Pursuant to the Insurance (Amendment) Act, 2015, any claim under the policy shall be governed as per the below mentioned clause in substitution to existing clause of the policy contract

Important information to know - Section 45 - What it says?

Section 45 - Policy shall not be called in question on the ground of mis-statement after three years

Provisions regarding policy not being called into question in terms of Section 45 of the Insurance Act, 1938, as amended by Insurance Laws (Amendment) Act, 2015 are as follows:

• No Policy of Life Insurance shall be called in question on any ground whatsoever after expiry of 3 yrs from

• the date of insurance of policy or

• the date of commencement of risk or

• the date of revival of policy or

• the date of rider to the policy whichever is later.

• On the ground of fraud, a policy of Life Insurance may be called in question within 3 years from

• the date of insurance of policy or

• the date of commencement of risk or

• the date of revival of policy or

• the date of rider to the policy whichever is later.

For this, the insurer should communicate in writing to the insured or legal representative or nominee or assignees of insured, as applicable, mentioning the ground and materials on which such decision is based.

• Fraud means any of the following acts committed by insured or by his agent, with the intent to deceive the insurer or to induce the insurer to issue a life insurance policy:
• The suggestion, as a fact of that which is not true and which the insured does not believe to be true;
• The active concealment of a fact by the insured having knowledge or belief of the fact;
• Any other act fitted to deceive; and
• Any such act or omission as the law specifically declares to be fraudulent.
• Mere silence is not fraud unless, depending on circumstances of the case, it is the duty of the insured or his agent keeping silence to speak or silence is in itself equivalent to speak.
• No Insurer shall repudiate a life insurance Policy on the ground of Fraud, if the Insured / beneficiary can prove that the misstatement was true to the best of his knowledge and there was no deliberate intention to suppress the fact or that such mis-statement of or suppression of material fact are within the knowledge of the insurer. Onus of disproving is upon the policyholder, if alive, or beneficiaries.
• Life insurance Policy can be called in question within 3 years on the ground that any statement of or suppression of a fact material to expectancy of life of the insured was incorrectly made in the proposal or other document basis which policy was issued or revived or rider issued. For this, the insurer should communicate in writing to the insured or legal representative or nominee or assignees of insured, as applicable, mentioning the ground and materials on which decision to repudiate the policy of life insurance is based.
• In case repudiation is on ground of mis-statement and not on fraud, the premium collected on policy till the date of repudiation shall be paid to the insured or legal representative or nominee or assignees of insured, within a period of 90 days from the date of repudiation.
• Fact shall not be considered material unless it has a direct bearing on the risk undertaken by the insurer. The onus is on insurer to show that if the insurer had been aware of the said fact, no life insurance policy would have been issued to the insured.
• The insurer can call for proof of age at any time if he is entitled to do so and no policy shall be deemed to be called in question merely because the terms of the policy are adjusted on subsequent proof of age of life insured.

Hence it is important to know When and Why Claim Repudiation happens

• In the claims findings if it is established that there had been a material suppression of facts pertaining to the proposal information, which would have impacted the assessment of risk, if disclosed at the proposal stage, then it may lead to repudiation of the claim.
• If documents submitted at the Proposal / Claims stage are not genuine, it would also lead to claim repudiation. Hence it is very important to read through the Proposal form and submit factual details at the proposal stage and provide genuine Know Your Customer requirements to ensure that in case of the unfortunate event of death, the claim always gets paid.

In case of any queries drop an email at claims.lifeinsurance@adityabirlacapital.com for quick query resolutions.

[ Disclaimer : This is not a comprehensive list of amendments of Insurance Laws (Amendment) Ordinance,2014 and only a simplified version prepared for general information. Policy Holders are advised to refer to Original Ordinance Gazette Notification dated December 26 , 2014 for complete and accurate details. ]