On what grounds can an insurer reject a claim?

Typically non-disclosure or misstatement of a material fact, breach of a policy condition or an excluded risk. Rejection must be justified under the policy and the regulator's rules on claims.

What is the role of the Insurance Ombudsman?

A policyholder can complain to the Ombudsman, without a court case, about disputes of limited value, including delays and wrongful repudiation.

Do insurance intermediaries need a licence?

Yes. Brokers, agents and corporate agents must be registered or licensed under the IRDAI's regulations.

Can an insurer be sued in consumer forums?

Yes. Deficiency of service by an insurer is within the jurisdiction of consumer commissions under the Consumer Protection Act, 2019.

Insurance Lawyers, India | Alagh & Kapoor Law Offices

Insurance in India is regulated under the Insurance Act, 1938 and the Insurance Regulatory and Development Authority of India Act, 1999. The Firm assists insurers, reinsurers and intermediaries on corporate, regulatory and commercial matters, and represents insurers and brokers in disputes.

What the law looks like

An insurance contract is one of utmost good faith: the proposer must disclose material facts, and a misstatement can allow the insurer to repudiate. For life insurance, the Insurance Act limits an insurer's right to call a policy into question on grounds of misstatement once the policy has run for three years, subject to the conditions in Section 45. Complaints against insurers can go to the Insurance Ombudsman, to consumer fora under the Consumer Protection Act, 2019, and to the courts.

Scope of Work

policy wordings and product development
review of contracts
regulatory matters
insurance and reinsurance disputes

Questions and Answers

On what grounds can an insurer reject a claim?: Typically non-disclosure or misstatement of a material fact, breach of a policy condition or an excluded risk. Rejection must be justified under the policy and the regulator's rules on claims.
What is the role of the Insurance Ombudsman?: A policyholder can complain to the Ombudsman, without a court case, about disputes of limited value, including delays and wrongful repudiation.
Do insurance intermediaries need a licence?: Yes. Brokers, agents and corporate agents must be registered or licensed under the IRDAI's regulations.
Can an insurer be sued in consumer forums?: Yes. Deficiency of service by an insurer is within the jurisdiction of consumer commissions under the Consumer Protection Act, 2019.

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