Kathmandu. The insurers have complained that they have started harassing the insurance companies by setting their own terms against the provisions related to insurance policies and additional facilities approved by the Nepal Insurance Authority.
According to the complaint received by Insurance Khabar from the aggrieved insured, some life insurers have limited this limit to Rs 20 lakh to Rs 30 lakh. Apart from this, the insured has also complained that the accident death benefit facility included in the main insurance policy was also determined by the insurer itself without giving the insurer an opportunity to choose.
The Insurance Authority has approved the ‘CI Rider’ to provide treatment expenses ranging from Rs 50 lakh to Rs 1 crore to the insured for the treatment of critical diseases. Under this additional facility, the insurer has to give the insured the choice to include treatment facility equal to the limit of the insured or the maximum amount of Rs 50 lakh, whichever is less. However, some life insurers are setting such limits arbitrarily and depriving the insured who are financially capable and have complete physical fitness.
“I am physically fit and I have also provided my medical report,” complained one of the aggrieved insured, adding, “But the insurance company is answering that I get only Rs 20 lakh and not Rs 50 lakh.” In case of being medically unfit, the insurer can reject the Critical Illness Treatment Benefit (CI Rider) included in the original policy, but there is no exemption to not include the risk equivalent to the insured within the maximum limit of the supplementary contract.
According to one of the insured, he could not pay the amount of insurance premium for the third year to 2 years after purchasing the insurance policy as he was out of the country. Because the concerned insurer has not given the facility to pay the insurance premium of the insurance policy purchased by him through digital payment or online. According to the insured, he is compelled to be present at the office of the insurer to pay the insurance premium every year. He has to pay the late fee again and again as he is not able to make the payment online.
According to the information given by another insured, he had initially opted for the accidental death benefit facility which was equal to 2 times the insured. He could not pay the renewal insurance premium from abroad as the insurer did not inform him on time (via email). Even when he tried to pay the renewal insurance premium through online once or twice, the representative of the customer service center replied that the renewal insurance premium of this policy should be paid from our branch.
After three years, when he returned home and tried to renew the insurance policy with a penalty, the insurer’s staff made him fill up a consent form stating that he was allowed to take only the accident benefit equivalent to the insured instead of the previous double accident benefit. Thus, he was forced to agree to the accident benefit benefit equivalent to the insured.
Section 69 of the Insurance Act, 2079 contains a provision regarding the work that the insurer should not do. Sub-section (1)(d) of this section provides that insurance policies should not be issued in any format other than those approved by the Authority and no other type of insurance policy other than the insurance policy approved in sub-section (1)(e).
The insured do not receive the information
Another complaint received by Insurance Khabar is that the insured has not been informed through e-mail about the date of renewal of the life insurance policy. In recent times, the number of insured people from Nepal going abroad for higher education or foreign employment has increased. Due to the lack of information through e-mail, the insured who lives outside Nepal for a long time should be deprived of paying the regular installment of the insurance policy or getting periodic benefits due to lack of prior information.
The insurer should inform the insured about the life insurance service (renewal date, confirmation of premium paid, date of living benefit payment, date of payment of principal and interest of the loan, prior notice before forfeiture of the policy, maturity date, insurance claim) to the insured through all the media as far as possible. However, the insurers have also complained that the insurer has been sending information only through SMS and they have not received such information regularly.
Sushil Dev Subedi, executive director of the Insurance Authority, said that no insurer can set the terms on its own against the approved insurance policy and the provisions related to additional facilities. “If any company puts conditions on its own with the intention of causing distress to the insured, then the authority will take action against such insurers,” he said, “The authority has also taken action if any insured has filed a complaint with the insured. Therefore, if any insured is in trouble, I request them to file a complaint with the authority.” ’
