The common man asks one real question…in case of motor accident claim, what am I expected to do? This is what will be discussed in this article.
The policy wording reads ‘this policy and the schedule shall be read together and any word or expression to which a specific meaning has been attached in any part of the policy or of the schedule shall bear the same meaning whenever they appear.’
Most important things in the above statement are: Policy and the Schedule. Generally, no insurance company gives the policy along with the schedule. On a single sheet they print the schedule and inform to download the policy, the terms and the conditions. You have not given them together…and yet you say that the policy and schedule shall be read together. Interesting! Please wait. I know the questions arising in your mind. You can download and read. What is the problem? There is no problem. However, please wait till the next point.
‘Notice shall be given in writing to the company immediately upon the occurrence of any accidental loss or damage.’ There are two key words in this statement which are verbatim taken from the policy terms and conditions. They are: in writing and immediately.
In Writing: The Insurer is specifying how the communication must be given in case of loss. It must be in writing and writing alone. Though all the insurance companies talk of saving paper, tech-savvy, log on to our website etc., the policy contractual terms and conditions clearly entail only one means of communication of the accidental loss or damage i.e., in writing. Any other method of communication if it being accepted then it is goodness of the insurance companies. As per the law, you are expected to inform in writing. It also means that it doesn’t stop the insurer from rejecting admission of a claim since it is not informed in writing. If giving the information in writing includes all electronic communication then it must be clearly stated so in the policy document as it becomes a part of the contract.
The insurer expects us to download the policy document…there is nothing wrong in it; and the same insurer asks us to give the claim intimation in ‘writing’ without mentioning any other electronic method of communication! Hope your wait is worth its while.
Immediately: What is immediately? It is interesting to observe this word when read this word in other policies. The Motor insurance policy says – immediately. Fire insurance policy says ASAP. Life insurance policy prescribes the period of intimation as within 15 days. We must know, therefore, what the insurer means by the word Immediately. For example: I met with an accident. My car is badly damaged and I am injured. The contractual obligation states that loss / damage to the vehicle must be intimated immediately. In other words, I should not go to a hospital / doctor for injuries. Rather I should go to the insurance company to inform about the loss or accident first because the Motor policy says – immediate. Unless, the word ‘immediately’ is not qualified, so as to make the term self-explanatory it will give one-sided freedom and privilege to deny any claim based on insurer’s interpretation.
‘Whenever details pertaining to any accident which results in a claim or conveyed by the insured to the insurer after reasonable period…’. The phrase ‘after reasonable period’ is as vague as the word ‘immediate’. Through this word the insurer is not giving away anything except a strong indication of the possibility of denial of a claim.
‘…insured shall provide the reasons for such delay to the insurer and insurer may on analysis on reasons provided by the insured condone the delay in intimation of claim or delay in providing the required information documents to the insurer’. The phrase is: the insurer may condone the delay either in claim intimation or in providing required information or documents to the insurer. Obviously, the insured does not know what is a reasonable period. Either the phrase reasonable period is quantified or it stinks of the ill-will of the insurer. Further, the phrase ‘the insurer may condone the delay’ indicates the possibility that the insurer may not condone the delay. What can be a reasonable period according to the insurer may not be a reasonable period according to the insured. An element of subjectivity, confusion and ill-will is apparent on the part of the insurer to delay or to deny the claim.
We are signing the insurance application so that we should not lose money should something happen to the car and also for the fear of law. Don’t you think these actions confirm the stupidity status quo of the policyholders?
About the Author
Dr. K. Raja Gopal Reddy is a seasoned internationally qualified Insurance professional.
What you are reading here, may not answer all the questions we have, but has the absolute power of asking unsettling questions which increase the interest in the strange world, and show the contradictory wonders lying just below the surface of the commonest things of life. Look at this disturbing but beautiful thought of Friedrich Nietzsche “God is dead. God remains dead. And we have killed him”.
Dr. Reddy can be reached at: raja66gopal@gmail.com
