Library Catalogue
A Critical Study of the Protection of Consumers in the Insurance Sector with Special Reference to Life Insurance and Health Insurance
Mr. P Ravi Shankar
A Critical Study of the Protection of Consumers in the Insurance Sector with Special Reference to Life Insurance and Health Insurance - Bangalore NLSIU 2015 - 414p
CONTENTS
DECLARATION;
CERTIFICATE;
ABSTRACT;
ACKNOWLEDGMENTS;
CONTENTS;
ABBREVIATIONS;
LIST OF FIGURES;
LIST OF TABLES;
LIST OF CASES;
CHAPTER-I;
Introduction;
1.1 Statement of the Problem;
1.2 Reason for the present study, its implications;
1.3 Review of existing literature;
1.4 Objectives of the Study;
1.5 Methodology and Scope of Research;
1.6 Hypotheses;
1.7 Research Questions;
1.8 Likely contribution of the Study;
1.9 Organisation of Chapters.;
CHAPTER-II;
Development of Insurance Laws in UK and USA;
2.1 United Kingdom;
2.1.1 General Aspects of Insurance in United Kingdom;
2.1.1.2 Important Legislation on Insurance:;
2.1.1.3 Role of Regulator;
2.1.1.4 Contract conditions.;
2.1.1.5 Consumer Protection;
2.1.2 Discussion and analysis of Life Insurance Contract;
2.1.3 Discussion on National Health Service and Private Medical Insurance;
2.1.4 Ombudsman and its role-Basic principles;
2.2 United States of America;
2.2.1 General Aspects of Insurance in United States of America;
2.2.1.1 Development of Insurance Business.;
2.2.1.2 Important Legislation on Insurance;
2.2.1.3 Role of Regulator;
2.2.1.4 Contract conditions;
2.2.1.5 Consumer Protection;
2.2.2 Discussion of Individual and Group Life Insurance contract;
2.2.3 Discussion on Patient’s Bill of Right and Health Insurance;
2.2.4 Ombudsman and its role-Basic principles;
CHAPTER- III;
Development of Insurance Laws and Regulatory frame work of Insurance in Indian perspective;
3.1 The Role of State under the Constitution;
3.2 Development and Important Legislations of Insurance in India;
3.3 Role of Insurance Regulatory Development Authority;
3.4 Essential elements of Insurance Contract;
3.5 Consumer Protection in Insurance Laws;
CHAPTER- IV;
Critical Legal analysis of Life and Health Insurance Policies;
4.1 Introduction;
4.2 Elements of Life Insurance and Health Insurance Contract;
4.2.1 Nature of Insurance Contract;
4.2.2 Basis of contract clause;
4.2.3 Warranty in insurance Contract;
4.2.4 Insurable Interest;
4.3 Standard Form of Contract;
4.4 General Terms and Conditions of Life Insurance Policy;
4.4.1 Interpretation of policy conditions;
4.4.2. Rules constituting words and phrases;
4.4.3 Previous interpretation;
4.4.4. Ordinary Meaning;
4.4.5 Special meaning of words;
4.4.6 Technical meaning of words;
4.4.7 Contra proferentem;
4.4.8 Policy to be looked upon as a whole;
4.5 Specific Life Insurance Policy conditions;
4.5.1 Proof of Age: 117
4.5.2 Forfeiture in certain cases. 118
4.5.3 Revival of lapsed policy 120
4.5.4 Suicide clause 121
4.5.5 Civil Death. 123
4.5.6 Types of accident and eligibility for Accident benefit. 125
4.5.7 Grace Period and Payment of Premiums. 136
4.5.8 Guaranteed Surrender Value. 137
4.6 Types of Health Insurance & Specific Health Insurance condition. 138
4.6.1 Exclusion Clause. 148
4.6.2 Deferred coverage of Risk. 150
4.6.3 Role of Third Party Administrator in Health Insurance. 151
4.6.4 Regulatory Role in Health Insurance. 152
CHAPTER-V;
Intermediaries in Insurance Law: A Critical Analysis of Legislation, Regulations and Case Laws.;
5.1 Pre-Contract Information.;
5.1.1 Definition and need for pre contract information.;
5.1.2 The importance and legal implication of pre contract information.;
5.1.3 The role of intermediary in pre contract information.;
5.2 The law governing intermediaries.;
5.2.1 Definition of Intermediary and legal status.;
5.2.2. The law governing intermediaries.;
5.2.3 Legal Relationship of intermediary with insurer and Insured.;
5.3 Agents’ role in Life and Health insurance contracts.;
5.3.1 Agent as first line underwriter.;
5.3.2. Agents role in collection of premium.;
5.3.3 Agents’ duties and rights.;
5.4 Regulating intermediaries.;
5.4.1 The Regulations and Guidelines of IRDA.;
5.4.2 Need for a comprehensive Agents Regulations.;
5.4.3 Protection of Consumer Interest.;
CHAPTER- VI;
Legal Rights and Responsibility of the Consumer and the Insurer: An Empirical Study;
6.1 Duty of Disclosure.;
6.2 Representation, Misrepresentation and fraud;
6.3 Utmost good faith and changing trend.;
6.4 Warranty.;
6.5 Right of return of premium.;
CHAPTER- VII;
Current Legal Protection and Remedy for the Insured and its adequacy;
7.1 Introduction;
7.2 IRDA Guidelines on Protection of Policy holder’s Interest;
7.2.1 Integrated Grievance Management System;
7.3 Alternate Dispute Resolution under Code of Civil Procedure 1908;
7.4. Origin and Development of Ombudsman;
7.4.1 Redress of Public Grievance Rules and Insurance Ombudsman Scheme;
7.4.2 Interpretation and interference with Ombudsman’s award by High Court.;
7.4.3 Banking Ombudsman;
7.4.4 Ombudsman in UK and USA;
7.5 Remedies Available before Civil Court.;
7.6 Consumer Protection and Permanent Lok Adalath;
7.6.1 Insurance Service as Public Utility Service.;
7.6.2 Procedure of reference to Permanent Lok adalat & its power ;
CHAPTER- VIII.;
Policy holders Protection under Consumer Protection Act 1986. ;
8.1 United Nations Guidelines for Consumer Protection;
8.2 Consumer protection rationales;
8.3. Voluntary Consumer Organization.;
8.4 Consumer Protection in India;
8.5 The Significance and importance of Consumer Protection Act, An analysis.;
8.5.1 Discussion on Definition;
8.5.2 Discussion on Consumer Protection Councils and its importance;
8.5.3 Discussion on Jurisdictions, Powers &Duties of Redress Agency;
8.5.4 Penal Provision;
8.5.5 Discussion of Consumer Protection Amendment Bill (2011)-An analysis;
CHAPTER-IX.;
Critical Analysis of Insurance Act and Proposed Amendments;
9.1 Assignment of Life Insurance Policies;
9.2 Legal effect of Nomination and proposed Amendment;
9.3 Non Contestable Clause;
9.4 Notice of options available to the assured on the lapsing of a policy;
9.5 Prohibition of cessation of payment of Commission;
9.6 Financial Sector Legislative Commission Report and insurance.Relevance to Insurance Sector..
9.7 Testing of Hypothesis.
CHAPTER-X..
Conclusion and Recommendations.
10.0 Conclusion.
10.1 Recommendations..
LIST OF APPENDIXES .
A. Questionnaire to Advocates.
B. Questionnaire to Agents.
C. Questionnaire to Policyholders.
D. Details of NCDRC orders.
E. Parliamentary questions and Answers.
BIBLIOGRAPHY.
BOOKS.
ARTICLES/JOURNALS/LEGISLATIONS.
REPORTS/BILLS/CODES/REGULATIONS.
WEBSITES.
Development of Insurance law - UK & USA Insurance Laws & Regulatory Frame Work - Indian Perspective Life and Health Insurance Policies - Critical Legal Analysis.
A Critical Study of the Protection of Consumers in the Insurance Sector with Special Reference to Life Insurance and Health Insurance - Bangalore NLSIU 2015 - 414p
CONTENTS
DECLARATION;
CERTIFICATE;
ABSTRACT;
ACKNOWLEDGMENTS;
CONTENTS;
ABBREVIATIONS;
LIST OF FIGURES;
LIST OF TABLES;
LIST OF CASES;
CHAPTER-I;
Introduction;
1.1 Statement of the Problem;
1.2 Reason for the present study, its implications;
1.3 Review of existing literature;
1.4 Objectives of the Study;
1.5 Methodology and Scope of Research;
1.6 Hypotheses;
1.7 Research Questions;
1.8 Likely contribution of the Study;
1.9 Organisation of Chapters.;
CHAPTER-II;
Development of Insurance Laws in UK and USA;
2.1 United Kingdom;
2.1.1 General Aspects of Insurance in United Kingdom;
2.1.1.2 Important Legislation on Insurance:;
2.1.1.3 Role of Regulator;
2.1.1.4 Contract conditions.;
2.1.1.5 Consumer Protection;
2.1.2 Discussion and analysis of Life Insurance Contract;
2.1.3 Discussion on National Health Service and Private Medical Insurance;
2.1.4 Ombudsman and its role-Basic principles;
2.2 United States of America;
2.2.1 General Aspects of Insurance in United States of America;
2.2.1.1 Development of Insurance Business.;
2.2.1.2 Important Legislation on Insurance;
2.2.1.3 Role of Regulator;
2.2.1.4 Contract conditions;
2.2.1.5 Consumer Protection;
2.2.2 Discussion of Individual and Group Life Insurance contract;
2.2.3 Discussion on Patient’s Bill of Right and Health Insurance;
2.2.4 Ombudsman and its role-Basic principles;
CHAPTER- III;
Development of Insurance Laws and Regulatory frame work of Insurance in Indian perspective;
3.1 The Role of State under the Constitution;
3.2 Development and Important Legislations of Insurance in India;
3.3 Role of Insurance Regulatory Development Authority;
3.4 Essential elements of Insurance Contract;
3.5 Consumer Protection in Insurance Laws;
CHAPTER- IV;
Critical Legal analysis of Life and Health Insurance Policies;
4.1 Introduction;
4.2 Elements of Life Insurance and Health Insurance Contract;
4.2.1 Nature of Insurance Contract;
4.2.2 Basis of contract clause;
4.2.3 Warranty in insurance Contract;
4.2.4 Insurable Interest;
4.3 Standard Form of Contract;
4.4 General Terms and Conditions of Life Insurance Policy;
4.4.1 Interpretation of policy conditions;
4.4.2. Rules constituting words and phrases;
4.4.3 Previous interpretation;
4.4.4. Ordinary Meaning;
4.4.5 Special meaning of words;
4.4.6 Technical meaning of words;
4.4.7 Contra proferentem;
4.4.8 Policy to be looked upon as a whole;
4.5 Specific Life Insurance Policy conditions;
4.5.1 Proof of Age: 117
4.5.2 Forfeiture in certain cases. 118
4.5.3 Revival of lapsed policy 120
4.5.4 Suicide clause 121
4.5.5 Civil Death. 123
4.5.6 Types of accident and eligibility for Accident benefit. 125
4.5.7 Grace Period and Payment of Premiums. 136
4.5.8 Guaranteed Surrender Value. 137
4.6 Types of Health Insurance & Specific Health Insurance condition. 138
4.6.1 Exclusion Clause. 148
4.6.2 Deferred coverage of Risk. 150
4.6.3 Role of Third Party Administrator in Health Insurance. 151
4.6.4 Regulatory Role in Health Insurance. 152
CHAPTER-V;
Intermediaries in Insurance Law: A Critical Analysis of Legislation, Regulations and Case Laws.;
5.1 Pre-Contract Information.;
5.1.1 Definition and need for pre contract information.;
5.1.2 The importance and legal implication of pre contract information.;
5.1.3 The role of intermediary in pre contract information.;
5.2 The law governing intermediaries.;
5.2.1 Definition of Intermediary and legal status.;
5.2.2. The law governing intermediaries.;
5.2.3 Legal Relationship of intermediary with insurer and Insured.;
5.3 Agents’ role in Life and Health insurance contracts.;
5.3.1 Agent as first line underwriter.;
5.3.2. Agents role in collection of premium.;
5.3.3 Agents’ duties and rights.;
5.4 Regulating intermediaries.;
5.4.1 The Regulations and Guidelines of IRDA.;
5.4.2 Need for a comprehensive Agents Regulations.;
5.4.3 Protection of Consumer Interest.;
CHAPTER- VI;
Legal Rights and Responsibility of the Consumer and the Insurer: An Empirical Study;
6.1 Duty of Disclosure.;
6.2 Representation, Misrepresentation and fraud;
6.3 Utmost good faith and changing trend.;
6.4 Warranty.;
6.5 Right of return of premium.;
CHAPTER- VII;
Current Legal Protection and Remedy for the Insured and its adequacy;
7.1 Introduction;
7.2 IRDA Guidelines on Protection of Policy holder’s Interest;
7.2.1 Integrated Grievance Management System;
7.3 Alternate Dispute Resolution under Code of Civil Procedure 1908;
7.4. Origin and Development of Ombudsman;
7.4.1 Redress of Public Grievance Rules and Insurance Ombudsman Scheme;
7.4.2 Interpretation and interference with Ombudsman’s award by High Court.;
7.4.3 Banking Ombudsman;
7.4.4 Ombudsman in UK and USA;
7.5 Remedies Available before Civil Court.;
7.6 Consumer Protection and Permanent Lok Adalath;
7.6.1 Insurance Service as Public Utility Service.;
7.6.2 Procedure of reference to Permanent Lok adalat & its power ;
CHAPTER- VIII.;
Policy holders Protection under Consumer Protection Act 1986. ;
8.1 United Nations Guidelines for Consumer Protection;
8.2 Consumer protection rationales;
8.3. Voluntary Consumer Organization.;
8.4 Consumer Protection in India;
8.5 The Significance and importance of Consumer Protection Act, An analysis.;
8.5.1 Discussion on Definition;
8.5.2 Discussion on Consumer Protection Councils and its importance;
8.5.3 Discussion on Jurisdictions, Powers &Duties of Redress Agency;
8.5.4 Penal Provision;
8.5.5 Discussion of Consumer Protection Amendment Bill (2011)-An analysis;
CHAPTER-IX.;
Critical Analysis of Insurance Act and Proposed Amendments;
9.1 Assignment of Life Insurance Policies;
9.2 Legal effect of Nomination and proposed Amendment;
9.3 Non Contestable Clause;
9.4 Notice of options available to the assured on the lapsing of a policy;
9.5 Prohibition of cessation of payment of Commission;
9.6 Financial Sector Legislative Commission Report and insurance.Relevance to Insurance Sector..
9.7 Testing of Hypothesis.
CHAPTER-X..
Conclusion and Recommendations.
10.0 Conclusion.
10.1 Recommendations..
LIST OF APPENDIXES .
A. Questionnaire to Advocates.
B. Questionnaire to Agents.
C. Questionnaire to Policyholders.
D. Details of NCDRC orders.
E. Parliamentary questions and Answers.
BIBLIOGRAPHY.
BOOKS.
ARTICLES/JOURNALS/LEGISLATIONS.
REPORTS/BILLS/CODES/REGULATIONS.
WEBSITES.
Development of Insurance law - UK & USA Insurance Laws & Regulatory Frame Work - Indian Perspective Life and Health Insurance Policies - Critical Legal Analysis.