Exclusion clauses in Insurance matters

The bottomline

Just because you’re insured, don’t assume you’re fully covered.

You need to see carefully two things-

1.     Exclusion clauses which specifically say you are not covered for these things

(IRDAI has come out with simplified vocabulary that must be used in policy documents and list of exclusions, which largely simplifies the exercise.)

A)   Death by suicide, wilful self-injury

B)   death occurring due to war, adventure sports or activities involving criminal activities

C)      “Cosmetic’ like sex change operations, plastic surgery, or dental surgeries.

D)    Accidents due to Acts of God or war.

E)    Health related insurance - the pre-existing disease (PED) exclusion or delayed coverage for some diseases

A)   Consumption of alcohol or drugs and

B)   General insurance t- fire, home, or office insurances common exclusions

war, civil wars

 terrorist activities

C)     Motor insurance

geographically valid driver’s licence,

driving under alcohal  influence

2.     Other terms that are subject to proof & Can be contested

1.     Accident case in accidental benifits –to be proved through investigation

2.     Vehical theft or accident- To be proved no negligence on the part of insured by insured

3.     Vehical accident claim-Consumtion of alcohol to be proved by insurance company through investigation

4.     Pre-existing –to be proved by insurance company

5.     Fraud –to be proved by insured it is not faraud

6.     Non-disclosure of material fact –to be proved by insurance

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