Denial of Life Insurance Insurance Claim

4 years ago

Respected Madam / Sir :

The late mother of my office colleague passed away a couple of years back. This colleague is the eldest daughter and having TWO younger sisters all THREE unmarried. The eldest daughter and the middle one are doing jobs in a Hospital and School respectively in Pune on contractual basis. The youngest daughter is appearing for graduation externally. As the Father of these three children was employed at The NIV, Pune and later on expired the mother of these three children was given a job after several years at The NIV on compassionate grounds. The mother had taken a loan of Rs. 15,00,000.00 for purchasing a dwelling ( at Wagholi to Manjari Road about 25 k to 30 ms from Pune for security of the THREE daughters) and an additional amount of Rs.1,60,000.00 for insuring Flat with the same Bank in the year 2016. Her age at the time of procuring the loan was 52 years. MOTHER WAS ILLITERATE. The claim was denied for the reason that the material facts of illness was not disclosed. The Proposal Form was not shared / given to them and only the Policy Certificate was handed over. As their claim was denied they were interacting with the Bank from several months and finally a copy of the Proposal Form was printed in their presence and handed over to them on 19.10.2018. After going through the Mandatory Proposal Form I, the undersigned noticed enough of errors the details of which which have been mentioned below :
1. SLIPSHOD METHOD OF FUNCTIONING BY THE REPRESENTATIVE DESIGNATED AS
THE FINANCIAL SERVICES ASSOCIATE, SALES OF THE BANK WHO FILLED THE
PROPOSAL FORM JUST FOR THE SAKE OF INCENTIVES / OR MAY BE TO ACHIEVE HIS TARGET
2. MEMBER ENROLLMENT / PROPOSAL FORM WAS NOT VALID AS THE MEMBER
ENROLLMENT / PROPOSAL FORM WAS FOUND TO BE INCOMPLETE AS THE MANDATORY POINTS
WERE JUST LEFT BLANK
3. DATE ON THE PROPOSAL FORM WAS MISSING
4. NAME AND SIGNATURE OF THE FINANCIAL SERVICES ASSOCIATE WAS MISSING
5. NAME, ADDRESS, OCCUPATION AND SIGNATURE OF THE WITNESS MISSING
6. NAME, ADDRESS AND SIGNATURE OF THE THIRD PERSON DECLARING THAT INSURED MEMBER
MEMBER HAS SIGNED IN VERNACULAR ALL MISSING.
NOW
AGAIN QUESTION IS AT THIS POINT IS THAT ON WHAT GROUNDS DID THE BANK DENY THE CLAIM WHEN IT WAS THE RESPONSIBILITY OF FINANCIAL SERVICES ASSOCIATE, SALES TO ENSURE THAT THE FORM WAS FILLED COMPLETELY AND CORRECTLY AS THE INSURED WAS ILLITERATE? In addition on the basis of this in valid Proposal Form HOW WAS THE POLICY CERTIFICATE RECOMMENDED / APPROVED and issued without the signature / seal of the Bank Manager pertaining to that particular Branch on the Proposal Form.
The Proposal Form should have been rejected by the concerned Authority, asked the applicant to undergo a Medical Examination Test and increased the premium accordingly to avoid further complications.
Madam / Sir, our humble request to give us your valuable guidance and advice AND our next course action in this regard.
The Family of these THREE daughters is in a miserable condition as of now.
Your expert advice and guidance in this regard shall be highly appreciated and remembered throughout.

Yours truly,

( Robert Paul )
Purchase Officer
KEM Hospital Research Centre
Pune - 411 011