yogesh/Aditya Jeevan Saral".
Prashant Doshi
In Reply to Amit Kumar 5 months agoAge below 45 yrs at the inception of the policy need not worry about returns
Anil Kumar
5 months agoWhat is the number of policy affected / premium amounts gobbled up by LIC in this. An article headlining this will probably wake more people up / get regulatory and finance ministry cranking.
Sucheta Dalal
In Reply to Anil Kumar 5 months agoWe are in the Supreme Court because no amount of writing, cover stories, RTI and memorandums worked. It is a long process. You may want to read these two articles of 2017 and 2018 to know the hard work that has gone behind the litigation.
2017: https://www.moneylife.in/article/life-insurance-lic-jeevan-saral-a-toxic-product/50333.html
2018: https://www.moneylife.in/article/will-lic-be-made-to-pay-for-the-horrible-mis-selling-of-jeevan-saral/53802.html
google within our site and you will find more!
Panch Deo Pandey
5 months agoI support money life foundation, thank you for supporting us. I believe, we will get a justice.
Panch Deo Pandey
5 months agoAs a L I C agent I have sold this policy to many people almost my relatives and I also buy this policy. This is very hazardous for us.
Prashant Doshi
In Reply to Panch Deo Pandey 5 months agoWait and watch...the mass fraud shall be opened at SC
Sucheta Dalal
In Reply to Panch Deo Pandey 5 months agoMr Pandey, do write to [email protected] so that those who have this policy can join the petition free of charge. WE are sending affidavits for them to send to their clients. This needs to be done before 10 July since case comes up on 15th July. You can also call 49205000 and speak to Mr Yogesh Sapkale today. We are sending out draft affidavits today
Bhushan Dhingra
5 months agoPlease update me as well as I have also invested in this policy and I am hardly getting anything back. Kindly update how and where to register a complaint against this.
Aditya Joby
In Reply to Bhushan Dhingra 5 months agoHi!
Thanks for your comment. I am a part of Moneylife, and hope I can resolve your issue regarding the Jeevan Saral Policy you have. Here is the link to a maturity calculator, created by an independent agency (so all your doubts are alleviated).
https://www.investobite.com/maturity-calculator/lic-jeevan-saral-plan-165.html
If you still believe that you have been cheated, please send us a mail at [email protected], with the subject:"Attn: Yogesh/Aditya Jeevan Saral".
SANDESH PAWAR
5 months agoAlthough I don't own the policy, I would like to give big "Thank you" on behalf of the policy holders. I am proud to be associated with an organisation like yours.
Vikas Gupta
5 months agoGr8...
Harish
5 months agoGreat Work MoneyLife!
Pradip Chinnakonda
5 months agoPlease update.